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BBB Accreditation

A BBB Accredited Business since

BBB has determined that Kaiser Permanente of Colorado meets BBB accreditation standards, which include a commitment to make a good faith effort to resolve any consumer complaints. BBB Accredited Businesses pay a fee for accreditation review/monitoring and for support of BBB services to the public.

BBB accreditation does not mean that the business' products or services have been evaluated or endorsed by BBB, or that BBB has made a determination as to the business' product quality or competency in performing services.


Reason for Rating

BBB rating is based on 13 factors. Get the details about the factors considered.

Factors that lowered the rating for Kaiser Permanente of Colorado include:

  • 74 complaint(s) filed against business

Factors that raised the rating for Kaiser Permanente of Colorado include:

  • Length of time business has been operating
  • Response to 74 complaint(s) filed against business
  • Resolution of complaint(s) filed against business


Customer Complaints Summary Read complaint details

74 complaints closed with BBB in last 3 years | 40 closed in last 12 months
Complaint Type Total Closed Complaints
Advertising/Sales Issues 35
Billing/Collection Issues 14
Delivery Issues 0
Guarantee/Warranty Issues 0
Problems with Product/Service 25
Total Closed Complaints 74

Customer Reviews Summary Read customer reviews

3 Customer Reviews on Kaiser Permanente of Colorado
Customer Experience Total Customer Reviews
Positive Experience 0
Neutral Experience 0
Negative Experience 3
Total Customer Reviews 3

Additional Information

BBB file opened: October 01, 1976 Business started: 07/01/1969 Business started locally: 07/01/1969
Licensing, Bonding or Registration
Many local municipalities, townships and counties have registration, bonding and/or licensing requirements. The BBB encourages you to check with the appropriate agency to be certain any requirements are currently being met.

Permit and license requirements for regulated industries in the State of Colorado can be viewed at the following website:

http://www.colorado.gov/pacific/dora/licenses-and-permits-0

To view the registration of a business with the Colorado Secretary of State click below:

http://www.sos.state.co.us/biz/BusinessEntityCriteriaExt.do

Licensing, Bonding or Registration

This business is in an industry that may require professional licensing, bonding or registration. BBB encourages you to check with the appropriate agency to be certain any requirements are currently being met.

These agencies may include:

Board of Medical Examiners
1560 Broadway Ste 1300, Denver CO 80202
www.dora.state.co.us/medical
Phone Number: (303) 894-7690
medical@dora.state.co.us

Division of Insurance
1560 Broadway Ste 850, Denver CO 80202
www.dora.state.co.us/insurance/
Phone Number: (303) 894-7499
insurance@dora.state.co.us

Business Management
Mr. Thomas Currigan Jr., Director of Community Ms. Carolyn Bell, Customer Service Manager Ms. Laura Berens, CorrespondenceRep-Mem Svcs Mr. Jack Cochran, Executive Medical Director Mr. Richard French, Member Svc-Supv Ms. Amanda Greenland, Case Resolution Manager Ms. Donna Lynne, CEO/President Mr. Scott Moede Ms. Kristin Snyder, President of Public Affairs
Contact Information
Principal: Mr. Thomas Currigan Jr., Director of Community
Business Category

Health Maintenance Organizations Insurance - Health Physicians & Surgeons - Medical-M.D. Physicians & Surgeons - Family Practice Physicians & Surgeons - Cardiology Services Physicians & Surgeons - Oncology Physicians & Surgeons - Orthopedic Surgery Physicians & Surgeons - Pediatrics Health & Medical - General

Alternate Business Names
Kaiser Foundation Health Plan
Industry Tips
Home Health Care Providers Insurance

Customer Review Rating plus BBB Rating Summary

Kaiser Permanente of Colorado has received 0 out of 5 stars based on 0 Customer Reviews and a BBB Rating of B.

BBB Customer Review Rating plus BBB Rating Overview

Additional Locations

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    Parker, CO 80138

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    Aurora, CO 80015

  • 2045 Franklin St
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    Denver, CO 80205

  • 2345 Bent Way
    Longmont Medical Offices

    Longmont, CO 80503

  • 2500 S Havana St
    Member Services

    Aurora, CO 80014 (303) 338-3718

  • 280 Exempla Cir
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    Lafayette, CO 80026

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    Evergreen, CO 80439

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    Englewood, CO 80113

  • 5257 S Wadsworth Blvd
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  • 580 Mohawk Dr
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  • 7600 Shaffer Pkwy
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  • 7701 Sheridan Blvd
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  • 8383 W Alameda Ave
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  • 9285 Hepburn St
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    Highlands Ranch, CO 80129

  • PO Box 373090

    Denver, CO 80237 (303) 338-3800

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BBB Customer Review Rating plus BBB Rating Overview


BBB Customer Reviews Rating represents the customers opinions of the business. The Customer Review Rating is based on the number of positive, neutral and negative customer reviews posted that are calculated to produce a score.

Customer Review Experience Value
Positive Review 5 points per review
Neutral Review 3 points per review
Negative Review 1 point per review

BBB letter grades represent the BBB's opinion of the business. The BBB grade is based on BBB file information about the business. In some cases, a business' grade may be lowered if the BBB does not have sufficient information about the business despite BBB requests for that information from the business.
Details

BBB Letter Grade Scale

BBB Rating Value
A+ 5
A 4.66
A- 4.33
B+ 4
B 3.66
B- 3.33
C+ 3
C 2.66
C- 2.33
D+ 2
D 1.66
D- 1.33
F 1
NR -----
Star Rating scale

  Average Score
5 stars 5.00
4.5 stars 4.50-4.99
4 stars 4.00-4.49
3.5 stars 3.50-3.99
3 stars 3.00-3.49
2.5 stars 2.50-2.99
2 stars 2.00-2.49
1.5 stars 1.50-1.99
1 star 0-1.49

BBB Customer Review Rating plus BBB Rating is not a guarantee of a business' reliability or performance, and BBB recommends that consumers consider a business' BBB Rating and Customer Review Rating in addition to all other available information about the business. If the BBB Rating is NR then only Customer Reviews are used for the Star Rating.

Complaint Detail(s)

5/21/2016 Billing/Collection Issues | Read Complaint Details
X

Additional Notes

Complaint: I had signed my family up for a Kaiser Permanete health insurance plan in December of 2015, beginning January 2016. We had to pay the January 2016 premium in December in order to obtain coverage. After we signed up for the Kaiser plan, our family had a change in events which caused us to be covered under a different health insurance company and plan (*****), with an effective start date of January 1, 2016. We notified Kaiser Member Services of this change by phone and was told to mail a letter requesting a retroactive refund for the January premium that was paid ($603.00), which we did. We had to make several contact attempts before we received a letter asking us to supply proof of coverage from our other insurance with an effective date of 1/1/2016 in order for the refund to be processed. After we provided the proof of coverage by mail, we received a letter dated April 12, 2016 stating that they would not be refunding the premium. When I called back in to a member services representative on April 21, 2016, I was told to file a complaint, which I did (Complaint #: *** *** ***) and I would hear back in 2-3 days. I still have not received a response to this complaint. We fully and timely complied with and provided all information that was requested. There should be no reason why we haven't already been refunded, or why we haven't received an update relative to the complaint that was filed.

Desired Settlement: No claims were made on this health insurance plan, and we received no value or coverage as this was insurance plan replaced with *****, on the same exact start date of the Kaiser Plan (1/1/2016). I am requesting a full refund of the unused paid premium ($603.00) on or before June 15, 2016.

Business Response:

 

Dear Ms. *******,

This is in response to your email received on May 17, 2016, forwarding concerns on behalf of our member, **** ******, regarding an awaited premium refund.  We value the opportunity to review and respond to their grievance and apologize for the member’s dissatisfaction.

We have verified that Mr. ****’s concerns have been documented and shared with the appropriate Membership Administration Department leaders, to include the Manager. I have additionally filed a complaint regarding our member’s customer service experience, as he should’ve been contacted by a Case Resolution Specialist to further discuss the initial complaint. This notification includes the Customer Experience Sr. Manager and Case Resolution Supervisor.

The Membership Administration provided their response to the January 2016 binder/premium payment refund request, prior to the life event resulting in family healthcare coverage change. The cancel date has been changed to December 31, 2015, and the $604.82 paid will be refunded back to the original credit card used at the time of enrollment. Please apologize to the member for any frustration or inconvenience that may have been caused by this overall matter. Also, I am available to assist, should any additionally related questions arise.

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

**** ***** ****** ****** ******* ********  *****

Written requests will be reviewed by Member Services Administration who will respond to you in writing within 14 calendar days of the receipt of the member’s request. We may extend this timeframe up to an additional 14 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 BBB 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 8 a.m. to 5 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 **************.  You may also contact our department through our Web site at kaiserpermanente.org.

