October 19, [redacted] Complaint Case # [redacted] Consumer: [redacted] *** Case Opened: October 15, Dear Mr [redacted] , This is in response to your email received on October 15, 2017, forwarding concerns on behalf of our member, [redacted] ***, regarding payment of $made April 10, 2017, for services received March 20, Mr [redacted] received information from Kaiser Permanente Customer Experience department August 1, 2017, advising charges for services on March 20, 2017, had been adjusted to show he owed $29.54, rather than $59.08, leaving a credit of $ Mr [redacted] has asked the refund in this amount be issued to him We value the opportunity to review and respond to their grievance and apologize for the member’s dissatisfaction We have confirmed Mr***’s previous concerns submitted to Kaiser Permanente were appropriately documented in our record keeping system and shared with leaders of our organization Research has confirmed Mr [redacted] had an appointment June 5, 2017, which resulted in a charge of $ Since the credit on the account matched the amount due, the credit of $was applied to the charges due for services June 5, We verified a bill was not mailed to Mr [redacted] for services June 5, 2017, as the payment had been applied to the account and showed no balance due We have verified a refund is not due to Mr*** The member’s feedback is essential to our commitment of continuous improvement in delivering the highest quality, most appropriate and compassionate care Our goal is to deliver excellent service to our members Grievances expressed by our members do not affect their coverage in any way If the above noted member is dissatisfied with the resolution, they have the right to request a second review Please have them put the request in writing to: [redacted] [redacted] Written requests will be reviewed by Member Services Administration who will respond to you in writing within calendar days of the receipt of the member’s requestWe may extend this timeframe up to an additional calendar days at the member’s request or if there is a need for additional information and the delay is in the best interest of the member If the Revdex.com or the member has any questions, please contact me at [redacted] Also, you may contact Member Services: Denver/Boulder members may call [redacted] , toll free at [redacted] , between a.mto p.m., Monday through Friday Deaf, hard of hearing, or speech impaired members who use a TTY may call [redacted] Colorado Springs members please call [redacted] or deaf, hard of hearing or speech-impaired members who use TTY may call [redacted] You may also contact our department through our Web site at kaiserpermanente.org Please thank our member for their understanding in this matterWe know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente Sincerely, [redacted]
Dear [redacted] , This is in response to your email received on July 18, 2016, forwarding concerns on behalf of our member, [redacted] , regarding an incorrect bill for services and difficulty in having the issue resolved with Kaiser Permanente We value the opportunity to review and respond to their grievance and apologize for the member’s dissatisfaction Mr [redacted] explained he is continually receiving a bill from Kaiser Permanente in the amount of $for services rendered on June 13, Mr [redacted] states he has already paid the $and when attempting to have the charge removed from his account, Kaiser Permanente staff have not been helpful We have formally documented and shared [redacted] ’s concerns with the appropriate leadership, to include the Patient Financial Services Department supervisorPlease apologize to the member, on behalf of Kaiser Permanente (KP), for any frustration that may have been caused by this overall matter Additionally, review confirms the June payment of $was received by Mr [redacted] and funds were not posted appropriately to his account Mr [redacted] ’s account has been corrected and he will no longer receive invoices for the $charge The member’s feedback is essential to our commitment of continuous improvement in delivering the highest quality, most appropriate and compassionate care Our goal is to deliver excellent service to our members Grievances expressed by our members do not affect their coverage in any way If the above noted member is dissatisfied with the resolution, they have the right to request a second review Please have them put the request in writing to: [redacted] [redacted] Written requests will be reviewed by Member Services Administration who will respond to you in writing within calendar days of the receipt of the member’s requestWe may extend this timeframe up to an additional calendar days at the member’s request or if there is a need for additional information and the delay is in the best interest of the member If the Revdex.com or the member has any questions, please contact me at ###-###-#### Also, you may contact Member Services: Denver/Boulder members may call ###-###-####, toll free at ###-###-####, between a.mto p.m., Monday through Friday Deaf, hard of hearing, or speech impaired members who use a TTY may call ###-###-#### Colorado Springs members please call ###-###-#### or deaf, hard of hearing or speech-impaired members who use TTY may call [redacted] You may also contact our department through our Web site at kaiserpermanente.org Please thank our member for their understanding in this matterWe know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente Sincerely, [redacted] Complex Case Resolution Specialist Customer Experience
Revdex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] , and find that this resolution is satisfactory to me Sincerely, [redacted]
Dear [redacted] , This is in response to your email received on August 7, 2016, forwarding the rebuttal to our original response provided on August 5, 2016, on behalf of our member, [redacted] Ms [redacted] brought several points to our attention in her rejection of the response · Level of care provided by the primary care physician o Tests were ordered that were unnecessary while her primary care physician was out of the officeo Ms [redacted] states it is her choice whether to complete tests ordered by physicians as no medical proof has been provided that the testing is neededo Concerns of billing the insurance company for medically unindicated testing have been brought up o Ms [redacted] is concerned with the director of the clinic reviewing her grievances when she has never seen the director of the clinic · Kaiser Permanente staff following dress code· Concerned about responses from Kaiser Permanente when one person is to have been assigned to work with her · Wait times when calling the call center· Quality of the mobile applicationWe value the opportunity to review and respond to the grievanceWe also apologize for the member’s continued dissatisfactionOn August 8, I sent a letter to Ms [redacted] stating I informed several members of her physician’s leadership team; Chief of Internal Medicine, Nursing Manager, and Medical Office Director of concerns related to her care The information provided to the leadership team addressed the issues of tests being ordered that were unnecessary Prior to this date Ms [redacted] had expressed doubt about procedures recommended by her primary care physician At that time I communicated with the nurse manager who confirmed the testing was medically indicated The leadership team continues to discuss care needed by Ms [redacted] and intend on partnering with her regarding her care Kaiser Permanente is not in the practice of billing insurance companies for unnecessary treatments The insurance company will not pay for services that are not medically necessaryShould Ms [redacted] choose to select a new primary care physician, she may contact Kaiser Permanente Physician Selection Services at ###-###-#### to discuss selecting a different physician who is accepting new patientsThe complaint Ms [redacted] filed April 13, regarding a staff member’s attire and hair color was addressed with appropriate managers of the department Members are not notified of the outcome of any disciplinary action stemming from a complaintI am the point of contact for Ms [redacted] ’s concerns My direct phone number is ###-###-#### I have been in communication with Ms [redacted] previously, both by phone and mailed correspondence New concerns that are submitted, whether by calling, emailing or through the Revdex.com are directed to me to address Ms [redacted] is welcome to contact me directly at any timeConcerns of wait times at the call center will be addressed with the managers of the department Several avenues are available for communicating with Kaiser Permanente staff Use of kp.org is recommended for non-emergent, non-urgent questions and concerns – both for medical staff and member services In order to reach the physician specifically regarding care, Ms [redacted] may call ###-###-#### Again, I am available to assist Ms [redacted] as wellMs [redacted] ’s dissatisfaction with the mobile site has been communicated to the Manager of Digital Operations in June of this yearThe member’s communication is appreciated, as it allows us to try to remedy this entire situationIf the Revdex.com or the member has any questions, please contact me at ###-###-####Also, you may contact Member Services: Denver/Boulder members may call ###-###-####, toll free at ###-###-####, between a.mto p.m., Monday through Friday Deaf, hard of hearing, or speech impaired members who use a TTY may call ###-###-#### Colorado Springs members please call ###-###-#### or deaf, hard of hearing or speech-impaired members who use TTY may call [redacted] You may also contact our department through our Web site at kaiserpermanente.orgPlease thank our member for their understanding in this matterWe know that they have a choice for their healthcare, and we thank them for choosing Kaiser PermanenteSincerely, [redacted] Complex Case Resolution Specialist Member Experience
May 11, [redacted] Complaint Case # [redacted] Consumer: [redacted] , [redacted] Case Opened: April 17, Dear Mr [redacted] , This is in response to your email received on May 4, 2017, forwarding the rebuttal to our original response provided on April 24, 2017, on behalf of, [redacted] The member replied stating that he does not accept Kaiser Permanente’s previous response advising that his requested refund was not honoredMr [redacted] continues to ask that KP refund the premium paid, as one representative informed that he had days to submit the required documentation reflecting proof of another health insurance We value the opportunity to review and respond to the grievanceWe also apologize for the member’s dissatisfaction I submitted the details of the 2nd review request to our Membership Administration Department asking for reconsideration of the decision made to not refund the premium payment Mr [redacted] had paid prior to canceling the planAfter additional review, the requested refund has been honoredThe plan now reflects in our membership system as cancelled/never activePlease advise Mr [redacted] to allow up to weeks for the expedited refund check in the amount of $1,to be processed, mailed, and received The member’s feedback is essential to our commitment of continuous improvement in delivering the highest quality, most appropriate and compassionate care Our goal is to deliver excellent service to our members Grievances expressed by our members do not affect their coverage in any way If the above noted member is dissatisfied with the resolution, they have the right to request a second review Please have them put the request in writing to: Kaiser Permanente [redacted] [redacted] Written requests will be reviewed by Member Services Administration who will respond to you in writing within calendar days of the receipt of the member’s requestWe may extend this timeframe up to an additional calendar days at the member’s request or if there is a need for additional information and the delay is in the best interest of the member If the Revdex.com or the member has any questions, please contact me at [redacted] Also, you may contact Member Services: [redacted] members may call [redacted] , toll free at [redacted] , between a.mto p.m., Monday through Friday Deaf, hard of hearing, or speech impaired members who use a TTY may call [redacted] [redacted] members please call [redacted] or deaf, hard of hearing or speech-impaired members who use TTY may call [redacted] You may also contact our department through our Web site at kaiserpermanente.org Please thank our member for his patience while resolving this matterI’d also be happy to assist Mr [redacted] , should he have any additionally related question/concerns Sincerely, [redacted]