Please thank our member for their understanding in this matter. We know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente.

Sincerely,

**** ** *****

Complex Case Resolution Specialist

Member Experience

Consumer Response:
Better Business Bureau:

I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution is satisfactory to me.

Sincerely,

****** ****

5/18/2016 Billing/Collection Issues | Read Complaint Details
X

Additional Notes

Complaint: I signed up for health care coverage with Kaiser via the Colorado Exchange after getting laid off from my job. I was laid off on 11/20/2015. I tried to sign up for a one month plan (to cover December 2015) and then start the regular coverage on 1/1/2016. They have screwed up my account. The Kaiser website shows that my account is paid thru 11/30/2015. That's not correct. (The coverage shouldn't have even started until 12/1/2015.) I have paid the premiums for 12/2015 thru 4/2016. I will be mailing in the premium for May. I've had to mail in the premium payments because, even though I signed up to have the premiums automatically charged to my credit card, Kaiser hasn't done that. I have called Kaiser an estimated 60 times. I have spent approximately 40 hours on the phone or on hold trying to straighten this out. I don't get consistent answers when I talk to them. They seem incapable, for whatever reason, of actually fixing the problem. This has been going on for five months. I don't think it's any closer to being resolved than it was five months ago. My main concern is that if I ever need medical coverage, or, God forbid, I get in a car accident, Kaiser will refuse to cover me because they'll say I haven't paid the premiums. That's not true. I have been paying the premiums. Your incompetent billing department hasn't been crediting me.

Desired Settlement: Credit my account for the payments I have made. Have the premium payments automatically be charged to my credit card.

Business Response:

May 10, 2016

* **** *******

Dispute Resolution/Helpline Specialist

Denver/Boulder BBB

P.O. Box 48179

Denver, Colorado 80204

Complaint Case #                11417689

Consumer:                             ******** ***** **

Case Opened:                       April 27, 2016

Dear Ms. *******,

This is in response to your email received on April 29, 2016, forwarding concerns on behalf of our member ***** ******* and current premium payment account discrepancies. We value the opportunity to review and respond to their grievance and apologize for the member’s dissatisfaction.

We have formally documented and shared Mr. ********* concerns with the appropriate Consolidated Service Center/On-Exchange Issues Department leadership. The case has been assigned to the Member Issues Resolution Team (MIRT), whom I have been communicating with directly.

Mr. ******* is confirmed in Kaiser Permanente’s (KP) system to have health plan coverage from December 1, 2015 through current. MIRT is working with our third party vendor (HPS) to ensure that all of the information reflected in the HPS billing system (SLP) is accurate and the same as KP’s system. I am sincerely sorry for any frustration and inconvenience that may have been caused to Mr. ******* by this overall matter. I ask that he please allow MIRT and HPS some time to follow through accordingly. Please encourage Mr. ******* to contact me directly for progress updates, as well as to discuss any additionally related issues that might arise.

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

2500 South Havana Street

Aurora, Colorado  80014

Written requests will be reviewed by Member Services Administration who will respond to you in writing within 14 calendar days of the receipt of the member’s request. We may extend this timeframe up to an additional 14 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 BBB or the member has any questions, please contact me at ***** ********.

Also, you may contact Member Services:

Denver/Boulder members may call ************, toll free at 1-800-632-9700, between 8 a.m. to 5 p.m., Monday through Friday.  Deaf, hard of hearing, or speech impaired members who use a TTY may call ************. 

Colorado Springs members please call 1-888-681-7878 or deaf, hard of hearing or speech-impaired members who use TTY may call 1-800-521-4874.  You may also contact our department through our Web site at kaiserpermanente.org.

Please thank our member for their understanding in this matter. We know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente.

Sincerely,

**** ** *****

Complex Case Resolution Specialist

Member Experience

Consumer Response:

 
Complaint: 11417689

I am rejecting this response because:

Although a lot more long-winded, this is basically EXACTLY the same response I've gotten from Kaiser the last 15 times I've talked to them over the last 5 months (now 5.5 months).  That is, "We've escalated the problem.  Give it some time to work its way through the system.  Call us back in 7-10 business days."  That has accomplished absolutely nothing so far.  Why would I believe it's different now?

I gave you the criteria for success in the original problem complaint in the "Desired Outcome" section.  I should be able to log in to my Kaiser account and see that my "Paid thru" date is the end of the current month.  It still shows 11/30/2015.  I also want the premium payments to be automatically charged to my credit card.  As of the latest premium, that hasn't happened.

I can't accept a response that says, "We're working on it".  I've been down that road.  An acceptable response would be, "It's fixed.  You can log in and verify".

Sincerely,


***** *******

Business Response:

May 17, 2016

* **** *******

Trade Practice Specialist

Denver/Boulder BBB

P.O. Box 48179

Denver, Colorado 80204

Complaint Case #               11417689

Consumer:                            ******** ***** *

Case Opened:                      April 27, 2016

Dear Ms. ********

This is in response to your email received on May 12, 2016, forwarding the rebuttal to our original response, on behalf of our member, ***** *******. 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. ********* billing history was updated on May 16, 2016. The member is now billed correctly from 12/1/2015 to current (6/1/2016) and shows a correct net due amount of $386.61 (June); account is paid through 5/31/2015.

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 withdrawal. The payment system is not a feature that we will be able to adjust/change on his behalf. Should Mr. ******* 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 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

2500 South Havana Street

Aurora, Colorado  80014

Written requests will be reviewed by Member Services Administration who will respond to you in writing within 14 calendar days of the receipt of the member’s request. We may extend this timeframe up to an additional 14 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 BBB or the member has any questions, please contact me at (**** ********.

Also, you may contact Member Services:

Denver/Boulder members may call ************, toll free at 1-800-632-9700, between 8 a.m. to 5 p.m., Monday through Friday.  Deaf, hard of hearing, or speech impaired members who use a TTY may call ************. 

Colorado Springs members please call 1-888-681-7878 or deaf, hard of hearing or speech-impaired members who use TTY may call 1-800-521-4874.  You may also contact our department through our Web site at kaiserpermanente.org.

Please thank our member for their understanding in this matter. We know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente.

Sincerely,

**** ** *****

Complex Case Resolution Specialist

Member Experience

Consumer Response:

 
Better Business Bureau:

I have reviewed the response made by the business in reference to complaint ID 11417689, and find that this resolution is satisfactory to me.

Sweet Mother of God, it looks like it's actually fixed!  I'll have to wait until the end of the month to see if my credit card is automatically billed.  I'm hoping that if there's any problem with that, it should be much easier to fix.


Sincerely,

***** *******

 

5/17/2016 Problems with Product/Service | Read Complaint Details
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Additional Notes

Complaint: I will attempt to chronologically outline the matter, which has gone on for months and is still not resolved. My daughter ***** ***** is a Kaiser member and I am the insured. The initial issue was approval to see Dr. ******** ****** on 11/23/2015. ***** has a very a serious medical condition and her primary at Kaiser agreed that continued treatment from Dr. ******** ******, who had been treating ***** for years was appropriate.  Her health record number is - can not include in complaint.  Seeing Dr ****** one or two times per year, as Kaiser had approved last year and in years past. Please note: we filed a DORA - Department of Insurance Complaint. In the answer to this complaint Kaiser noted that no claim had been denied, received an apology and a note to please contact Kaiser if we receive a bill.  This letter is dated Dec 17 2015.  It is 3 pages long and signed by ****** ********, Division file number is 250825MG Also note: we filed a level I appeal, letter from Kaiser is dated 1/20/2016 and claim number is ---can not include in complaint and this letter notes another apology and determination that ***** qualifies for services. Also note complain to BBB,  Complaint ID#: 75271249,  Business Name: Kaiser Permanente of Colorado in December. All indications were that the matter was fully resolved.  I was satisfied with the response that ****** ******** provided, noting  "If you receive a bill for ******* services on November 23, please contact Kaiser Permanente immediately".  Please noted that I have received a letter from University Physicians for services dated 11/23/2015 and have called them as well.  They noted that they have billed Kaiser twice and will not bill again.  Kaiser is not paying the bill. During the week of March 22, I mailed all documents to include the Kaiser response to Department of Insurance, Kaiser answer to the Appeal, and  the actual bill for Dr. ****** to Kaiser Claims.   On April 11, ***** attempted to communicate with someone at Kaiser, and got this response. -------------------------------------------- Dear ***** *****,  Thank you for your inquiry and for using the Kaiser Permanente Web site.  I have requested that this claim be reprocessed. Upon review, it appears  that the claim has processed incorrectly and you should be billed your  office visit copay. The reference number for the reprocess request is  S-201534081. You may call our Claims Department directly at 303-338-3600  to check on the status. Please allow 30 days for the review and you will  receive a new Explanation of Benefits (EOB) in the mail once completed  Claim #  Provider ******** ******  Date of Service 11/23/2015  Total Billed $430  KP Paid $0  Provider Liability $123.79  Allowed Amount $306.21  Deductible Amount $306.21  In order to ensure your concerns received on April 11, 2016 are  correctly addressed, I have documented them as a formal complaint and  forwarded them to the Denver Member Services Support Department where a  Senior Case Resolution Specialist will be assigned to investigate this  concern on your behalf and respond to you in writing as quickly as  possible, but no later than 30 calendar days. If it is in your best  interest, a representative may extend this time frame up to 14 calendar  days, to ensure a thorough investigation is completed.  At Kaiser Permanente, member satisfaction is one of our highest  priorities and we sincerely regret to hear that we have not met your  expectations.  Please be assured that it is our desire and mission to consistently  provide considerate, compassionate care that is of the highest quality.  We are continuously exploring ways to improve the services we provide  and you taking time to communicate your experience will be a  contribution toward these efforts. We appreciate your patience and  apologize for the inconvenience this may have caused.  If we can be of further assistance, please contact Member Services at  ************, toll free at **************, between 8 a.m. to 5 p.m.,  Monday through Friday. Deaf, hard of hearing, or speech impaired people  who use a TTY may call ************. You may also contact our department  through our Web site at kaiserpermanente.org.  Thank you for giving Kaiser Permanente the opportunity to care for you  {and your family}.  We hope you will continue to use and enjoy our Web site. Be healthy.  Live well. Thrive.  Sincerely,  **** *****  Customer Service Representative  Kaiser Permanente Member Service Contact Center  Phone :  ---------------------------------------- I received a statement for "remittance" dated 4/15/2016 with a notice of my appeal rights. It notes 430.00 is "not covered" for date of service 11/23/15.

Desired Settlement: There is really no compensation for the stress this causes my daughter, the time I spend trying to help her, the financial costs for the number of times I have to mail packets of hollow Kaiser promises to resolve a months old matter.  Resolution: Pay for Dr. ******** office visit and send me written proof that University Physicians has been paid. Letter of apology for time, frustration and poor customer services. Adjustment to their current BBB rating to reflect poor customer service.

Business Response:

May 11, 2016

**** *******

Dispute Resolution/Helpline Specialist

Denver/Boulder BBB

P.O. Box 48179

Denver, Colorado 80204

Complaint Case #                11421072

Consumer:                             ***** *****  

Case Opened:                       April 29, 2016

Dear Ms. *******,

This is in response to your email received on April 29, 2016, forwarding concerns on behalf of our member, ***** ***** and her father ****** *****. The member and her father continue to express dissatisfaction with ******* billed amount of the claim for services received on November 23, 2015.

Being that this matter has been addressed as an initial complaint as well as a 2nd review, I am treating the current case as a 3rd review. The issue remains to be disagreement with the $430.00 “not covered” for ***** to be seen by Dr. ******** ******.

I have confirmed that the details of this complaint have been documented and shared with the appropriate department leaders. The 2nd review response letter was mailed to the member on May 5, 2016, advising that the disputed cost will remain as member responsibility. The denied claim was reprocessed and the member billed the allowed $306.21, which went toward the deductible. The Member Service Contact Center (MSCC), as well as any other Kaiser Permanente (KP) department is able to submit any claim believed to be processed incorrectly to the Claims Department via internal process. From the emailed feedback that the member received from the MSCC, the representative believed that the November 23, 2015 should’ve been processed as a specialist copay and submitted the case to the Claims Department. The Claims Department review concluded that the disputed claim was processed correctly towards the member’s deductible and an explanation provided; the service was received at an outpatient hospital setting (Children’s Hospital), which is subject to deductible.

KP will not be reprocessing the claim, and the $306.21 remains as member responsibility per Ms. ****** Evidence of Coverage. Please note that all internal grievance options offered by KP in regards to this concern have been exhausted. I am sincerely sorry, as I realize that this is not the resolution that the member and her father were seeking. Should you have any additional comments or questions that I may answer, please do not hesitate to contact me directly at the phone number listed below.

Sincerely,

**** ** *****

***** ********

Complex Case Resolution Specialist

Member Experience

4/28/2016 Billing/Collection Issues | Read Complaint Details
X

Additional Notes

Complaint: In Sept of 2014 my husband, ***** was seen at Kaiser for an issue. As usual there was a co-pay due. The co-pay was paid by CC. In Jan. of this year, he received a call from BC Services stating that they were trying to collect on behalf of Kaiser. He asked for a copy of the bill. In Feb he received a notice in the mail from BC Services. No details of what the charges were for. It showed 56.17 due. As this is a COLLECTION agency, *** asked that I pay them the 40.00 that was the original bill. We could not find a copy of the cc receipt. It was paid 2/17/16. I called BC Services and faxed information to them. February 26,2016 I received a notice from BC Services in MY name. What? Who actually is being billed? March 11, 2016, I received a statement from BC Services and it shows the date in Sept that *** was treated. I AGAIN sent information showing it was paid, not once TWICE! April 19, 2016, *** received a notice from BC Services at our business address. This is completely unacceptable. MY Credit, ***** Credit is being clouded over an issue that should have been resolved back in Sept, when the payment was made in the first place.

Desired Settlement: BILLING ADJUSTMENT. This is abuse of those in Collections. How many others have to suffer someone's inadequate power. THE BILL HAS BEEN PAID TWICE. KAISER OWES US MONEY.

Business Response:

April 26, 2016

**** *******

Trade Practice Specialist

Denver/Boulder BBB

P.O. Box 48179

Denver, Colorado 80204

Complaint Case #                11401135

Consumer:                             ***** ****** ** Case Opened:                       April 19, 2016

Dear Ms. *******,

This is in response to your email received on April 21, 2016, forwarding concerns on behalf of our former member, ***** ******. Mr. ******** wife, ***** submitted an email explaining that they her husband is being billed by a collections agency for date of service September 10, 2015. She disagrees with the charge, being that the copay was paid at the time of service. Additionally, a general bill or past due notice was never received prior to the collections letter.

We value the opportunity to review and respond to this matter and apologize for their overall dissatisfaction. I’ve outreached the Kaiser Permanente (KP) Patient Financial Services Department for further research and clarification of the collections bill. I’ve been advised that the $40 copay was paid for Mr. ******** September 10, 2015 office visit with ******* ** ********, PA., at Westminster Family Practice. The member had an x-ray following that visit, which billed out for $56.17. Per the member’s Evidence of Coverage, the x-ray was billed appropriately towards the plan deductible:

DEDUCTIBLES

The following Deductibles apply under your plan:

Embedded Medical Deductible:

$500/Individual per year

$1,500/Family per year

Does not apply to Out-of-Pocket Maximum

X-ray, Laboratory and Special Procedures You Pay

Diagnostic and therapeutic X-rays

(Subject to medical Deductible; Applies to Out-of-Pocket Maximum)

30% Coinsurance

The bill is documented as having been mailed to the address we have on file for the member from his group plan employer:

613 WCR 53

Kennesburg, CO 80643

Our Health Connect system shows the member’s address as being in Fort Lupton, which is a system that can be changed by KP staff. However, our Membership Administration system shows the Keenesburg address, and this information can only be changed by the submitted request from the group plan employer.

I am very sorry for any frustration that may have been caused to the member and his wife by this overall matter. Please encourage them to contact me directly, should they have any additionally related questions.

Sincerely,

**** ** ***** ***** ********

Complex Case Resolution Specialist

Member Experience

Consumer Response:

 
Better Business Bureau:

The address change was  submitted months prior on occasions.  At the time of notice from Collections, the employer was no longer allowed access to the site to change the address.

A breakdown of the billing would have solved all before sending to collections.  The balance will be paid to Kaiser. 

I have reviewed the response made by the business in reference to complaint ID 11401135, and find that this resolution is satisfactory to me.

Sincerely,

***** ****** *

4/20/2016 Problems with Product/Service | Read Complaint Details
X

Additional Notes

Complaint: I am writing because my wife has been removed from my policy, I assume, due to previous billing errors. She is pregnant and due May 15th, and spent Saturday night crying herself to sleep upon reading the letter. My first complaint was closed by BBB caseworkers as Kaiser showed “good faith” in resolving the case. The problem lies in the fact the issue has not been fully resolved, as new problems have arisen. Our account shows a due date for the next bill as 02/01/2017. This is causing refunds to our account. Any repayment is simply refunded. Kaiser employees have noted the problem, and stated it will take "40 days' to correct the billing issue, and to wait for the correction and pay when prompted. If the past is any indication, this will take many months to resolve. I expect by then I will have lost my insurance coverage again. Kaiser has had 6 months to fix the many issues they have caused. Fixing things halfway is not good enough. We’re losing our insurance coverage again, through no fault of our own..