August 16, [redacted] [redacted] Complaint Case # [redacted] Consumer: [redacted] Case Opened: 08/10/ Dear [redacted] , This is in response to your email received on August 8, forwarding concerns on behalf of; [redacted] regarding her request for Kaiser Permanente to provider her father’s medical recordsWe value the opportunity to review and respond to their grievance and apologize for the member’s daughters dissatisfaction We have formally documented and shared [redacted] grievance with the appropriate leadership Based on review, the daughter, [redacted] , has been contacted directly from our Health Information Services release of information department on several occasionsEach time it has been explained that the “Collection of Personal Property by Affidavit” will not suffice for obtaining her father’s medical records [redacted] is on the death certificate as Informant for her mother; however, we have nothing allowing us to release records for the father She has been instructed to go to the courts and be appointed his personal representative in order to be able to obtain her father’s medical records Kaiser Permanente is unable to release information without the appropriate required documents If the Revdex.com or the member has any questions, please contact me at [redacted] Also, you may contact Member Services: [redacted] members may call [redacted] , toll free at [redacted] , between a.mto p.m., Monday through Friday Deaf, hard of hearing, or speech impaired members who use a TTY may call [redacted] [redacted] members please call [redacted] or deaf, hard of hearing or speech-impaired members who use TTY may call [redacted] You may also contact our department through our Web site at [redacted] Please thank our member for their understanding in this matterWe know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente Sincerely, [redacted]
August 16, [redacted] Complaint Case # [redacted] Consumer: [redacted] Case Opened: 09/14/ Dear [redacted] , This is in response to your email received on August 8,forwarding concerns on behalf of our member; [redacted] regarding his request for Kaiser Permanente to pay the balance owed on his biopsy completed on February 24, at [redacted] *** We value the opportunity to review and respond to their grievance and apologize for the member’s dissatisfaction Research confirms a check in the amount of $1,was issued to the provider (***) on October 12,The check cleared our bank on October 18,The check number is [redacted] The check was mailed to: [redacted] I have requested a copy of the front and back of the check and will provide it to [redacted] for the provider to research and apply the payment to the members account If the Revdex.com or the member has any questions, please contact me at [redacted] Also, you may contact Member Services: [redacted] members may call [redacted] , toll free at [redacted] , between a.mto p.m., Monday through Friday Deaf, hard of hearing, or speech impaired members who use a TTY may call [redacted] [redacted] members please call [redacted] or deaf, hard of hearing or speech-impaired members who use TTY may call [redacted] You may also contact our department through our Web site at kaiserpermanente.org Please thank our member for their understanding in this matterWe know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente Sincerely, [redacted]
August 31, [redacted] Revdex.com Serving Denver/Boulder [redacted] [redacted] Complaint Case # [redacted] Consumer: [redacted] Case Opened: 8/17/ Dear Mr [redacted] , This is in response to your email received on August 18, forwarding concerns on behalf of our member; [redacted] regarding her request to have a refund for $for premium payment that was deducted from her accountWe value the opportunity to review and respond to their grievance and apologize for the member’s dissatisfaction We have formally documented and shared [redacted] grievance with the appropriate leadership Research indicates the correct refund amount based on premiums due verses premiums paid is ($777.70)A request was processed and the member should have her the fund returned to her in hours based on her financial institutions posting policiesPlease note the members’ policy currently has a correct balance due of $ If the Revdex.com or the member has any questions, please contact me at [redacted] Also, you may contact Member Services: Denver/Boulder members may call [redacted] , toll free at [redacted] , between a.mto p.m., Monday through Friday Deaf, hard of hearing, or speech impaired members who use a TTY may call [redacted] Colorado Springs members please call [redacted] or deaf, hard of hearing or speech-impaired members who use TTY may call [redacted] You may also contact our department through our Web site at [redacted] Please thank our member for their understanding in this matterWe know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente Sincerely, [redacted] Complex Case Resolution Specialist Member Experience
October 2, [redacted] *** [redacted] Complaint Case # [redacted] Consumer: [redacted] Case Opened: 09/18/ Dear Mr [redacted] , This is in response to your email received on September 18, forwarding concerns on behalf of [redacted] regarding charges $ billed to [redacted] for emergency he treatment received on June 18, We value the opportunity to review and respond to their grievance and apologize for the member’s dissatisfaction We have formally documented and shared [redacted] ’s grievance with the appropriate leadership Research indicates the claims received from [redacted] Medical Center, and Carepoint Emergency Medicine was appropriately denied for service date June 18, Mr Jensen, was seen and treated on June 18, 2017, at [redacted] Medical Center, Emergency Department The claims received for the services were appropriately denied because [redacted] ’s coverage with Kaiser Permanente, terminated May 31, Feedback received from the Policy & Contract Administration Department, confirms that there is no coverage available to the member past their disenrollment date [redacted] ’s new coverage would be responsible for the ER visit and they would need to give authorization for any follow up visits he would want/need with a Kaiser Permanent’s Colorado Physician Medical Group physician In addition, emergency room services would not fall under the scope of a post-operative visit Kaiser Permanente cannot honor [redacted] ’s request to cover service date June 18, [redacted] will need to supply the treating providers with his new carrier information If the Revdex.com or the member has any questions, please contact me at [redacted] Also, you may contact Member Services: [redacted] members may call [redacted] , toll free at [redacted] , between a.mto p.m., Monday through Friday Deaf, hard of hearing, or speech impaired members who use a TTY may call [redacted] [redacted] members please call [redacted] or deaf, hard of hearing or speech-impaired members who use TTY may call [redacted] You may also contact our department through our Web site at [redacted] Please thank our member for their understanding in this matterWe know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente Sincerely, [redacted]
May 3, [redacted] *** [redacted] ***Complaint Case # [redacted] Consumer: [redacted] Case Opened: April 1, Dear Mr [redacted] ,This is in response to your email received on April 27, 2017, forwarding concerns on behalf of our member, [redacted] , regarding charges billed of $for the Bone Density Study completed January 17, 2017, and $for the ultrasound completed January 26, We value the opportunity to review and respond to their grievance and apologize for the member’s dissatisfaction.Ms [redacted] ’s spouse has disputed charges as he feels the charges are unwarranted because the services were ordered during Ms [redacted] ’s preventive visit on January 12, Mr [redacted] states services are mandated by law to be provided at no cost to the Health Plan subscriber The concerns have been formally documented and shared with the appropriate managers and physician leaders of our programPlease apologize to the member, on behalf of Kaiser Permanente (KP), for any frustration that may have been caused by this overall matterIn addition, we have further reviewed Mr [redacted] ’s concerns related to the charges from January 17, and January 26, Kaiser Permanente offers specific preventive tests at no cost to detect certain diseases early If the physician orders a test because of an existing health condition, the test is no longer preventive The Bone Density Scan was ordered to treat Osteoporosis, as Ms [redacted] was previously diagnosed We are unable to waive the charge of $billed for the Bone Density Scan One mammogram is provided annually at no charge We verified an initial screening mammogram was completed January 12, No charges were billed for this service based on her preventive benefit The tissue density lowered the sensitivity of the mammogram requiring additional evaluation A second mammogram exam was completed on January 26, We confirmed no charges were billed to Ms [redacted] for the second mammogram The additional mammogram yielded the same result as the first due to the tissue density The diagnostic ultrasound was completed to confirm there were no abnormalities Kaiser Permanente is offering a one-time service gesture to waive the charges of $for the ultrasound completed January 26, It may take one or more billing cycles for this amount to be adjusted off the account.The member’s feedback is essential to our commitment of continuous improvement in delivering the highest quality, most appropriate and compassionate care Our goal is to deliver excellent service to our members Grievances expressed by our members do not affect their coverage in any way If the above noted member is dissatisfied with the resolution, they have the right to request a second review Please have them put the request in writing to: [redacted] [redacted] ***Written requests will be reviewed by Member Services Administration who will respond to you in writing within calendar days of the receipt of the member’s requestWe may extend this timeframe up to an additional calendar days at the member’s request or if there is a need for additional information and the delay is in the best interest of the member If the Revdex.com or the member has any questions, please contact me at [redacted] .Also, you may contact Member Services: [redacted] members may call [redacted] , toll free at [redacted] , between a.mto p.m., Monday through Friday Deaf, hard of hearing, or speech impaired members who use a TTY may call [redacted] [redacted] members please call [redacted] or deaf, hard of hearing or speech-impaired members who use TTY may call [redacted] You may also contact our department through our Web site at [redacted] Please thank our member for their understanding in this matterWe know that they have a choice for their healthcare, and we thank them for choosing Kaiser PermanenteSincerely, [redacted] Member Experience
June 22, [redacted] Trade Practice Specialist Denver/Boulder Revdex.com P.OBox Denver, Colorado Complaint Case # [redacted] Consumer: ***, *** Case Opened: June 14, Dear Ms [redacted] , This is in response to your email received on June 16, 2016, forwarding concerns on behalf of our member, [redacted] ***, regarding termination of her healthcare plan purchased through Connect for Health Colorado (C4) We value the opportunity to review and respond to their grievance and apologize for the member’s dissatisfaction Mrs [redacted] explained that their policy was cancelled due to non-payment, due to confusion as to when the monthly premium was dueShe is disappointed with C4’s unwillingness to work with them, and is requesting that Kaiser Permanente (KP) consider allowing for coverage to continue once the account is paid to be current We have formally documented and shared Mrs***’s concerns with the appropriate Consolidated Service Center/On-Exchange Issues Department leadership, to include the Department ManagerPlease apologize to the member, on behalf of Kaiser Permanente (KP), for any frustration that may have been caused to her and her family by this overall matter I additionally forwarded Mrs***’s reinstatement request to our Member Issues Resolution Team (MIRT), as they specifically address On-Exchange issuesOn June 21, 2016, the MIRT Business Analyst submitted for reinstatement considerationI regret to inform that the Membership Administration responded that they will not honor the Mrs***’s request, and they provided the following explanation: The Non-compliant verbiage only applies to members who have dunning notices or past due lettersThis is a new enrollment, and there is no indication that the member attempted to make a paymentAll KP notices are compliant and the member was termed correctlyThe member is paid until Apr 2016, and proper notifications were issued before plan termination on 6/7/(grace period is days)We can reconsider the request, if proof of payment after 4/28/can be providedThank you Please ask Mrs [redacted] to review the Membership Administration response and contact me directly, if she has any related questionsAgain, please express my sincere apologies for her consequential frustration, as I realize that this is not the resolution she was seeking The member’s feedback is essential to our commitment of continuous improvement in delivering the highest quality, most appropriate and compassionate care Our goal is to deliver excellent service to our members Grievances expressed by our members do not affect their coverage in any way If the above noted member is dissatisfied with the resolution, they have the right to request a second review Please have them put the request in writing to: Kaiser Permanente Member Services [redacted] Aurora, Colorado Written requests will be reviewed by Member Services Administration who will respond to you in writing within calendar days of the receipt of the member’s requestWe may extend this timeframe up to an additional calendar days at the member’s request or if there is a need for additional information and the delay is in the best interest of the member If the Revdex.com or the member has any questions, please contact me at [redacted] Also, you may contact Member Services: Denver/Boulder members may call [redacted] , toll free at 1-800- [redacted] , between a.mto p.m., Monday through Friday Deaf, hard of hearing, or speech impaired members who use a TTY may call [redacted] Colorado Springs members please call 1-888- [redacted] or deaf, hard of hearing or speech-impaired members who use TTY may call 1-800- [redacted] You may also contact our department through our Web site at kaiserpermanente.org Please thank our member for their understanding in this matterWe know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente Sincerely, [redacted] Complex Case Resolution Specialist Member Experience