Desired Settlement: Kaiser needs to reinstate my wife, and correct the new billing error that is causing automatic refunds to my account, and ensure that all problems from the past are completely resolved.

Business Response:

April 11, 2016

**** *******

Trade Practice Specialist

Denver/Boulder BBB

P.O. Box 48179

Denver, Colorado 80204

Complaint Case #               11295439

Consumer:                            ********* ******* 

Case Opened:                      March 28, 2016

Dear Ms. *******,

This is in response to your email received on March 28, 2016, forwarding our member, ******* **********, newly submitted complaint. The member continues to wait for him and his wife’s health plan premium account discrepancies and invoice errors to be fixed, so that they will stop receiving termination letter.

The member is upset, as he had closed his last case with the BBB, in “good faith” that I would ensure that the issues are fixed. Meanwhile, he has received letters threating to term the plan, which is understandably concerning. Please advise Mr. ******** that their plan is effective:

GROUP SGR RL ST  EFF       END

80001   015 AA AC 010116 999999

427-4030-23 **************** 12201977 AA  010115

424-4030-29 ************       03151977 BB  100115

Additionally, I had never closed the case and been continuously working with MIRT ((KP’s Member Issues Resolution Team) to fix all of the problems that are causing the described letters to be automatically generated/mailed. That being said, HPS (our third party billing) states that they are still working on the account problems. HPS is quite aware that this is an escalated matter and have informed us that a technical issue appears to be keeping them from resolving the issues. Leadership from MIRT and HPS are involved, but the account discrepancies are still reflecting. What I can assure the member of, is that any issues that may arise while HPS is working to correct the account details will be fixed.

I realize that this is frustrating for Mr. ********, as it has been for MIRT and myself, as well, not being able to immediately assist him satisfactorily. For this lacking timeliness, I am sincerely sorry, and MIRT will continue to provide me with frequent updates that they receive from HPS. Please encourage Mr. ******** to contact me, as I will relay the information and work the case until completely resolved.

Sincerely,

**** ** ***** ***** ********

Complex Case Resolution Specialist

Member Experience

4/12/2016 Problems with Product/Service | Read Complaint Details
X

Additional Notes

Complaint: I called to schedule an appointment with the Urology Department. They told me they had no availability through May and that their booking system doesn't allow them to book as far ahead as June. In order to schedule my appointment, I was told to call back at a later time. The appointment is regarding a vasectomy and this procedure is also booking 2 months out. That means in order for me to get a vasectomy, I have a minimum wait time of 4 months and to initiate the process, I'm required to continue calling back to check and see if they are even able to book the initial appointment.

Desired Settlement: I'd like to be able to book my appointment with Urology and receive a vasectomy in less than 4 months since I'm paying for this healthcare.

Business Response:

April 2, 2016

**** *******

Dispute Resolution/Helpline Specialist

Denver/Boulder BBB

P.O. Box 48179

Denver, Colorado 80204

Complaint Case #               11295869

Consumer:                            ***** ****

Case Opened:                      March 28, 2016

Dear Ms. *******,

This is in response to your email received on March 29, 2016, forwarding concerns on behalf of our member, **** ****, regarding his procedure scheduling access concern.  We value the opportunity to review and respond to their grievance and apologize for the member’s dissatisfaction.

We have formally documented and shared Mr. ****** grievance details with the appropriate Kaiser Permanente Colorado Urology Department leadership, to include the Nursing Manager. I am sincerely sorry for any frustration that this overall matter may have caused to you.

The vasectomy procedure scheduling process was explained to be booked 3 months in advance. The next bookable schedule comes out in the middle of April for appointments in June. There are not any sooner appointments, unless someone is to cancel. Being that cancellations are not typical, there is not a waitlist available. Instead, members are welcome to call as often as daily to inquire if there has been any cancellation. This is a surgical procedure done only on Thursdays and Fridays, and the department will not be able to accommodate scheduling requests outside of the standard process. Please thank the Mr. **** for his much appreciated feedback, as he is a valued KP member. Should he have any additionally related questions, I am available at the phone number listed below.

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

2500 South Havana Street

Aurora, Colorado  80014

Written requests will be reviewed by Member Services Administration who will respond to you in writing within 14 calendar days of the receipt of the member’s request. We may extend this timeframe up to an additional 14 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 BBB or the member has any questions, please contact me at ***** ********.

Also, you may contact Member Services:

Denver/Boulder members may call 303-338-3800, toll free at 1-800-632-9700, between 8 a.m. to 5 p.m., Monday through Friday.  Deaf, hard of hearing, or speech impaired members who use a TTY may call 303-338-3820. 

Colorado Springs members please call 1-888-681-7878 or deaf, hard of hearing or speech-impaired members who use TTY may call 1-800-521-4874.  You may also contact our department through our Web site at kaiserpermanente.org.

Please thank our member for their understanding in this matter. We know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente.

Sincerely,

**** ** ***** Complex Case Resolution Specialist

Member Experience

4/10/2016 Problems with Product/Service | Read Complaint Details
X

Additional Notes

Complaint: For an unknown reason my coverage via Connect For Health with Kaiser Colorado was cancelled retro dated 12/31/15. I started contacting Kaiser and Connect Colorado in December upon receipt of Termination Letter. I was told by Connect for Colorado my health care was processed on 12/16; 12/23 and 12/24 due to Kaiser not receiving it. On 1/9/16 My wife ****** ****** (AOR for my account and childrens) contacted Kaiser, the kaiser rep suggested we mail premium payment for January so we don't show "term due to no payment". My wife mailed payment immediately a few short days later check was cashed. My wife then contacted kaiser to confirm on 1/27/16 and was told money was sitting in account but no place to apply, the Kaiser rep suggested we enroll through open enrollment directly with Kaiser since we do not receive a tax credit. kaiser transferred to Enrollment Dept for Kaiser, my wife spend 2 hours on the phone with *** ***** ************ *** *****. My wife completed the enrollment for myself and my 2 children who have chronic illnesses. We were given Case #369337 and ID#379503 to follow up for coverage starting on 2/1/16. Credit card was given over the phone to pay $750 in premium and set up auto withdraw each month there after. On 2/3/16 my wife called to check status and was given confirmation S-196920495 and coverage was good as of 2/1/16. This was such a relief. Well a few days later my son needed refill of medication and upon picking up my wife was told Coverage was term as of 12/31/15. My wife called and was told that coverage was retracted as of 2/3/16 due to SPECIAL ENROLLMENT BOX CHECKED. This is not anything we did nor did we know about, we used Kaiser rep to enroll to eliminate mistakes or delay in coverage. So on 2/15/16 only one of the many other times we have called to get no resolution to this matter, ********* from KAISER so helpful got recommendation from a supervisor at Kaiser for me to file a grievance in which my wife did immediately. Ref #s197665933 and application ID#50240365 these numbers were given to me along with Refund Request for Connect Colorado Prem. $717.16 Ticket #113923266. ********* said an AOR will need to be completed but WILL NOT HOLD UP PROCESS; and in 2 weeks time we should have a status mean while use Believe Me Policy. I was told that the Special Enrollment was an Error on Kaiser side and was apologized to and the Grievance is taken very seriously. Today is 3/16/16 and after several more phone calls, all I get in return is annoyed Reps from Kaiser and NO COVERAGE for my family. This is very upsetting, my son is hearing impaired with ADD and my daughter has Asthma and ADHD, the pharmacy is annoyed with me after all this time. And we are paying the ultimate price of not being covered for something was not an error due to our fault. Kaiser made all the recommendations, we followed steps that were given to us and almost half way through March all we get is us the Believe Me Policy. Now we have missed all open enrollments for 2016 and past our 60 days with Credible Certificate of Coverage. Kaiser has told me if Kaiser does not reverse and make coverage retro 2/1/16 we will not only be responsible for all Pharmacy charges and visits, but also can't be covered through Kaiser until Jan 2017. Both my children were born into the Kaiser System since 1998, and not once have they been without coverage. How does Kaiser expect me to relax and wait, when a Grievance shouldn't have had to be filed to correct a SIMPLE error from their employee! I have also called ****** ************* ************ who is the Case Resolution Manager called 3/9, 3/10, 3/12, 3/14/16 NO RESPONSE. I was told she has a 24 hour to 48 hour turn around on calls today is 3/16/16 and no missed calls or messages. If managers are not responding how does the consumer expect to be taken care and trust Kaiser? I am desperate, this is causing stress and serious hardship on our family.

Desired Settlement: I would like to have someone who is in management or has authority to give me information. And most of all correct the error of their employee and re-instate health coverage for my family retro 2/1/16 as promised. Kaiser should also make sure all prescriptions and visits are also retro active taken care of. I realize I will need to pay approx. $2250.00 for the active piece but my records show I have not ever had history of non payment. My family deserves an apology and Kaiser should be accountable for this issue and recognize and train their team to prevent future issues like this.