September 28, [redacted] Revdex.com Serving Denver/Boulder [redacted] [redacted] Complaint Case # [redacted] Consumer: [redacted] Case Opened: [redacted] Dear [redacted] This is in response to your email received on September 26, forwarding concerns on behalf of our member; [redacted] regarding charges billed to the member for date of service April 19, We value the opportunity to review and respond to their grievance and apologize for the member’s dissatisfaction We have formally documented and shared [redacted] grievance with the appropriate leadership Research indicates a $copayment was appropriately applied to service date April 19, The member was schedule for an office visit on December 29, at the Westminster Medical Office, Primary Care Department The visit was scheduled for symptoms of a sinus infection with minutes alloted for the visit The member was appropriately billed a $ office visit copayment per her employer group Health Maintenance Organization (HMO) health planThe member was seen at treated on April 19, for a different issue and charged appropriately If the Revdex.com or the member has any questions, please contact me at [redacted] Also, you may contact Member Services: Denver/Boulder members may call [redacted] , toll free at [redacted] , between a.mto p.m., Monday through Friday Deaf, hard of hearing, or speech impaired members who use a TTY may call [redacted] Colorado Springs members please call [redacted] or deaf, hard of hearing or speech-impaired members who use TTY may call [redacted] You may also contact our department through our Web site at kaiserpermanente.org Please thank our member for their understanding in this matterWe know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente Sincerely, [redacted] Complex Case Resolution Specialist Member Experience
Initial Business Response / [redacted] (1000, 5, 2015/08/28) */ August 28, [redacted] Trade Practices & Helpline Specialist [redacted] @denver.Revdex.com.org XXX XXX-XXXX XXX XXX-XXXXFax Complaint Case # XXXXXXXX Consumer: [redacted] Case Opened: August 20, Dear Ms [redacted] This is in response to your email received on August 20, 2015, forwarding concerns on behalf of our member; [redacted] , regarding his July 8, [redacted] Saint [redacted] 's procedure cost disputeWe value the opportunity to review and respond to his grievance and apologize for the member's dissatisfaction We have formally documented and shared Mr [redacted] 's concerns with the appropriate leaders at the Kaiser Permanente (KP) Medical Financial Counseling (MFC) department, to include the SupervisorsI have also reached out to St***'s Patient Representative requesting additional research and feedback The KP MFC department does not have any documentation of Mr [redacted] requesting/receiving a cost estimate for his July 8, procedure, nor do they have an employee by the name of [redacted] I was also informed that, per MFC protocol, the member would've been advised to contact the hospital in which the procedure would be performed for any requested cost estimates The St***'s Patient Representative put me in contact with their Medical Financial Counseling Supervisor, though she was also not able to locate any documentation of a cost estimate being providedShe did confirm, however, that St***'s does typically contact patients prior to a scheduled hospital visitThe Supervisor also stated that Mr [redacted] was initially checked in for his procedure as "inpatient" surgery; inpatient surgery falls under the $500/day member benefitThe procedure type changed to "outpatient", which she explained is usually due to coding changes prompted by physician driven ordersOutpatient falls under the 30% member responsibility benefit The member disputed July 8, 2015, Exempla Saint [redacted] procedure costs incurred were appropriately billed in accordance to the member's Evidence of Coverage (EOC), and I am unable to honor the member's monetary requestPlease sincerely apologize to Mr [redacted] on behalf of KP, as it is disappointing to have a valued member express frustrationThe St***'s MFC Supervisor provided me with the following contact, should Mr [redacted] choose to further discuss this perceived cost misinformation issue or any additional concerns relative to this case: Rose Bonet (Director of Patient Access-Exempla St***'s) (XXX) XXX-XXXX The member's feedback is essential to our commitment of continuous improvement in delivering the highest quality, most appropriate and compassionate careOur goal is to deliver excellent service to our membersGrievances expressed by our members do not affect their coverage in any wayIf the above noted member is dissatisfied with the resolution, they have the right to request a second reviewPlease have them put the request in writing to: Kaiser Permanente Member Services [redacted] Aurora, Colorado XXXXX Written requests will be reviewed by Member Services Administration who will respond to you in writing within calendar days of the receipt of the member's requestWe may extend this timeframe up to an additional calendar days at the member's request or if there is a need for additional information and the delay is in the best interest of the member If the Revdex.com or the member has any questions, please contact me at (XXX) XXX-XXXX Also, you may contact Member Services: Denver/Boulder members may call XXX-XXX-XXXX, toll free at X-XXX-XXX-XXXX, between a.mto p.m., Monday through FridayDeaf, hard of hearing, or speech impaired members who use a TTY may call XXX-XXX-XXXX Colorado Springs members please call X-XXX-XXX-XXXX or deaf, hard of hearing or speech-impaired members who use TTY may call X-XXX-XXX-XXXXYou may also contact our department through our Web site at kaiserpermanente.org Please thank our member for their understanding in this matterWe know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente Sincerely, [redacted] Complex Case Resolution Specialist Member Experience Initial Consumer Rebuttal / [redacted] (3000, 7, 2015/09/12) */ (The consumer indicated he/she DID NOT accept the response from the business.) Changing coding and verbiage of said stay overnight in the hospital after I was quoted a specific price in order to up charge the patient us very close to being illegalThis is what is referred to as a shellStating one thing to make a qualified decision and to budget for a procedure only to be lied to, cheated and over charged is unacceptable in any business, but in the new universal healthcare world is a crime Final Business Response / [redacted] (4000, 9, 2015/09/17) */ September 17, [redacted] Trade Practices & Helpline Specialist [redacted] @denver.Revdex.com.org XXX XXX-XXXX XXX XXX-XXXXFax Complaint Case # XXXXXXXX Consumer: [redacted] Case Opened: August 20, Dear Ms [redacted] This is in response to your email received on September 15,forwarding the rebuttal to our original response provided on August 28,on behalf of our member; [redacted] , regarding his July 8, Exempla Saint [redacted] 's procedure cost disputeWe value the opportunity to review and respond to his grievance and apologize for the member's dissatisfaction We regret his continued dissatisfactionHowever, Mr.Bishcoff request for review of these concerns was completed on July 27, and again on August 28, when a final resolution was renderedTherefore, he has exhausted all internal grievance options offered by Kaiser Permanente However, we have formally documented and shared Mr [redacted] 's concerns with the appropriate leaders at the Kaiser Permanente (KP) Medical Financial Counseling (MFC) department, to include the SupervisorsIn addition we had all calls that were made to our Member Services Department pulled and reviewedThe call completed by Mr.Bishcoff on July 6, at 8:46am was to cancel an appointmentThe member did not discuss or request any cost estimates in regards to any upcoming procedures Please thank our member for their understanding in this matterWe know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente Sincerely, [redacted] Complex Case Resolution Specialist Member Experience Department Kaiser Foundation Health Plan of Colorado Final Consumer Response / [redacted] (4200, 11, 2015/09/18) */ (The consumer indicated he/she DID NOT accept the response from the business.) The call on July was NOT TO CANCEL AN APPOINTMENTKaiser is not telling the truth and will now cause me financial distress withhold get to declare bankruptcy due to you not honoring your price quote on July 6, in the afternoonNot in the morningI have repeatedly ask you to honor your quote and you repeatedly lie about the quoteHow would I know all these details if I did not call? This is just a shame in the way you treat your membersI have not exhausted all my requests to remedy this matter because I was given the opportunity to appeal the August decision which I sent a certified letter to the department, so that would be yet another questionable statement by KaiserThank you Kaiser for taking care of your patients with such care
April 2, [redacted] Dispute Resolution/Helpline Specialist Denver/Boulder Revdex.com P.OBox Denver, Colorado Complaint Case # Consumer: [redacted] *** Case Opened: March 16, Dear Ms [redacted] , This is in response to your email received on April 1, 2016, forwarding the rebuttal to our original response provided on April 1, 2016, on behalf of our member, [redacted] The member is seeking an immediate decision from Kaiser Permanente (KP), as to whether his healthcare plan reinstatement request will be honored We value the opportunity to review and respond to their grievance and apologize for the member’s dissatisfaction The KP Membership Administration has now been able to review the retrieved call recording, between the member and KP representative assisting with the initial enrollmentThe emailed response received from the Membership Administration Team Lead is as follows: RE: [redacted] This request was further reviewed by upper management, and I am pleased to inform you it was approvedProspect will have the option to choose: Open Enrollment, which will give an effective date of 3/1/Requirements: a new completed/ signed application and binder payment through current month (April)Special Enrollment Period, with an effective date of 2/1/16: Requirements: a new completed/ signed application and binder payment through current month (April)Please review with prospect which options he prefers Once a response is received, we will email you an application and provide you a secure fax # where the application can be faxedI have contacted the member’s wife, [redacted] , and communicated this information, and I will be further assisting the family with the enrollment processPlease thank Mrand Mrs [redacted] for their patience with KP, while we were reviewing/considering the reinstatement of Louie and his dependentsI am also sincerely sorry for any errors or misunderstandings that may have been caused this inconvenience to Mr [redacted] .The member’s feedback is essential to our commitment of continuous improvement in delivering the highest quality, most appropriate and compassionate care Our goal is to deliver excellent service to our members Grievances expressed by our members do not affect their coverage in any way If the above noted member is dissatisfied with the resolution, they have the right to request a second review Please have them put the request in writing to:Kaiser PermanenteMember Services South Havana StreetAurora, Colorado 80014Written requests will be reviewed by Member Services Administration who will respond to you in writing within calendar days of the receipt of the member’s requestWe may extend this timeframe up to an additional calendar days at the member’s request or if there is a need for additional information and the delay is in the best interest of the member If the Revdex.com or the member has any questions, please contact me at ( [redacted] Also, you may contact Member Services: Denver/Boulder members may call [redacted] , toll free at 1-800-632-9700, between a.mto p.m., Monday through Friday Deaf, hard of hearing, or speech impaired members who use a TTY may call [redacted] Colorado Springs members please call 1-888-681-or deaf, hard of hearing or speech-impaired members who use TTY may call 1-800-521- You may also contact our department through our Web site at kaiserpermanente.org Please thank our member for their understanding in this matterWe know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente Sincerely, [redacted] Complex Case Resolution Specialist Member Experience