Business Response:

March 30, 2016

**** *******

Dispute Resolution/Helpline Specialist

Denver/Boulder BBB

P.O. Box 48179

Denver, Colorado 80204

Complaint Case #               11238060

Consumer:                            ******* *****  

Case Opened:                      March 16, 2016

Dear Ms. *******,

This is in response to your email received on March 16, 2016, forwarding concerns on behalf of our member, ***** ******, regarding the healthcare coverage intended to be enrolled in for 2016.  We value the opportunity to review and respond to their grievance and apologize for the member’s dissatisfaction.

We have formally documented and shared Mr. ******** concerns with the appropriate Consolidated Service Center (CSC)/KPIF-Off Exchange Issues Department, to include the manager. I am sincerely sorry for any frustration that may have been caused by this overall matter. Per further discussion with the member’s wife, I’ve been advised that the member chose to enroll directly with Kaiser Permanente’s (KP) Membership Administration Department for his 2016 healthcare coverage, in an attempt to avoid the previously experienced issues with his plan purchased through Connect for Health Colorado (C4). Unfortunately, the assisting KP representative checked an incorrect box on the application, which resulted in missing open enrollment. Consequentially, Mr. ****** is requesting that KP allow for coverage preferably back to January 1, 2016, or at least back to the February 1, 2016 date that he had been initially informed would be his enrollment date.

I submitted Mr. ******** benefits enrollment request accordingly to the CSC-KPIF Membership Administration Department, along with a detailed explanation of the circumstances pertaining to his attempt to enroll. Unfortunately, the department has not yet made the reinstatement decision. The call between the member and the assisting enrollment representative was ordered, as to allow for a thorough review of the communication. The department will advise once reviewed and of the decision made. Please thank Mr. ****** for his patience with this matter, and assure him that I will be calling immediately upon receiving the necessary feedback. My time estimate is no later than Monday April 5, 2016, and I welcome the member to contact me with any questions or is he is seeking an update.

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

2500 South Havana Street

Aurora, Colorado  80014

Written requests will be reviewed by Member Services Administration who will respond to you in writing within 14 calendar days of the receipt of the member’s request. We may extend this timeframe up to an additional 14 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 BBB or the member has any questions, please contact me at ***** *********

Also, you may contact Member Services:

Denver/Boulder members may call ************, toll free at 1-800-632-9700, between 8 a.m. to 5 p.m., Monday through Friday.  Deaf, hard of hearing, or speech impaired members who use a TTY may call ************. 

Colorado Springs members please call 1-888-681-7878 or deaf, hard of hearing or speech-impaired members who use TTY may call 1-800-521-4874.  You may also contact our department through our Web site at kaiserpermanente.org.

Please thank our member for their understanding in this matter. We know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente.

Sincerely,

**** ** *****

Complex Case Resolution Specialist

Member Experience

Consumer Response:


Complaint: 11238060

I am rejecting this response because: My wife and I have been patient from literally 12/16/15; following every step and advice given to us regarding my family and their coverage.  I did not want to accept the response by Kaiser and have this case closed as it is not resolved.  The response is what we have been receiving on all occasions 1/9/16, 1/27/16, 1/29/16, 2/1/16, 2/3/16 again on 2/15/16 and on this date we were given 30 days for resolution.  In notes by ********* on 2/15/16 was quoted "we need to get this turned around as this was no fault of your's Mrs. ******".  *** ***** from California Rep for Kaiser took enrollment on 1/27/16 English was very broken heavy Spanish accent, clearly marked the wrong box when the same information had been given to her.  We were directed to enroll directly through Kaiser since the Exchange gave us no tax credit.  We followed advice and are in a worse situation.  My children are without Medical Coverage as I am too.  We don't feel that we need to wait even longer to get coverage.  Kaiser has taken so long that even our Certificates of Coverage are now VOID giving us a break in coverage WAY OVER 60 days from 12/31/15.  This has truly left our family in a detrimental position, causing a hardship emotionally and Financially especially if Kaiser rejects reinstatement.  My wife and I are losing sleep over this, we have never been without coverage in over 28 years.

Kaiser on many occasions even reference conversation #S197665933 reassured by filing Grievance we would taken care within 30 days (3/24/16) if not sooner, now we have an even longer extension going into April.  My wife is prepared to pay full premiums dated back to 1/1/2016 to bring us current to meet premium requirements.  My kids need medications and visits, and the Believe Policy makes my family feel like we are in the wrong by the way of treatment rec'd in clinic.  I have a hernia I can't take care of and we have had kaiser for over 26 years.  Please help my family get coverage this is all we are asking, we applied within deadlines and gave payment via Credit Card, and the error was not ours.  We are not asking for extra money or anything just the coverage we applied for and by the advice of Kaiser Reps we got off the Exchange.  Now in worse position.

The resolution is simple please reinstate prefer back to 1/1/16 if not as recommended by *** ***** in California 2/1/16.  We feel for some reason we are being discriminated against and our Health Coverage is being held hostage.  This wait is long enough and not good for our health at all costs.


Sincerely,

***** ******

Business Response:

April 2, 2016

**** *******

Dispute Resolution/Helpline Specialist

Denver/Boulder BBB

P.O. Box 48179

Denver, Colorado 80204

Complaint Case #               11238060

Consumer:                            ******* ***** 

Case Opened:                      March 16, 2016

Dear Ms. *******,

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, ***** ******. The member is seeking an immediate decision from Kaiser Permanente (KP), as to whether his 2016 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 2016 enrollment. The emailed response received from the Membership Administration Team Lead is as follows:

RE: ***** ******

This request was further reviewed by upper management, and I am pleased to inform you it was approved. Prospect will have the option to choose:

  • Open Enrollment, which will give an effective date of 3/1/16. 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 faxed.

     

    I have contacted the member’s wife, ******, and communicated this information, and I will be further assisting the family with the enrollment process. Please thank Mr. and Mrs. ****** for their patience with KP, while we were reviewing/considering the reinstatement of Louie and his dependents. I am also sincerely sorry for any errors or misunderstandings that may have been caused this inconvenience 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:

    Kaiser Permanente

    Member Services

    2500 South Havana Street

    Aurora, Colorado  80014

    Written requests will be reviewed by Member Services Administration who will respond to you in writing within 14 calendar days of the receipt of the member’s request. We may extend this timeframe up to an additional 14 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 BBB or the member has any questions, please contact me at (**** ********.

Also, you may contact Member Services:

Denver/Boulder members may call ************, toll free at 1-800-632-9700, between 8 a.m. to 5 p.m., Monday through Friday.  Deaf, hard of hearing, or speech impaired members who use a TTY may call ************. 

Colorado Springs members please call 1-888-681-7878 or deaf, hard of hearing or speech-impaired members who use TTY may call 1-800-521-4874.  You may also contact our department through our Web site at kaiserpermanente.org.

Please thank our member for their understanding in this matter. We know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente.

Sincerely,

**** ** *****

Complex Case Resolution Specialist

Member Experience

3/29/2016 Billing/Collection Issues | Read Complaint Details
X

Additional Notes

Complaint: My premium is supposed to be $9 Connect for Health Colorado has verified this several times. Kaiser hit my bank account for over $350 instead of $9, and over 5 times I've called, they still have not resolved the issue. They owe me over $340 back. And now, they have just send me another bill for $181, when it should be $9. I cancelled service and should not be receiving a bill at all, let alone one that is 2000% of what it should have been, while they owe me over $340.

Desired Settlement: My $344.32 be refunded immediately and any and all other bills be cancelled.

Business Response:

March 10, 2016

* **** *******

Trade Practice Specialist

Denver/Boulder BBB

P.O. Box 48179

Denver, Colorado 80204

Complaint Case #                11155486

Consumer:                             ******** *******  

Case Opened:                       February 25, 2016

Dear Ms. *******,

This is in response to your email received on February 18, 2016, forwarding concerns on behalf of our member, ******* *******, regarding the incorrect premium amount being automatically deducted from his account.  We value the opportunity to review and respond to their grievance and apologize for the member’s dissatisfaction.

We have formally documented and shared Mr. ********* concerns with the appropriate Consolidated Service Center/KPIF On-Exchange Department leadership, to include the overseeing Manager. I am very sorry for any frustration or inconvenience that may have been caused to Mr. ******* by this overall matter. A case has been posted with Kaiser Permanente’s (KP) Member Issues Resolution Team (MIRT), as they assist specifically with issues pertaining to plans purchased through Connect for Health Colorado (C4). Your plan is currently reflecting as termed on February 29, 2016. MIRT was able to confirm that our third party billing company (HPS) corrected the member’s premium amount to the $9.03 that it should be. On March 9, 2016, HPS advised that they are re-running the bill, which will result in a refund to process for the member.