January 23, [redacted] Revdex.com Serving Denver/Boulder EFlorida Ave., SteDenver, Colorado Complaint Case # [redacted] Consumer: [redacted] ***Case Opened: 1/19/Dear Mr [redacted] , This is in response to your email received on January 19, 2018, forwarding concerns on behalf of our member; [redacted] regarding his request to see a Liver Specialists at [redacted] , or [redacted] in Aurora, ColoradoWe value the opportunity to review and respond to their grievance and apologize for the member’s dissatisfactionWe have formally documented and shared Mr [redacted] grievance with the appropriate leadership Mr [redacted] request for authorization to see a specialist at [redacted] in Aurora, Colorado for a second opinion was denied because services are available with a contracted Southern Colorado Kaiser Permanente providerIn addition, a new denial letter was generated on January 23, to reflect the correct diagnosis for this requestMr [redacted] appeal rights have been provided in the denial letterMr [redacted] may appeal this decision in writing by sending his request to:Appeals ProgramKaiser PermanenteP.OBox 378066Denver, CO 80237-8066Or you can fax the letter to: 1-866-466- If the Revdex.com or the member has any questions, please contact me at (303) 338-Also, you may contact Member Services: Denver/Boulder members may call 303-338-3800, toll free at 1-800-632-9700, between a.mto p.m., Monday through Friday Deaf, hard of hearing, or speech impaired members who use a TTY may call 303-338- Colorado Springs members please call 1-888-681-or deaf, hard of hearing or speech-impaired members who use TTY may call 1-800-521- You may also contact our department through our Web site at kaiserpermanente.orgPlease thank our member for their understanding in this matterWe know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente Sincerely, Suda P [redacted] Complex Case Resolution SpecialistMember Experience
Revdex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] , and find that this resolution is satisfactory to me Sincerely, [redacted] ***
November 8, [redacted] Dispute Resolution SpecialistDenver/Boulder Revdex.comP.OBox 48179Denver, Colorado 80204Complaint Case # [redacted] Consumer: [redacted] Case Opened: October 18, 2016Dear [redacted] This is in response to your email received on November 7, 2016, forwarding the rebuttal to our original response provided on November 1, 2016, on behalf of our member, [redacted] The member is advising that the services in question were not completed, and therefore she should not have to payWe value the opportunity to review and respond to the grievanceWe also apologize for the member’s dissatisfaction.I’ve confirmed the procedure was completed and was appropriately billed A one-time gesture will be offered to remove the charge of $off the account, as mentioned in the initial response [redacted] and I had the opportunity to speak this afternoon about the procedure and subsequent bills she received Should [redacted] have further questions regarding her concerns, she is welcome to call me at 303-338- The member’s communication is appreciated, as it allows us to try to remedy this entire situationPlease apologize to the member again for his expressed dissatisfaction and continued inconvenience caused.The member’s feedback is essential to our commitment of continuous improvement in delivering the highest quality, most appropriate and compassionate care Our goal is to deliver excellent service to our members Grievances expressed by our members do not affect their coverage in any way If the above noted member is dissatisfied with the resolution, they have the right to request a second review Please have them put the request in writing to:Kaiser PermanenteMember Services [redacted] ***Written requests will be reviewed by Member Services Administration who will respond to you in writing within calendar days of the receipt of the member’s requestWe may extend this timeframe up to an additional calendar days at the member’s request or if there is a need for additional information and the delay is in the best interest of the member If the Revdex.com has any questions, please contact me at [redacted] .Also, you may contact Member Services: Denver/Boulder members may call [redacted] , toll free at [redacted] , between a.mto p.m., Monday through Friday Deaf, hard of hearing, or speech impaired members who use a TTY may call [redacted] Colorado Springs members please call [redacted] or deaf, hard of hearing or speech-impaired members who use TTY may call [redacted] You may also contact our department through our Web site at kaiserpermanente.org.Please thank our member for their understanding in this matterWe know that they have a choice for their healthcare, and we thank them for choosing Kaiser PermanenteSincerely, [redacted] ***Complex Case Resolution SpecialistCustomer Experience
July 27, [redacted] Dispute Resolution Specialist [redacted] @denver.Revdex.com.orgPhone: [redacted] Complaint Case # [redacted] Consumer: [redacted] ***Case Opened: June 14, 2016Dear Ms [redacted] ,This is in response to your email received on June 28, 2016, forwarding concerns on behalf of our member; [redacted] ***The member noted above expressed their continued concerns regarding the cancellation of her health plan Therefore, our member has requested a second review of their initial grievance and that we reconsider allowing Ms [redacted] to reinstate health plan coverage.I regret our member’s continued dissatisfaction, but I value the opportunity you have given me to review and respond to their continued concernsReviews of our member’s grievance and the management of out member’s initial concerns expressed to our Member Services liaison team have been completedAs follow up to our member’s concerns, I have confirmed that our Member Services liaisons have formally documented our member’s grievance appropriately and shared it with the appropriate managers and physician leaders of our programFurthermore, I am unable to honor the request for reinstatement I have reviewed Ms ***’s Evidence of Coverage regarding premium payments The contract provides the following information regarding dues and grace periods: Payment of DuesDues must be paid and received in advanceYou must then pay the correct amount before the beginning of a month to have coverage for that monthIf you do not pay in time, we will send you a notice that you are in defaultYou then have a grace period in which to pay your Dues without loss of membershipIf you do not pay within the grace period, we will terminate your membershipOnlyMembers for whom we have received the correct amount are entitled to benefits under this Membership Agreement.Grace PeriodsIf we are not receiving an advance payment of premium tax credit on your behalf, we will provide a 31-day grace period for payment of any Dues other than the first month’s DuesWe will send written notice stating when the grace period beginsIf we do not receive your Dues by the end of the grace period, we will terminate your membership so that it ends at 11:pm on the last day of the grace periodWe or providers may bill you as a non-Member for any Services you received after your last day of membership.Again, I thank the Revdex.com and our member for the time you both took to share these continued concerns, since member feedback is essential to our commitment of continuous improvement in delivering the highest quality, most appropriate and compassionate care Our goal is to deliver excellent service to our members Grievances expressed by our members do not affect their coverage in any way If the Revdex.com or our member has any questions, please contact Member Services: Denver/Boulder members may call [redacted] , toll free at 1-800- [redacted] , between a.mto p.m., Monday through Friday Deaf, hard of hearing, or speech impaired members who use a TTY may call [redacted] Colorado Springs members please call 1-888- [redacted] or deaf, hard of hearing or speech-impaired members who use TTY may call 1-800- [redacted] You may also contact our department through our Web site at kaiserpermanente.org.We thank the Revdex.com and the member for given Kaiser Permanente another opportunity to research this matterSincerely, [redacted] ***Kaiser PermanenteComplex Case Resolution SpecialistCustomer Experience
December 30, [redacted] Dispute Resolution & Helpline Specialist Denver/Boulder Revdex.com P.OBox Denver, Colorado Complaint Case # Consumer: [redacted] Case Opened: December 18, Dear Ms [redacted] This is in response to your email received on December 21, 2015, forwarding concerns on behalf of our member, [redacted] ***, regarding a disputed service bill receivedWe value the opportunity to review and respond to their grievance and apologize for the member's dissatisfaction We have formally documented and shared Mrs [redacted] concerns with the appropriate leaders at the Patient Financial Services (PFS) Department, to include the PFS SupervisorOn behalf of Kaiser Permanent (KP), I am very sorry for any frustration and inconvenience that may have been caused to the member by this matterI reached out, via telephone to the member, to further inquire about the disputed bill, as I was not able to locate the amount specified in her complaintFeedback received from PFS confirms that the $2,bill was mailed in November and December to the member for services received from November 12, through November 15, The charges, however, were corrected on December 15, 2015, which is why I was not able to locate the amountApparently, there were issues with Connect for Health Colorado (C4), causing a discrepancy in the member's health plan coverage detailsTherefore, the bills mailed were being processed as a non-memberThe corrected plan information is showing to have been updated in our system on December 14, 2015, at which time the claims were filed for the first time to the insurance, and the charges consequentially corrected Should the member have any additional questions pertaining to services received within KP, please advise her to contact PFS at [redacted] )The Claims Department ( [redacted] ) will be able to assist with questions about services received outside ofKP The member's feedback is essential to our commitment of continuous improvement in delivering the highest quality, most appropriate and compassionate careOur goal is to deliver excellent service to our membersGrievances expressed by our members do not affect their coverage in any wayIf the above noted member is dissatisfied with the resolution, they have the right to request a second reviewPlease have them put the request in writing to: Kaiser Permanente Member Services South Havana Street Aurora, Colorado Written requests will be reviewed by Member Services Administration who will respond to you in writing within calendar days of the receipt of the member's requestWe may extend this timeframe up to an additional calendar days at the member's request or if there is a need for additional information and the delay is in the best interest of the member If the Revdex.com or the member has any questions, please contact me at [redacted] Also, you may contact Member Services: Denver/Boulder members may call [redacted] , toll free at 1-800-632-9700, between a.mto p.m., Monday through FridayDeaf, hard of hearing, or speech impaired members who use a TTY may call [redacted] Colorado Springs members please call 1-888-681-or deaf, hard of hearing or speech-impaired members who use TTY may call 1-800-521-You may also contact our department through our Web site at kaiserpermanente.org Please thank our member for their understanding in this matterWe know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente Sincerely, [redacted] Complex Case Resolution Specialist Member Experience
May 17, [redacted] Trade Practice Specialist Denver/Boulder Revdex.com P.OBox Denver, Colorado Complaint Case # Consumer: [redacted] Case Opened: April 27, Dear Ms [redacted] This is in response to your email received on May 12, 2016, forwarding the rebuttal to our original response, on behalf of our member, [redacted] The member is requesting to have his On-Exchange issues resolved We value the opportunity to review and respond to their grievance and apologize for the member’s dissatisfaction Our Member Issues Resolution Team (MIRT) has advised that Mr [redacted] billing history was updated on May 16, The member is now billed correctly from 12/1/to current (6/1/2016) and shows a correct net due amount of $(June); account is paid through 5/31/ If the premium payments are still not being deducted from the member’s credit card, please ask him to verify the information entered for the automatic withdrawalThe payment system is not a feature that we will be able to adjust/change on his behalfShould Mr [redacted] have any further questions relating to his account, please advise him that I’d be happy to assist The member’s feedback is essential to our commitment of continuous improvement in delivering the highest quality, most appropriate and compassionate care Our goal is to deliver excellent service to our members Grievances expressed by our members do not affect their coverage in any wayIf the above noted member is dissatisfied with the resolution, they have the right to request a second review Please have them put the request in writing to: Kaiser Permanente Member Services South Havana Street Aurora, Colorado Written requests will be reviewed by Member Services Administration who will respond to you in writing within calendar days of the receipt of the member’s requestWe may extend this timeframe up to an additional calendar days at the member’s request or if there is a need for additional information and the delay is in the best interest of the member If the Revdex.com or the member has any questions, please contact me at ( [redacted] Also, you may contact Member Services: Denver/Boulder members may call [redacted] , toll free at 1-800-632-9700, between a.mto p.m., Monday through Friday Deaf, hard of hearing, or speech impaired members who use a TTY may call [redacted] Colorado Springs members please call 1-888-681-or deaf, hard of hearing or speech-impaired members who use TTY may call 1-800-521- You may also contact our department through our Web site at kaiserpermanente.org Please thank our member for their understanding in this matterWe know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente Sincerely, [redacted] Complex Case Resolution Specialist Member Experience