I will continue to follow through with MIRT, until the case has been satisfactorily resolved. Please inform Mr. ******* that I am available to contact personally, should he be seeking an update as to where the refund is the process. Again, I am very sorry for the continued problems experienced, and I am also happy to answer any additionally related questions.

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

2500 South Havana Street

Aurora, Colorado  80014

Written requests will be reviewed by Member Services Administration who will respond to you in writing within 14 calendar days of the receipt of the member’s request. We may extend this timeframe up to an additional 14 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 BBB or the member has any questions, please contact me at ***** *********

Also, you may contact Member Services:

Denver/Boulder members may call 303-338-3800, toll free at 1-800-632-9700, between 8 a.m. to 5 p.m., Monday through Friday.  Deaf, hard of hearing, or speech impaired members who use a TTY may call 303-338-3820. 

Colorado Springs members please call 1-888-681-7878 or deaf, hard of hearing or speech-impaired members who use TTY may call 1-800-521-4874.  You may also contact our department through our Web site at kaiserpermanente.org.

Please thank our member for their understanding in this matter. We know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente.

Sincerely,

**** ** ***** Complex Case Resolution Specialist

Member Experience

Business Response:

March 16, 2016

**** *******

Trade Practice Specialist

Denver/Boulder BBB

P.O. Box 48179

Denver, Colorado 80204

Complaint Case #                11155486

Consumer:                             ******** ******* 

Case Opened:                       February 25, 2016

Dear Ms. ********

This is in response to your email received on March 15, 2016, forwarding the rebuttal to our original response provided on March 10, 2016, on behalf of our member, ******* *******. The member is advising that the refund has not yet been received, as well as requesting that Kaiser Permanente (KP) pay his bank fee caused by monies we had withdrawn in error.

We value the opportunity to review and respond to their grievance and apologize for the member’s dissatisfaction.

I’ve confirmed with the Member Issues Resolution Team (MIRT) that the $344.32 refund was corrected by our billing system (HPS) on 3/11/2016. I have requested that MIRT outreach HPS to inquire as to where in the process the member’s refund currently is. Mr. ******* is welcome to contact me directly at the bolded phone number listed below for an update.

In regards to the overdraft fee incurred by this issue, I’d be happy to pay for that. Please request that Mr. ******* provide me with proof that the $12.50 charge was caused when KP deducted the monies from his account. He can attach it to this case, email it to me directly at ******************** or fax it to (303) 338-3220.

The member’s communication is appreciated, as it allows us to try to remedy this entire situation. Please 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 Permanente

Member Services

2500 South Havana Street

Aurora, Colorado  80014

Written requests will be reviewed by Member Services Administration who will respond to you in writing within 14 calendar days of the receipt of the member’s request. We may extend this timeframe up to an additional 14 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 BBB or the member has any questions, please contact me at (**** ********.

Also, you may contact Member Services:

Denver/Boulder members may call 303-338-3800, toll free at 1-800-632-9700, between 8 a.m. to 5 p.m., Monday through Friday.  Deaf, hard of hearing, or speech impaired members who use a TTY may call 303-338-3820. 

Colorado Springs members please call 1-888-681-7878 or deaf, hard of hearing or speech-impaired members who use TTY may call 1-800-521-4874.  You may also contact our department through our Web site at kaiserpermanente.org.

Please thank our member for their understanding in this matter. We know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente.

Sincerely,

**** ** *****

Complex Case Resolution Specialist

Member Experience

Consumer Response:

 
Complaint: 11155486

I am rejecting this response because:

I have not received the refund yet.

 


Sincerely,

******* *******

3/22/2016 Billing/Collection Issues | Read Complaint Details
X

Additional Notes

Complaint: Please consider this notice of a formal request for an appeal of the decision relating to claim number --------. Please find attached a copy of the Explanation of Benefits I received related to this claim number with a statement date of 11/12/2015. Please also find attached an Explanation of Benefits with a statement date of 10/29/2015 clearly showing that I met my out of pocket maximum (OOP) by the date of service that is in contention. I believe this claim should never have been denied as I had an individual coverage plan at the time of service and had previously met my out of pocket maximum. The EOB associated with this claim number relegates the billed amount to the “family” deductible amount; however, at no time did I have a family member associated with my individual insurance plan. Therefore there should be no need to meet a family deductible. My daughter was covered under an individual insurance plan through Humana (medical ID -------) and at no time between 11/3/2015 and 12/31/2015 was covered under an insurance plan with Kaiser Permanente. I have called Member Services on multiple occasions to address this issue and have seen no resolution, necessitating this formal appeal:

Desired Settlement: I would like Kaiser Permanente to pay in full the outstanding amount billed by Banner Health, which should have been covered under my individual insurance plan in the first place.

Business Response:

March 19, 2016

**** *******

Trade Practice Specialist

Denver/Boulder BBB

P.O. Box 48179

Denver, Colorado 80204

Complaint Case #                11193296

Consumer:                             ********* *********

Case Opened:                       March 9, 2016

Dear Ms. *******,

This is in response to your email received on March 10, 2016, forwarding concerns on behalf of our member, ********* ********, pertaining to her November 12, 2015 inaccurately processed claim.  We value the opportunity to review and respond to their grievance and apologize for the member’s dissatisfaction.

Ms. ******** case was already being worked within the Case Resolution Team. Therefore, I’ve opened a Second Review of the initial complaint and have followed through to ensure that the matter was resolved. Ms. ******** concerns were appropriately documented and shared with the Claims Department leadership and the disputed claim submitted for reprocessing due to the accumulation discrepancy expressed.

The member has probably already been advised by the Case Resolution Specialist (CSR) working her initial grievance, that the disputed 2015 claim was in fact reprocessed. Banner Health was consequentially paid for the November 3, 2015 date of service accordingly.

Please express my sincere apologies to Ms. ******** for any frustration and inconvenience that may have been caused by this overall matter. Should she have any remaining questions related to the claim situation, please encourage her to contact the CSR, per the contact information listed on the response letter provided.

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

2500 South Havana Street

Aurora, Colorado  80014

Written requests will be reviewed by Member Services Administration who will respond to you in writing within 14 calendar days of the receipt of the member’s request. We may extend this timeframe up to an additional 14 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 BBB or the member has any questions, please contact me at ***** ********.

Also, you may contact Member Services:

Denver/Boulder members may call ************, toll free at 1-800-632-9700, between 8 a.m. to 5 p.m., Monday through Friday.  Deaf, hard of hearing, or speech impaired members who use a TTY may call ************. 

Colorado Springs members please call 1-888-681-7878 or deaf, hard of hearing or speech-impaired members who use TTY may call 1-800-521-4874.  You may also contact our department through our Web site at kaiserpermanente.org.

Please thank our member for their understanding in this matter. We know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente.

Sincerely,

**** ** *****

Complex Case Resolution Specialist

Member Experience

Consumer Response:


Better Business Bureau:

I have reviewed the response made by the business in reference to complaint ID 11193296, and while I'm ultimately satisfied with the resolution, I am still very unhappy with the customer service I received throughout this entire process. Kaiser Permanente's response indicates that my case was in the process of being resolved when I filed this complaint with the BBB, that my "case was already being worked within the Case Resolution Team"; I would like to point out that before I filed a formal complaint I tried to work with the Member Services Representatives, who 1) kept telling me that a resolution would be reached within 30-45 days (this was 3 months or approximately 90 days after I initially requested the claim be reprocessed) 2) had absolutely no idea how their insurance coverage worked (telling me that I had not reached my out of pocket maximum) 3) told me that a supervisor would call me back, when in fact, I never was able to speak with a supervisor even after requesting two times. The fact of the matter is that I requested on at least five different occasions that this claim be reprocessed, and it was not until I asked to file a complaint about each and every Member Services Representative that I spoke with from 11/3/2015-3/8/2016 that my claim was even forwarded to the Case Resolution Team, this information is from one of the members of that team, who reported she only received my information after I made a complaint on 3/8/2016. I genuinely feel like Kaiser was stalling in order to avoid paying the claim; whether that is truthfully what they were doing is impossible to know, but as a consumer that is certainly how it appeared. 


I will say that once I filed multiple complaints, my situation was resolved rather quickly, and that I appreciate. 


Sincerely,
********* ********

3/7/2016 Billing/Collection Issues | Read Complaint Details
X

Additional Notes

Complaint: In June 2015, I gave birth to a baby. A perfectly normal labor & delivery, and perfectly normal child. Shortly after the baby was born, I added him to my family health insurance plan through Kaiser Permanente via Connect for Health Colorado. Everything went smoothly. I began paying the new premium July 2015. I hadn't received a new billing yet, but I figured the paperwork would all work itself out. On July 31, 2015, I took my older son, DS1 to the doctor because he had taken a spill on his scooter. The receptionist informed me my plan was cancelled on May 31, 2015. I had never received any notice of cancellation and had been paying all premiums. I spent the next hour in the doctor's office on the phone with Connect for Health CO as well as Kaiser Member Services trying to work it out. They finally let my son see the doctor, and assurances were made that the problem would be resolved. The billing issue took about 2 months to get all figured out, but eventually it was and I was happy. In early December 2015, I received a letter stating I owed additional premiums. For ease of explaining the situation, I have pasted the text of a letter that was sent via certified mail on January 11, 2016; it was signed for by **** ****** of Connect For Health Colorado on 1/15/16 and by * ****** of Kaiser Permanente on or around January 19, 2015 (He did not date the return receipt): To Whom it may concern: I am writing today to attempt to resolve some billing discrepancies on my account. On December 2, 2015, I received a billing statement reflecting an adjustment on my account in the amount of $909.41. This total reflects adjustments of $163.76 x 5 for the months of January 2015 through May 2015, and $90.61 for the month of June 2015. These are itemized as “Health Premium Charge due to Subsidy Adjustment” on the billing statement. However, I have never received any subsidy of my premium payments, in 2015 or any other year and have always paid the full “retail” price for health insurance premiums due to my family’s income level exceeding the limits for subsidization. On December 2, 2015, I contacted Kaiser Permanente Premium billing department, and discuss this bill with a representative. At that time, I explained that I felt the adjustments were actually due to Kaiser incorrectly billing me for my infant son’s, ****, insurance for these months. He was born on June *, 2015, and added to my policy after his birth. Kaiser is attempting to bill for his portion ($163.76) of our new total monthly premium ($1,016.95) for the months in which he had not yet been born, January –May 2015. The amount of the adjustment for June of $90.61 is a complete mystery to me. I had begun paying the new amount of $1,016.95 starting with July 2015 and had expected that there may be a partial month’s premium still due for June 2015; Kaiser had previously billed an adjustment of $110.83 in October 2015, which I presumed at the time to be a prorated amount for the month of June 2015 and has already been paid. The Kaiser representative referred me back to Connect for Health Colorado and stated that the issue arose with them. I contacted Connect for Health Colorado on December 2, 2015 and they issued me ticket #*****-***** for an investigation of this issue and assured me that it would be resolved. All told, I spent approximately 90 minutes of time on the phone with Kaiser and Connect for Health Colorado on December 2, 2015 in order to resolve this issue. On December 15, 2015, I received another statement from Kaiser stating that this adjustment amount was still outstanding on my account. I again called Kaiser, and spent approximately 60 minutes on the phone with a very helpful gentleman who researched the problem, and told me that the bill I had received was sent in error and that there was no outstanding balance on my account. On January 4, 2016 I received another billing statement from Kaiser. Yet again, the adjustment amount was still showing up as unpaid. I once again called Kaiser, and spoke with a woman markedly less pleasant with the man I spoke with on December 15. She left me on hold to “review all of the notes” for approximately 40 minutes. At that point, the call was disconnected on Kaiser’s side and I never did receive any call back from her. I did request a call back from the automated queue, but no return call was ever received. I have now received (3) billing statements from Kaiser for these incorrect charges, all of them informing me that non-payment may result in cancellation of my policy. I have spent over 3 hours on phone calls attempting to resolve the issue. I sincerely hope that this written correspondence does not continue to fall on deaf ears as my previous communications have and that this matter can be resolved once and for all. I respectfully request a written response that this issue is being resolved by Kaiser and/or Connect for Health Colorado as soon as possible. I have now received notification from Kaiser that my family's health insurance plan has been cancelled due to non-payment of this bogus premium charge, effective February 6, 2016. I have filed a grievance through their online system on February 14, 2016 that has not yet been responded to. According to Connect For Health CO, they have sent the information to Kaiser at least twice, on December 2, 2015 and again on January 21, 2016. My phone calls and written correspondence have had no effect on this incorrect billing, and now Kaiser has left my family in the precarious position of not having health insurance for the bulk of 2016. We have no ability to obtain other insurance because the open enrollment period has closed, and our income level is too high to qualify for Medicaid, CHP+, etc.

Desired Settlement: I would like for Kaiser to promptly re-instate my family's health insurance policy with no lapse in coverage, and resolve the billing discrepancy for the premiums being billed for DS2 health insurance for January-May 2015 because he had not yet been born.

Business Response:

March 1, 2016

**** *******

Trade Practice Specialist

Denver/Boulder BBB

P.O. Box 48179

Denver, Colorado 80204

Complaint Case #                11138497

Consumer:                             ****** ***********

Case Opened:                       February 16, 2016

Dear Ms. ********

This is in response to your email received on February 17, 2016, forwarding concerns on behalf of our member, ****** ***********, regarding incorrect 2016 plan termination and an effective date discrepancy for ****.  We value the opportunity to review and respond to her grievance and apologize for the member’s dissatisfaction.

We have formally documented and shared Mrs. ***********’s complaint details with the appropriate Consolidated Service Center/On-Exchange Issues Department leadership, to include the overseeing manager. I am very sorry for any frustration and concern that may have been caused by the member’s healthcare coverage issues experienced. The problems between Kaiser Permanente (KP), Connect for Health Colorado (C4), and our third party billing vendor (HPS) are known to executive leadership, and they are continuously being analyzed/worked on. Unfortunately, some of our members who purchased their coverage through C4, reported not having been advised of a possible termination until actually termed.

I submitted a case with the Member Issues Resolution Team (MIRT, as they specifically handle C4 plan issues by communicating with C4 and HPS accordingly. Ultimately, Mrs. *********** has been reinstated without a coverage break. Additonally, her dependent, ****, is now showing to be effective as of 6/8/2015. Again, I am sincerely apologetic for these problems that have occurred. Unfortunately, those member that deal with these types of plan problems, sometimes have other situations arise. The most efficient method in resolving such issues, is for the member to deal with only one person that is already aware of the details and capable of properly outreaching MIRT for the needed assistance. Please thank Mrs. *********** for being a valued KP member, and to please contact me directly with any additionally related questions.

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

2500 South Havana Street

Aurora, Colorado  80014

Written requests will be reviewed by Member Services Administration who will respond to you in writing within 14 calendar days of the receipt of the member’s request. We may extend this timeframe up to an additional 14 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 BBB or the member has any questions, please contact me at (303) 338-3073.

Also, you may contact Member Services:

Denver/Boulder members may call 303-338-3800, toll free at 1-800-632-9700, between 8 a.m. to 5 p.m., Monday through Friday.  Deaf, hard of hearing, or speech impaired members who use a TTY may call 303-338-3820. 

Colorado Springs members please call 1-888-681-7878 or deaf, hard of hearing or speech-impaired members who use TTY may call 1-800-521-4874.  You may also contact our department through our Web site at kaiserpermanente.org.

Please thank our member for their understanding in this matter. We know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente.

Sincerely,

**** ** *****

Complex Case Resolution Specialist

Member Experience


Business Response:

March 7, 2016

**** *******

Trade Practice Specialist

Denver/Boulder BBB

P.O. Box 48179

Denver, Colorado 80204

Complaint Case #                11138497

Consumer:                             ************ ****** 

Case Opened:                       March 2, 2016

Dear Ms. ********

This is in response to your email received on March 2, 2016, forwarding the rebuttal to our original response provided on March 1, 2016, on behalf of our member, ****** ***********. The member is requesting that her account balance discrepancies be completely resolved.

First of all, we truly do value the opportunity to review and respond to their grievance and apologize for the member’s dissatisfaction. Secondly, I am sincerely sorry for misunderstanding the actual member issue.

The Member Issues Resolution Team (MIRT) confirmed that both Kaiser Permanente’s (KP) Common Membership (CM), as well as our billing system (HPS) reflect ****** effective date and birthdate as 9/9/2016. HPS is currently reviewing the account and will be providing an account audit. Though expedited, the audit is expected to take approximately another week to complete. Once I receive the summary of payments due/paid, I will contact Ms. *********** via telephone to further discuss the details. This will allow us to find out where the problem lies with the incorrect outstanding balance she’s seeing online.

I sincerely apologize about the continued problems that the member is experiencing with her health plan account. I also am appreciative of her patience, as I realize that resolution has not been timely. Again, please offer Ms. *********** my direct phone number, should she choose to check on the status of her account audit. Otherwise, I will outreach immediately upon receipt.

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

2500 South Havana Street

Aurora, Colorado  80014

Written requests will be reviewed by Member Services Administration who will respond to you in writing within 14 calendar days of the receipt of the member’s request. We may extend this timeframe up to an additional 14 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 BBB or the member has any questions, please contact me at (303) 338-3073.