October 19, [redacted] Complaint Case # [redacted] Consumer: [redacted] *** Case Opened: October 15, Dear Mr [redacted] , This is in response to your email received on October 15, 2017, forwarding concerns on behalf of our member, [redacted] ***, regarding payment of $made April 10, 2017, for services received March 20, Mr [redacted] received information from Kaiser Permanente Customer Experience department August 1, 2017, advising charges for services on March 20, 2017, had been adjusted to show he owed $29.54, rather than $59.08, leaving a credit of $ Mr [redacted] has asked the refund in this amount be issued to him We value the opportunity to review and respond to their grievance and apologize for the member’s dissatisfaction We have confirmed Mr***’s previous concerns submitted to Kaiser Permanente were appropriately documented in our record keeping system and shared with leaders of our organization Research has confirmed Mr [redacted] had an appointment June 5, 2017, which resulted in a charge of $ Since the credit on the account matched the amount due, the credit of $was applied to the charges due for services June 5, We verified a bill was not mailed to Mr [redacted] for services June 5, 2017, as the payment had been applied to the account and showed no balance due We have verified a refund is not due to Mr*** The member’s feedback is essential to our commitment of continuous improvement in delivering the highest quality, most appropriate and compassionate care Our goal is to deliver excellent service to our members Grievances expressed by our members do not affect their coverage in any way If the above noted member is dissatisfied with the resolution, they have the right to request a second review Please have them put the request in writing to: [redacted] [redacted] Written requests will be reviewed by Member Services Administration who will respond to you in writing within calendar days of the receipt of the member’s requestWe may extend this timeframe up to an additional calendar days at the member’s request or if there is a need for additional information and the delay is in the best interest of the member If the Revdex.com or the member has any questions, please contact me at [redacted] Also, you may contact Member Services: Denver/Boulder members may call [redacted] , toll free at [redacted] , between a.mto p.m., Monday through Friday Deaf, hard of hearing, or speech impaired members who use a TTY may call [redacted] Colorado Springs members please call [redacted] or deaf, hard of hearing or speech-impaired members who use TTY may call [redacted] You may also contact our department through our Web site at kaiserpermanente.org Please thank our member for their understanding in this matterWe know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente Sincerely, [redacted]
Dear [redacted] , This is in response to your email received on July 18, 2016, forwarding concerns on behalf of our member, [redacted] , regarding an incorrect bill for services and difficulty in having the issue resolved with Kaiser Permanente We value the opportunity to review and respond to their grievance and apologize for the member’s dissatisfaction Mr [redacted] explained he is continually receiving a bill from Kaiser Permanente in the amount of $for services rendered on June 13, Mr [redacted] states he has already paid the $and when attempting to have the charge removed from his account, Kaiser Permanente staff have not been helpful We have formally documented and shared [redacted] ’s concerns with the appropriate leadership, to include the Patient Financial Services Department supervisorPlease apologize to the member, on behalf of Kaiser Permanente (KP), for any frustration that may have been caused by this overall matter Additionally, review confirms the June payment of $was received by Mr [redacted] and funds were not posted appropriately to his account Mr [redacted] ’s account has been corrected and he will no longer receive invoices for the $charge The member’s feedback is essential to our commitment of continuous improvement in delivering the highest quality, most appropriate and compassionate care Our goal is to deliver excellent service to our members Grievances expressed by our members do not affect their coverage in any way If the above noted member is dissatisfied with the resolution, they have the right to request a second review Please have them put the request in writing to: [redacted] [redacted] Written requests will be reviewed by Member Services Administration who will respond to you in writing within calendar days of the receipt of the member’s requestWe may extend this timeframe up to an additional calendar days at the member’s request or if there is a need for additional information and the delay is in the best interest of the member If the Revdex.com or the member has any questions, please contact me at ###-###-#### Also, you may contact Member Services: Denver/Boulder members may call ###-###-####, toll free at ###-###-####, between a.mto p.m., Monday through Friday Deaf, hard of hearing, or speech impaired members who use a TTY may call ###-###-#### Colorado Springs members please call ###-###-#### or deaf, hard of hearing or speech-impaired members who use TTY may call [redacted] You may also contact our department through our Web site at kaiserpermanente.org Please thank our member for their understanding in this matterWe know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente Sincerely, [redacted] Complex Case Resolution Specialist Customer Experience
Revdex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] , and find that this resolution is satisfactory to me Sincerely, [redacted]
Dear [redacted] , This is in response to your email received on August 7, 2016, forwarding the rebuttal to our original response provided on August 5, 2016, on behalf of our member, [redacted] Ms [redacted] brought several points to our attention in her rejection of the response · Level of care provided by the primary care physician o Tests were ordered that were unnecessary while her primary care physician was out of the officeo Ms [redacted] states it is her choice whether to complete tests ordered by physicians as no medical proof has been provided that the testing is neededo Concerns of billing the insurance company for medically unindicated testing have been brought up o Ms [redacted] is concerned with the director of the clinic reviewing her grievances when she has never seen the director of the clinic · Kaiser Permanente staff following dress code· Concerned about responses from Kaiser Permanente when one person is to have been assigned to work with her · Wait times when calling the call center· Quality of the mobile applicationWe value the opportunity to review and respond to the grievanceWe also apologize for the member’s continued dissatisfactionOn August 8, I sent a letter to Ms [redacted] stating I informed several members of her physician’s leadership team; Chief of Internal Medicine, Nursing Manager, and Medical Office Director of concerns related to her care The information provided to the leadership team addressed the issues of tests being ordered that were unnecessary Prior to this date Ms [redacted] had expressed doubt about procedures recommended by her primary care physician At that time I communicated with the nurse manager who confirmed the testing was medically indicated The leadership team continues to discuss care needed by Ms [redacted] and intend on partnering with her regarding her care Kaiser Permanente is not in the practice of billing insurance companies for unnecessary treatments The insurance company will not pay for services that are not medically necessaryShould Ms [redacted] choose to select a new primary care physician, she may contact Kaiser Permanente Physician Selection Services at ###-###-#### to discuss selecting a different physician who is accepting new patientsThe complaint Ms [redacted] filed April 13, regarding a staff member’s attire and hair color was addressed with appropriate managers of the department Members are not notified of the outcome of any disciplinary action stemming from a complaintI am the point of contact for Ms [redacted] ’s concerns My direct phone number is ###-###-#### I have been in communication with Ms [redacted] previously, both by phone and mailed correspondence New concerns that are submitted, whether by calling, emailing or through the Revdex.com are directed to me to address Ms [redacted] is welcome to contact me directly at any timeConcerns of wait times at the call center will be addressed with the managers of the department Several avenues are available for communicating with Kaiser Permanente staff Use of kp.org is recommended for non-emergent, non-urgent questions and concerns – both for medical staff and member services In order to reach the physician specifically regarding care, Ms [redacted] may call ###-###-#### Again, I am available to assist Ms [redacted] as wellMs [redacted] ’s dissatisfaction with the mobile site has been communicated to the Manager of Digital Operations in June of this yearThe member’s communication is appreciated, as it allows us to try to remedy this entire situationIf the Revdex.com or the member has any questions, please contact me at ###-###-####Also, you may contact Member Services: Denver/Boulder members may call ###-###-####, toll free at ###-###-####, between a.mto p.m., Monday through Friday Deaf, hard of hearing, or speech impaired members who use a TTY may call ###-###-#### Colorado Springs members please call ###-###-#### or deaf, hard of hearing or speech-impaired members who use TTY may call [redacted] You may also contact our department through our Web site at kaiserpermanente.orgPlease thank our member for their understanding in this matterWe know that they have a choice for their healthcare, and we thank them for choosing Kaiser PermanenteSincerely, [redacted] Complex Case Resolution Specialist Member Experience
May 11, [redacted] Complaint Case # [redacted] Consumer: [redacted] , [redacted] Case Opened: April 17, Dear Mr [redacted] , This is in response to your email received on May 4, 2017, forwarding the rebuttal to our original response provided on April 24, 2017, on behalf of, [redacted] The member replied stating that he does not accept Kaiser Permanente’s previous response advising that his requested refund was not honoredMr [redacted] continues to ask that KP refund the premium paid, as one representative informed that he had days to submit the required documentation reflecting proof of another health insurance We value the opportunity to review and respond to the grievanceWe also apologize for the member’s dissatisfaction I submitted the details of the 2nd review request to our Membership Administration Department asking for reconsideration of the decision made to not refund the premium payment Mr [redacted] had paid prior to canceling the planAfter additional review, the requested refund has been honoredThe plan now reflects in our membership system as cancelled/never activePlease advise Mr [redacted] to allow up to weeks for the expedited refund check in the amount of $1,to be processed, mailed, and received The member’s feedback is essential to our commitment of continuous improvement in delivering the highest quality, most appropriate and compassionate care Our goal is to deliver excellent service to our members Grievances expressed by our members do not affect their coverage in any way If the above noted member is dissatisfied with the resolution, they have the right to request a second review Please have them put the request in writing to: Kaiser Permanente [redacted] [redacted] Written requests will be reviewed by Member Services Administration who will respond to you in writing within calendar days of the receipt of the member’s requestWe may extend this timeframe up to an additional calendar days at the member’s request or if there is a need for additional information and the delay is in the best interest of the member If the Revdex.com or the member has any questions, please contact me at [redacted] Also, you may contact Member Services: [redacted] members may call [redacted] , toll free at [redacted] , between a.mto p.m., Monday through Friday Deaf, hard of hearing, or speech impaired members who use a TTY may call [redacted] [redacted] members please call [redacted] or deaf, hard of hearing or speech-impaired members who use TTY may call [redacted] You may also contact our department through our Web site at kaiserpermanente.org Please thank our member for his patience while resolving this matterI’d also be happy to assist Mr [redacted] , should he have any additionally related question/concerns Sincerely, [redacted]
August 16, [redacted] [redacted] Complaint Case # [redacted] Consumer: [redacted] Case Opened: 08/10/ Dear [redacted] , This is in response to your email received on August 8, forwarding concerns on behalf of; [redacted] regarding her request for Kaiser Permanente to provider her father’s medical recordsWe value the opportunity to review and respond to their grievance and apologize for the member’s daughters dissatisfaction We have formally documented and shared [redacted] grievance with the appropriate leadership Based on review, the daughter, [redacted] , has been contacted directly from our Health Information Services release of information department on several occasionsEach time it has been explained that the “Collection of Personal Property by Affidavit” will not suffice for obtaining her father’s medical records [redacted] is on the death certificate as Informant for her mother; however, we have nothing allowing us to release records for the father She has been instructed to go to the courts and be appointed his personal representative in order to be able to obtain her father’s medical records Kaiser Permanente is unable to release information without the appropriate required documents If the Revdex.com or the member has any questions, please contact me at [redacted] Also, you may contact Member Services: [redacted] members may call [redacted] , toll free at [redacted] , between a.mto p.m., Monday through Friday Deaf, hard of hearing, or speech impaired members who use a TTY may call [redacted] [redacted] members please call [redacted] or deaf, hard of hearing or speech-impaired members who use TTY may call [redacted] You may also contact our department through our Web site at [redacted] Please thank our member for their understanding in this matterWe know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente Sincerely, [redacted]
August 16, [redacted] Complaint Case # [redacted] Consumer: [redacted] Case Opened: 09/14/ Dear [redacted] , This is in response to your email received on August 8,forwarding concerns on behalf of our member; [redacted] regarding his request for Kaiser Permanente to pay the balance owed on his biopsy completed on February 24, at [redacted] *** We value the opportunity to review and respond to their grievance and apologize for the member’s dissatisfaction Research confirms a check in the amount of $1,was issued to the provider (***) on October 12,The check cleared our bank on October 18,The check number is [redacted] The check was mailed to: [redacted] I have requested a copy of the front and back of the check and will provide it to [redacted] for the provider to research and apply the payment to the members account If the Revdex.com or the member has any questions, please contact me at [redacted] Also, you may contact Member Services: [redacted] members may call [redacted] , toll free at [redacted] , between a.mto p.m., Monday through Friday Deaf, hard of hearing, or speech impaired members who use a TTY may call [redacted] [redacted] members please call [redacted] or deaf, hard of hearing or speech-impaired members who use TTY may call [redacted] You may also contact our department through our Web site at kaiserpermanente.org Please thank our member for their understanding in this matterWe know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente Sincerely, [redacted]
August 31, [redacted] Revdex.com Serving Denver/Boulder [redacted] [redacted] Complaint Case # [redacted] Consumer: [redacted] Case Opened: 8/17/ Dear Mr [redacted] , This is in response to your email received on August 18, forwarding concerns on behalf of our member; [redacted] regarding her request to have a refund for $for premium payment that was deducted from her accountWe value the opportunity to review and respond to their grievance and apologize for the member’s dissatisfaction We have formally documented and shared [redacted] grievance with the appropriate leadership Research indicates the correct refund amount based on premiums due verses premiums paid is ($777.70)A request was processed and the member should have her the fund returned to her in hours based on her financial institutions posting policiesPlease note the members’ policy currently has a correct balance due of $ If the Revdex.com or the member has any questions, please contact me at [redacted] Also, you may contact Member Services: Denver/Boulder members may call [redacted] , toll free at [redacted] , between a.mto p.m., Monday through Friday Deaf, hard of hearing, or speech impaired members who use a TTY may call [redacted] Colorado Springs members please call [redacted] or deaf, hard of hearing or speech-impaired members who use TTY may call [redacted] You may also contact our department through our Web site at [redacted] Please thank our member for their understanding in this matterWe know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente Sincerely, [redacted] Complex Case Resolution Specialist Member Experience
October 2, [redacted] *** [redacted] Complaint Case # [redacted] Consumer: [redacted] Case Opened: 09/18/ Dear Mr [redacted] , This is in response to your email received on September 18, forwarding concerns on behalf of [redacted] regarding charges $ billed to [redacted] for emergency he treatment received on June 18, We value the opportunity to review and respond to their grievance and apologize for the member’s dissatisfaction We have formally documented and shared [redacted] ’s grievance with the appropriate leadership Research indicates the claims received from [redacted] Medical Center, and Carepoint Emergency Medicine was appropriately denied for service date June 18, Mr Jensen, was seen and treated on June 18, 2017, at [redacted] Medical Center, Emergency Department The claims received for the services were appropriately denied because [redacted] ’s coverage with Kaiser Permanente, terminated May 31, Feedback received from the Policy & Contract Administration Department, confirms that there is no coverage available to the member past their disenrollment date [redacted] ’s new coverage would be responsible for the ER visit and they would need to give authorization for any follow up visits he would want/need with a Kaiser Permanent’s Colorado Physician Medical Group physician In addition, emergency room services would not fall under the scope of a post-operative visit Kaiser Permanente cannot honor [redacted] ’s request to cover service date June 18, [redacted] will need to supply the treating providers with his new carrier information If the Revdex.com or the member has any questions, please contact me at [redacted] Also, you may contact Member Services: [redacted] members may call [redacted] , toll free at [redacted] , between a.mto p.m., Monday through Friday Deaf, hard of hearing, or speech impaired members who use a TTY may call [redacted] [redacted] members please call [redacted] or deaf, hard of hearing or speech-impaired members who use TTY may call [redacted] You may also contact our department through our Web site at [redacted] Please thank our member for their understanding in this matterWe know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente Sincerely, [redacted]
May 3, [redacted] *** [redacted] ***Complaint Case # [redacted] Consumer: [redacted] Case Opened: April 1, Dear Mr [redacted] ,This is in response to your email received on April 27, 2017, forwarding concerns on behalf of our member, [redacted] , regarding charges billed of $for the Bone Density Study completed January 17, 2017, and $for the ultrasound completed January 26, We value the opportunity to review and respond to their grievance and apologize for the member’s dissatisfaction.Ms [redacted] ’s spouse has disputed charges as he feels the charges are unwarranted because the services were ordered during Ms [redacted] ’s preventive visit on January 12, Mr [redacted] states services are mandated by law to be provided at no cost to the Health Plan subscriber The concerns have been formally documented and shared with the appropriate managers and physician leaders of our programPlease apologize to the member, on behalf of Kaiser Permanente (KP), for any frustration that may have been caused by this overall matterIn addition, we have further reviewed Mr [redacted] ’s concerns related to the charges from January 17, and January 26, Kaiser Permanente offers specific preventive tests at no cost to detect certain diseases early If the physician orders a test because of an existing health condition, the test is no longer preventive The Bone Density Scan was ordered to treat Osteoporosis, as Ms [redacted] was previously diagnosed We are unable to waive the charge of $billed for the Bone Density Scan One mammogram is provided annually at no charge We verified an initial screening mammogram was completed January 12, No charges were billed for this service based on her preventive benefit The tissue density lowered the sensitivity of the mammogram requiring additional evaluation A second mammogram exam was completed on January 26, We confirmed no charges were billed to Ms [redacted] for the second mammogram The additional mammogram yielded the same result as the first due to the tissue density The diagnostic ultrasound was completed to confirm there were no abnormalities Kaiser Permanente is offering a one-time service gesture to waive the charges of $for the ultrasound completed January 26, It may take one or more billing cycles for this amount to be adjusted off the account.The member’s feedback is essential to our commitment of continuous improvement in delivering the highest quality, most appropriate and compassionate care Our goal is to deliver excellent service to our members Grievances expressed by our members do not affect their coverage in any way If the above noted member is dissatisfied with the resolution, they have the right to request a second review Please have them put the request in writing to: [redacted] [redacted] ***Written requests will be reviewed by Member Services Administration who will respond to you in writing within calendar days of the receipt of the member’s requestWe may extend this timeframe up to an additional calendar days at the member’s request or if there is a need for additional information and the delay is in the best interest of the member If the Revdex.com or the member has any questions, please contact me at [redacted] .Also, you may contact Member Services: [redacted] members may call [redacted] , toll free at [redacted] , between a.mto p.m., Monday through Friday Deaf, hard of hearing, or speech impaired members who use a TTY may call [redacted] [redacted] members please call [redacted] or deaf, hard of hearing or speech-impaired members who use TTY may call [redacted] You may also contact our department through our Web site at [redacted] Please thank our member for their understanding in this matterWe know that they have a choice for their healthcare, and we thank them for choosing Kaiser PermanenteSincerely, [redacted] Member Experience
June 22, [redacted] Trade Practice Specialist Denver/Boulder Revdex.com P.OBox Denver, Colorado Complaint Case # [redacted] Consumer: ***, *** Case Opened: June 14, Dear Ms [redacted] , This is in response to your email received on June 16, 2016, forwarding concerns on behalf of our member, [redacted] ***, regarding termination of her healthcare plan purchased through Connect for Health Colorado (C4) We value the opportunity to review and respond to their grievance and apologize for the member’s dissatisfaction Mrs [redacted] explained that their policy was cancelled due to non-payment, due to confusion as to when the monthly premium was dueShe is disappointed with C4’s unwillingness to work with them, and is requesting that Kaiser Permanente (KP) consider allowing for coverage to continue once the account is paid to be current We have formally documented and shared Mrs***’s concerns with the appropriate Consolidated Service Center/On-Exchange Issues Department leadership, to include the Department ManagerPlease apologize to the member, on behalf of Kaiser Permanente (KP), for any frustration that may have been caused to her and her family by this overall matter I additionally forwarded Mrs***’s reinstatement request to our Member Issues Resolution Team (MIRT), as they specifically address On-Exchange issuesOn June 21, 2016, the MIRT Business Analyst submitted for reinstatement considerationI regret to inform that the Membership Administration responded that they will not honor the Mrs***’s request, and they provided the following explanation: The Non-compliant verbiage only applies to members who have dunning notices or past due lettersThis is a new enrollment, and there is no indication that the member attempted to make a paymentAll KP notices are compliant and the member was termed correctlyThe member is paid until Apr 2016, and proper notifications were issued before plan termination on 6/7/(grace period is days)We can reconsider the request, if proof of payment after 4/28/can be providedThank you Please ask Mrs [redacted] to review the Membership Administration response and contact me directly, if she has any related questionsAgain, please express my sincere apologies for her consequential frustration, as I realize that this is not the resolution she was seeking The member’s feedback is essential to our commitment of continuous improvement in delivering the highest quality, most appropriate and compassionate care Our goal is to deliver excellent service to our members Grievances expressed by our members do not affect their coverage in any way If the above noted member is dissatisfied with the resolution, they have the right to request a second review Please have them put the request in writing to: Kaiser Permanente Member Services [redacted] Aurora, Colorado Written requests will be reviewed by Member Services Administration who will respond to you in writing within calendar days of the receipt of the member’s requestWe may extend this timeframe up to an additional calendar days at the member’s request or if there is a need for additional information and the delay is in the best interest of the member If the Revdex.com or the member has any questions, please contact me at [redacted] Also, you may contact Member Services: Denver/Boulder members may call [redacted] , toll free at 1-800- [redacted] , between a.mto p.m., Monday through Friday Deaf, hard of hearing, or speech impaired members who use a TTY may call [redacted] Colorado Springs members please call 1-888- [redacted] or deaf, hard of hearing or speech-impaired members who use TTY may call 1-800- [redacted] You may also contact our department through our Web site at kaiserpermanente.org Please thank our member for their understanding in this matterWe know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente Sincerely, [redacted] Complex Case Resolution Specialist Member Experience
September 28, [redacted] Revdex.com Serving Denver/Boulder [redacted] [redacted] Complaint Case # [redacted] Consumer: [redacted] Case Opened: [redacted] Dear [redacted] This is in response to your email received on September 26, forwarding concerns on behalf of our member; [redacted] regarding charges billed to the member for date of service April 19, We value the opportunity to review and respond to their grievance and apologize for the member’s dissatisfaction We have formally documented and shared [redacted] grievance with the appropriate leadership Research indicates a $copayment was appropriately applied to service date April 19, The member was schedule for an office visit on December 29, at the Westminster Medical Office, Primary Care Department The visit was scheduled for symptoms of a sinus infection with minutes alloted for the visit The member was appropriately billed a $ office visit copayment per her employer group Health Maintenance Organization (HMO) health planThe member was seen at treated on April 19, for a different issue and charged appropriately If the Revdex.com or the member has any questions, please contact me at [redacted] Also, you may contact Member Services: Denver/Boulder members may call [redacted] , toll free at [redacted] , between a.mto p.m., Monday through Friday Deaf, hard of hearing, or speech impaired members who use a TTY may call [redacted] Colorado Springs members please call [redacted] or deaf, hard of hearing or speech-impaired members who use TTY may call [redacted] You may also contact our department through our Web site at kaiserpermanente.org Please thank our member for their understanding in this matterWe know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente Sincerely, [redacted] Complex Case Resolution Specialist Member Experience
Initial Business Response / [redacted] (1000, 5, 2015/08/28) */ August 28, [redacted] Trade Practices & Helpline Specialist [redacted] @denver.Revdex.com.org XXX XXX-XXXX XXX XXX-XXXXFax Complaint Case # XXXXXXXX Consumer: [redacted] Case Opened: August 20, Dear Ms [redacted] This is in response to your email received on August 20, 2015, forwarding concerns on behalf of our member; [redacted] , regarding his July 8, [redacted] Saint [redacted] 's procedure cost disputeWe value the opportunity to review and respond to his grievance and apologize for the member's dissatisfaction We have formally documented and shared Mr [redacted] 's concerns with the appropriate leaders at the Kaiser Permanente (KP) Medical Financial Counseling (MFC) department, to include the SupervisorsI have also reached out to St***'s Patient Representative requesting additional research and feedback The KP MFC department does not have any documentation of Mr [redacted] requesting/receiving a cost estimate for his July 8, procedure, nor do they have an employee by the name of [redacted] I was also informed that, per MFC protocol, the member would've been advised to contact the hospital in which the procedure would be performed for any requested cost estimates The St***'s Patient Representative put me in contact with their Medical Financial Counseling Supervisor, though she was also not able to locate any documentation of a cost estimate being providedShe did confirm, however, that St***'s does typically contact patients prior to a scheduled hospital visitThe Supervisor also stated that Mr [redacted] was initially checked in for his procedure as "inpatient" surgery; inpatient surgery falls under the $500/day member benefitThe procedure type changed to "outpatient", which she explained is usually due to coding changes prompted by physician driven ordersOutpatient falls under the 30% member responsibility benefit The member disputed July 8, 2015, Exempla Saint [redacted] procedure costs incurred were appropriately billed in accordance to the member's Evidence of Coverage (EOC), and I am unable to honor the member's monetary requestPlease sincerely apologize to Mr [redacted] on behalf of KP, as it is disappointing to have a valued member express frustrationThe St***'s MFC Supervisor provided me with the following contact, should Mr [redacted] choose to further discuss this perceived cost misinformation issue or any additional concerns relative to this case: Rose Bonet (Director of Patient Access-Exempla St***'s) (XXX) XXX-XXXX The member's feedback is essential to our commitment of continuous improvement in delivering the highest quality, most appropriate and compassionate careOur goal is to deliver excellent service to our membersGrievances expressed by our members do not affect their coverage in any wayIf the above noted member is dissatisfied with the resolution, they have the right to request a second reviewPlease have them put the request in writing to: Kaiser Permanente Member Services [redacted] Aurora, Colorado XXXXX Written requests will be reviewed by Member Services Administration who will respond to you in writing within calendar days of the receipt of the member's requestWe may extend this timeframe up to an additional calendar days at the member's request or if there is a need for additional information and the delay is in the best interest of the member If the Revdex.com or the member has any questions, please contact me at (XXX) XXX-XXXX Also, you may contact Member Services: Denver/Boulder members may call XXX-XXX-XXXX, toll free at X-XXX-XXX-XXXX, between a.mto p.m., Monday through FridayDeaf, hard of hearing, or speech impaired members who use a TTY may call XXX-XXX-XXXX Colorado Springs members please call X-XXX-XXX-XXXX or deaf, hard of hearing or speech-impaired members who use TTY may call X-XXX-XXX-XXXXYou may also contact our department through our Web site at kaiserpermanente.org Please thank our member for their understanding in this matterWe know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente Sincerely, [redacted] Complex Case Resolution Specialist Member Experience Initial Consumer Rebuttal / [redacted] (3000, 7, 2015/09/12) */ (The consumer indicated he/she DID NOT accept the response from the business.) Changing coding and verbiage of said stay overnight in the hospital after I was quoted a specific price in order to up charge the patient us very close to being illegalThis is what is referred to as a shellStating one thing to make a qualified decision and to budget for a procedure only to be lied to, cheated and over charged is unacceptable in any business, but in the new universal healthcare world is a crime Final Business Response / [redacted] (4000, 9, 2015/09/17) */ September 17, [redacted] Trade Practices & Helpline Specialist [redacted] @denver.Revdex.com.org XXX XXX-XXXX XXX XXX-XXXXFax Complaint Case # XXXXXXXX Consumer: [redacted] Case Opened: August 20, Dear Ms [redacted] This is in response to your email received on September 15,forwarding the rebuttal to our original response provided on August 28,on behalf of our member; [redacted] , regarding his July 8, Exempla Saint [redacted] 's procedure cost disputeWe value the opportunity to review and respond to his grievance and apologize for the member's dissatisfaction We regret his continued dissatisfactionHowever, Mr.Bishcoff request for review of these concerns was completed on July 27, and again on August 28, when a final resolution was renderedTherefore, he has exhausted all internal grievance options offered by Kaiser Permanente However, we have formally documented and shared Mr [redacted] 's concerns with the appropriate leaders at the Kaiser Permanente (KP) Medical Financial Counseling (MFC) department, to include the SupervisorsIn addition we had all calls that were made to our Member Services Department pulled and reviewedThe call completed by Mr.Bishcoff on July 6, at 8:46am was to cancel an appointmentThe member did not discuss or request any cost estimates in regards to any upcoming procedures Please thank our member for their understanding in this matterWe know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente Sincerely, [redacted] Complex Case Resolution Specialist Member Experience Department Kaiser Foundation Health Plan of Colorado Final Consumer Response / [redacted] (4200, 11, 2015/09/18) */ (The consumer indicated he/she DID NOT accept the response from the business.) The call on July was NOT TO CANCEL AN APPOINTMENTKaiser is not telling the truth and will now cause me financial distress withhold get to declare bankruptcy due to you not honoring your price quote on July 6, in the afternoonNot in the morningI have repeatedly ask you to honor your quote and you repeatedly lie about the quoteHow would I know all these details if I did not call? This is just a shame in the way you treat your membersI have not exhausted all my requests to remedy this matter because I was given the opportunity to appeal the August decision which I sent a certified letter to the department, so that would be yet another questionable statement by KaiserThank you Kaiser for taking care of your patients with such care
April 2, [redacted] Dispute Resolution/Helpline Specialist Denver/Boulder Revdex.com P.OBox Denver, Colorado Complaint Case # Consumer: [redacted] *** Case Opened: March 16, Dear Ms [redacted] , This is in response to your email received on April 1, 2016, forwarding the rebuttal to our original response provided on April 1, 2016, on behalf of our member, [redacted] The member is seeking an immediate decision from Kaiser Permanente (KP), as to whether his healthcare plan reinstatement request will be honored We value the opportunity to review and respond to their grievance and apologize for the member’s dissatisfaction The KP Membership Administration has now been able to review the retrieved call recording, between the member and KP representative assisting with the initial enrollmentThe emailed response received from the Membership Administration Team Lead is as follows: RE: [redacted] This request was further reviewed by upper management, and I am pleased to inform you it was approvedProspect will have the option to choose: Open Enrollment, which will give an effective date of 3/1/Requirements: a new completed/ signed application and binder payment through current month (April)Special Enrollment Period, with an effective date of 2/1/16: Requirements: a new completed/ signed application and binder payment through current month (April)Please review with prospect which options he prefers Once a response is received, we will email you an application and provide you a secure fax # where the application can be faxedI have contacted the member’s wife, [redacted] , and communicated this information, and I will be further assisting the family with the enrollment processPlease thank Mrand Mrs [redacted] for their patience with KP, while we were reviewing/considering the reinstatement of Louie and his dependentsI am also sincerely sorry for any errors or misunderstandings that may have been caused this inconvenience to Mr [redacted] .The member’s feedback is essential to our commitment of continuous improvement in delivering the highest quality, most appropriate and compassionate care Our goal is to deliver excellent service to our members Grievances expressed by our members do not affect their coverage in any way If the above noted member is dissatisfied with the resolution, they have the right to request a second review Please have them put the request in writing to:Kaiser PermanenteMember Services South Havana StreetAurora, Colorado 80014Written requests will be reviewed by Member Services Administration who will respond to you in writing within calendar days of the receipt of the member’s requestWe may extend this timeframe up to an additional calendar days at the member’s request or if there is a need for additional information and the delay is in the best interest of the member If the Revdex.com or the member has any questions, please contact me at ( [redacted] Also, you may contact Member Services: Denver/Boulder members may call [redacted] , toll free at 1-800-632-9700, between a.mto p.m., Monday through Friday Deaf, hard of hearing, or speech impaired members who use a TTY may call [redacted] Colorado Springs members please call 1-888-681-or deaf, hard of hearing or speech-impaired members who use TTY may call 1-800-521- You may also contact our department through our Web site at kaiserpermanente.org Please thank our member for their understanding in this matterWe know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente Sincerely, [redacted] Complex Case Resolution Specialist Member Experience
January 23, [redacted] Revdex.com Serving Denver/Boulder EFlorida Ave., SteDenver, Colorado Complaint Case # [redacted] Consumer: [redacted] ***Case Opened: 1/19/Dear Mr [redacted] , This is in response to your email received on January 19, 2018, forwarding concerns on behalf of our member; [redacted] regarding his request to see a Liver Specialists at [redacted] , or [redacted] in Aurora, ColoradoWe value the opportunity to review and respond to their grievance and apologize for the member’s dissatisfactionWe have formally documented and shared Mr [redacted] grievance with the appropriate leadership Mr [redacted] request for authorization to see a specialist at [redacted] in Aurora, Colorado for a second opinion was denied because services are available with a contracted Southern Colorado Kaiser Permanente providerIn addition, a new denial letter was generated on January 23, to reflect the correct diagnosis for this requestMr [redacted] appeal rights have been provided in the denial letterMr [redacted] may appeal this decision in writing by sending his request to:Appeals ProgramKaiser PermanenteP.OBox 378066Denver, CO 80237-8066Or you can fax the letter to: 1-866-466- If the Revdex.com or the member has any questions, please contact me at (303) 338-Also, you may contact Member Services: Denver/Boulder members may call 303-338-3800, toll free at 1-800-632-9700, between a.mto p.m., Monday through Friday Deaf, hard of hearing, or speech impaired members who use a TTY may call 303-338- Colorado Springs members please call 1-888-681-or deaf, hard of hearing or speech-impaired members who use TTY may call 1-800-521- You may also contact our department through our Web site at kaiserpermanente.orgPlease thank our member for their understanding in this matterWe know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente Sincerely, Suda P [redacted] Complex Case Resolution SpecialistMember Experience
Revdex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] , and find that this resolution is satisfactory to me Sincerely, [redacted] ***
November 8, [redacted] Dispute Resolution SpecialistDenver/Boulder Revdex.comP.OBox 48179Denver, Colorado 80204Complaint Case # [redacted] Consumer: [redacted] Case Opened: October 18, 2016Dear [redacted] This is in response to your email received on November 7, 2016, forwarding the rebuttal to our original response provided on November 1, 2016, on behalf of our member, [redacted] The member is advising that the services in question were not completed, and therefore she should not have to payWe value the opportunity to review and respond to the grievanceWe also apologize for the member’s dissatisfaction.I’ve confirmed the procedure was completed and was appropriately billed A one-time gesture will be offered to remove the charge of $off the account, as mentioned in the initial response [redacted] and I had the opportunity to speak this afternoon about the procedure and subsequent bills she received Should [redacted] have further questions regarding her concerns, she is welcome to call me at 303-338- The member’s communication is appreciated, as it allows us to try to remedy this entire situationPlease apologize to the member again for his expressed dissatisfaction and continued inconvenience caused.The member’s feedback is essential to our commitment of continuous improvement in delivering the highest quality, most appropriate and compassionate care Our goal is to deliver excellent service to our members Grievances expressed by our members do not affect their coverage in any way If the above noted member is dissatisfied with the resolution, they have the right to request a second review Please have them put the request in writing to:Kaiser PermanenteMember Services [redacted] ***Written requests will be reviewed by Member Services Administration who will respond to you in writing within calendar days of the receipt of the member’s requestWe may extend this timeframe up to an additional calendar days at the member’s request or if there is a need for additional information and the delay is in the best interest of the member If the Revdex.com has any questions, please contact me at [redacted] .Also, you may contact Member Services: Denver/Boulder members may call [redacted] , toll free at [redacted] , between a.mto p.m., Monday through Friday Deaf, hard of hearing, or speech impaired members who use a TTY may call [redacted] Colorado Springs members please call [redacted] or deaf, hard of hearing or speech-impaired members who use TTY may call [redacted] You may also contact our department through our Web site at kaiserpermanente.org.Please thank our member for their understanding in this matterWe know that they have a choice for their healthcare, and we thank them for choosing Kaiser PermanenteSincerely, [redacted] ***Complex Case Resolution SpecialistCustomer Experience
July 27, [redacted] Dispute Resolution Specialist [redacted] @denver.Revdex.com.orgPhone: [redacted] Complaint Case # [redacted] Consumer: [redacted] ***Case Opened: June 14, 2016Dear Ms [redacted] ,This is in response to your email received on June 28, 2016, forwarding concerns on behalf of our member; [redacted] ***The member noted above expressed their continued concerns regarding the cancellation of her health plan Therefore, our member has requested a second review of their initial grievance and that we reconsider allowing Ms [redacted] to reinstate health plan coverage.I regret our member’s continued dissatisfaction, but I value the opportunity you have given me to review and respond to their continued concernsReviews of our member’s grievance and the management of out member’s initial concerns expressed to our Member Services liaison team have been completedAs follow up to our member’s concerns, I have confirmed that our Member Services liaisons have formally documented our member’s grievance appropriately and shared it with the appropriate managers and physician leaders of our programFurthermore, I am unable to honor the request for reinstatement I have reviewed Ms ***’s Evidence of Coverage regarding premium payments The contract provides the following information regarding dues and grace periods: Payment of DuesDues must be paid and received in advanceYou must then pay the correct amount before the beginning of a month to have coverage for that monthIf you do not pay in time, we will send you a notice that you are in defaultYou then have a grace period in which to pay your Dues without loss of membershipIf you do not pay within the grace period, we will terminate your membershipOnlyMembers for whom we have received the correct amount are entitled to benefits under this Membership Agreement.Grace PeriodsIf we are not receiving an advance payment of premium tax credit on your behalf, we will provide a 31-day grace period for payment of any Dues other than the first month’s DuesWe will send written notice stating when the grace period beginsIf we do not receive your Dues by the end of the grace period, we will terminate your membership so that it ends at 11:pm on the last day of the grace periodWe or providers may bill you as a non-Member for any Services you received after your last day of membership.Again, I thank the Revdex.com and our member for the time you both took to share these continued concerns, since member feedback is essential to our commitment of continuous improvement in delivering the highest quality, most appropriate and compassionate care Our goal is to deliver excellent service to our members Grievances expressed by our members do not affect their coverage in any way If the Revdex.com or our member has any questions, please contact Member Services: Denver/Boulder members may call [redacted] , toll free at 1-800- [redacted] , between a.mto p.m., Monday through Friday Deaf, hard of hearing, or speech impaired members who use a TTY may call [redacted] Colorado Springs members please call 1-888- [redacted] or deaf, hard of hearing or speech-impaired members who use TTY may call 1-800- [redacted] You may also contact our department through our Web site at kaiserpermanente.org.We thank the Revdex.com and the member for given Kaiser Permanente another opportunity to research this matterSincerely, [redacted] ***Kaiser PermanenteComplex Case Resolution SpecialistCustomer Experience
December 30, [redacted] Dispute Resolution & Helpline Specialist Denver/Boulder Revdex.com P.OBox Denver, Colorado Complaint Case # Consumer: [redacted] Case Opened: December 18, Dear Ms [redacted] This is in response to your email received on December 21, 2015, forwarding concerns on behalf of our member, [redacted] ***, regarding a disputed service bill receivedWe value the opportunity to review and respond to their grievance and apologize for the member's dissatisfaction We have formally documented and shared Mrs [redacted] concerns with the appropriate leaders at the Patient Financial Services (PFS) Department, to include the PFS SupervisorOn behalf of Kaiser Permanent (KP), I am very sorry for any frustration and inconvenience that may have been caused to the member by this matterI reached out, via telephone to the member, to further inquire about the disputed bill, as I was not able to locate the amount specified in her complaintFeedback received from PFS confirms that the $2,bill was mailed in November and December to the member for services received from November 12, through November 15, The charges, however, were corrected on December 15, 2015, which is why I was not able to locate the amountApparently, there were issues with Connect for Health Colorado (C4), causing a discrepancy in the member's health plan coverage detailsTherefore, the bills mailed were being processed as a non-memberThe corrected plan information is showing to have been updated in our system on December 14, 2015, at which time the claims were filed for the first time to the insurance, and the charges consequentially corrected Should the member have any additional questions pertaining to services received within KP, please advise her to contact PFS at [redacted] )The Claims Department ( [redacted] ) will be able to assist with questions about services received outside ofKP The member's feedback is essential to our commitment of continuous improvement in delivering the highest quality, most appropriate and compassionate careOur goal is to deliver excellent service to our membersGrievances expressed by our members do not affect their coverage in any wayIf the above noted member is dissatisfied with the resolution, they have the right to request a second reviewPlease have them put the request in writing to: Kaiser Permanente Member Services South Havana Street Aurora, Colorado Written requests will be reviewed by Member Services Administration who will respond to you in writing within calendar days of the receipt of the member's requestWe may extend this timeframe up to an additional calendar days at the member's request or if there is a need for additional information and the delay is in the best interest of the member If the Revdex.com or the member has any questions, please contact me at [redacted] Also, you may contact Member Services: Denver/Boulder members may call [redacted] , toll free at 1-800-632-9700, between a.mto p.m., Monday through FridayDeaf, hard of hearing, or speech impaired members who use a TTY may call [redacted] Colorado Springs members please call 1-888-681-or deaf, hard of hearing or speech-impaired members who use TTY may call 1-800-521-You may also contact our department through our Web site at kaiserpermanente.org Please thank our member for their understanding in this matterWe know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente Sincerely, [redacted] Complex Case Resolution Specialist Member Experience
May 17, [redacted] Trade Practice Specialist Denver/Boulder Revdex.com P.OBox Denver, Colorado Complaint Case # Consumer: [redacted] Case Opened: April 27, Dear Ms [redacted] This is in response to your email received on May 12, 2016, forwarding the rebuttal to our original response, on behalf of our member, [redacted] The member is requesting to have his On-Exchange issues resolved We value the opportunity to review and respond to their grievance and apologize for the member’s dissatisfaction Our Member Issues Resolution Team (MIRT) has advised that Mr [redacted] billing history was updated on May 16, The member is now billed correctly from 12/1/to current (6/1/2016) and shows a correct net due amount of $(June); account is paid through 5/31/ If the premium payments are still not being deducted from the member’s credit card, please ask him to verify the information entered for the automatic withdrawalThe payment system is not a feature that we will be able to adjust/change on his behalfShould Mr [redacted] have any further questions relating to his account, please advise him that I’d be happy to assist The member’s feedback is essential to our commitment of continuous improvement in delivering the highest quality, most appropriate and compassionate care Our goal is to deliver excellent service to our members Grievances expressed by our members do not affect their coverage in any wayIf the above noted member is dissatisfied with the resolution, they have the right to request a second review Please have them put the request in writing to: Kaiser Permanente Member Services South Havana Street Aurora, Colorado Written requests will be reviewed by Member Services Administration who will respond to you in writing within calendar days of the receipt of the member’s requestWe may extend this timeframe up to an additional calendar days at the member’s request or if there is a need for additional information and the delay is in the best interest of the member If the Revdex.com or the member has any questions, please contact me at ( [redacted] Also, you may contact Member Services: Denver/Boulder members may call [redacted] , toll free at 1-800-632-9700, between a.mto p.m., Monday through Friday Deaf, hard of hearing, or speech impaired members who use a TTY may call [redacted] Colorado Springs members please call 1-888-681-or deaf, hard of hearing or speech-impaired members who use TTY may call 1-800-521- You may also contact our department through our Web site at kaiserpermanente.org Please thank our member for their understanding in this matterWe know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente Sincerely, [redacted] Complex Case Resolution Specialist Member Experience