Also, you may contact Member Services:

Denver/Boulder members may call 303-338-3800, toll free at 1-800-632-9700, between 8 a.m. to 5 p.m., Monday through Friday.  Deaf, hard of hearing, or speech impaired members who use a TTY may call 303-338-3820. 

Colorado Springs members please call 1-888-681-7878 or deaf, hard of hearing or speech-impaired members who use TTY may call 1-800-521-4874.  You may also contact our department through our Web site at kaiserpermanente.org.

Please thank our member for their understanding in this matter. We know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente.

Sincerely,

**** ** *****

Complex Case Resolution Specialist

Member Experience

Consumer Response:


Complaint: 11138497

I am rejecting this response because:

Once my premium billing discrepancy is resolved, I will consider the matter closed. Please reference letter dated March 7, 2016.

 

Also, ****** birthdate is JUNE 9, 2015. It is not spelled ****, and he wasnt born on June 8 2015 (last letter) or September 9, 2016 (this letter).

 

Thanks, 


Sincerely,

****** ***********

3/7/2016 Billing/Collection Issues | Read Complaint Details
X

Additional Notes

Complaint: I added my pregnant wife to my insurance through the exchange on the 23rd of September, with a coverage start date of 10/01/15. For two months, Kaiser said they had no record of her addition to my account. Many conference calls with Kaiser and Connect for Health were made, and the needed info was resent to Kaiser on two occasions. In early December, after assurances from Kaiser that things would be fixed, my wife received a bill for uninsured prenatal services provided, and I received a bill saying I owed $3534.74, in addition to my regular payment, for “health premium charge due to subsidy adj”. After another call to Kaiser, I learned Kaiser entered the add date for my wife as 1/1/15, instead of 10/1/15, billing us for the entire year. They also incorrectly added her as my daughter. I had many conference calls with Connect for health and Kaiser, where Connect for health confirmed the correct information, and then Kaiser employees noted the problems, and had me pay the correct amount. On January 8th, Kaiser sent a letter saying they were terminating my contract as of July 31st because “we did not receive your premium payment on or before the end of your grace period”. Despite assurances that the issue would be corrected, nothing has happened. On January 12th, Kaiser sent a Health Insurance Certificate of Creditable Coverage that states coverage through July 31, 2015, which I'm guessing will trigger a tax penalty. So this needs to be corrected now too.

Desired Settlement: The billing issues need to be resolved before Kaiser decides to cancel my 2016 policy! Kaiser also needs to have a serious look at their interdepartmental communications, give their customer service reps the ability to actually resolve issues, and hire more personnel as they are incapable of dealing with anything in a reasonable timeframe.

Business Response:

February 13, 2016

**** *******

Dispute Resolution/Helpline Specialist

Denver/Boulder BBB

P.O. Box 48179

Denver, Colorado 80204

Complaint Case #              11110992

Consumer:                            ********* *******

Case Opened:                      January 28, 2016

Dear Ms. *******,

This is in response to your email received on January 29, 2016, forwarding concerns on behalf of our member, ******* ********, regarding continuing issues experienced with his Kaiser Permanente (KP) healthcare plan purchased from Connect for Health Colorado (C4).  We value the opportunity to review and respond to their grievance and apologize for the member’s dissatisfaction.

We have formally documented and shared Mr. ********** complaint details with the appropriate Consolidated Service Center/KPIF, On-Exchange Issues Department leadership, to include the overseeing Manager. I am very sorry for frustration caused to Mr. ******** and his wife, as a result of dealing with the same issues for such a lengthy period of time.

C4, KP, and HPS (our third party billing vendor), all 3 communicate member problems with their accounts by way of a posted case and review of the added notes by a representative of each party. For KP, the Member Issues Resolution Team (MIRT), is the case owner, and the Case Resolution Team (CRT) acts as the liaison between our members and MIRT to provide members with relevant information and case updates. I realize that the timeliness of resolving issues that pertain to healthcare plans purchased through C4, have NOT been ideal. For this, I am sincerely apologetic, as I understand the urgency of needing to settle issues affecting an individual’s healthcare insurance.

MIRT has unfortunately been greatly affected in its ability to resolve these cases quickly for 2 reasons. They are dealing around the clock with more cases than ever planned for or expected; new MIRT representatives continue to join the team in an attempt to resolve cases. Secondly, they must (via the posted case) outreach C4 to confirm any eligibility/benefit discrepancies, as KP is not able to change any information for plans purchased through C4 until advised to do so by them. Any monies issues are then communicated through HPS, as they are responsible for correctly updating the billing system. Though MIRT is able to ensure that KP’s system reflects eligibility, once confirming the information with C4, they are unable to personally change monetary figures. None of this is an excuse for Mr. ******** inconvenienced by our processes, but rather an explanation as to provide a clearer picture of the situation. Upper management is very aware of the excessive amount of problems that KP is currently attempting to assist members with, and will hopefully come up with an effective resolution, so that are members do not have to worry about persistent account discrepancies.

At this time, Mr. ******** reflects eligibility from 1/1/2015 through current, and his wife Anna Mudale from 10/1/2015 through current:

GROUP SGR RL ST EFF       END RS RGN PL TP EN C CARR

80001 015 AA AC 010116       999999                                NCXS

                  AA AC 010115       123115                               NCXS

427-4030-23 ********,********D   12201977 AA  010115

424-4030-29 **************           03151977 BB  100115

MIRT noted in the posted case on 2/4/2016 a detailed summary of the founded issues, which appear to have all stemmed from the incorrect addition of the member’s wife. Mr. ********** account was at one time changed to the 10/1/2015 effective date, and Mrs. ******** at one time changed to a 1/1/2015 effective date. MIRT is noted to having requested for HPS to adjust the erroneous premium charges from 1/1/2015 to 9/1/2015. This is confirmed to have been updated accordingly on 2/9/2016, though 2/11/2016 notes that a bill/invoice adjustment is still required; MIRT emailed HPS to update immediately.

I ask that Mr. ******** contact me directly for any related questions or concerns. Sometimes members that have experienced previous plan issues have additional ones arise, and I am able to view/communicate case updates/progress. In regards to any claims that processed for the member or his wife, please ask Mr. ******** to contact me if these have not been reprocessed.

Again, my apologies for the frustration and inconvenience caused to our member and his wife. I am available to personally further 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 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

2500 South Havana Street

Aurora, Colorado  80014

Written requests will be reviewed by Member Services Administration who will respond to you in writing within 14 calendar days of the receipt of the member’s request. We may extend this timeframe up to an additional 14 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 BBB or the member has any questions, please contact me at ***** ********.

Also, you may contact Member Services:

Denver/Boulder members may call ************, toll free at 1-800-632-9700, between 8 a.m. to 5 p.m., Monday through Friday.  Deaf, hard of hearing, or speech impaired members who use a TTY may call ************. 

Colorado Springs members please call 1-888-681-7878 or deaf, hard of hearing or speech-impaired members who use TTY may call 1-800-521-4874.  You may also contact our department through our Web site at kaiserpermanente.org.

Please thank our member for their understanding in this matter. We know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente.

Sincerely,

**** ** *****

Complex Case Resolution Specialist

Member Experience

Tell us why here...

Consumer Response:

 
Complaint: 11110992

I am rejecting this response because:

Most of the serious issues for my original complaint still exist. I will not accept an explanation of the circumstances that Kaiser finds itself in as a resolution to the issue. Given Kaiser's record in my case, every issue needs to be resolved before any acceptance occurs. The issues as I see them now:

1. I received a notice in the mail on Saturday, Feb 20th, and dated February 12, 2016, that says my coverage will be terminated if a payment of $3,636.87 isn't received by March 14th, 2016. I find myself right back where I was in December of 2015 with this issue. Kaiser has been aware of these erroneous charges for at least two months, has agreed, and said these incorrect charges would be removed promplty. Demanding payment for monies not owed, with the threat of termination, seems to be fraudulent to me at this point. This issue needs to be fixed immediately. This is my second written complaint for this issue.

2. My wife, ****, still has an active bill on her account for services rendered that do not reflect charges as per our policy. The guarantor Acct # is 1061328, and her health record number is 424403029. The amount total amount billed is $390.59. My estimate for services due should be equal to or less than $165.59. Any and all bills needs to be corrected to reflect our insured status in 2015 and 2016 immediately. 

3. Billing amounts and dates on my account do not reflect actual payments made, though the total is correct. Please correct this. 

4. My current bill on the kaiser site has a due date of 2017.

Thank you for your prompt attention, and resolution of these issues.

Sincerely,

******* ********

Business Response:

February 29, 2016

**** *******

Trade Practice Specialist

Denver/Boulder BBB

P.O. Box 48179

Denver, Colorado 80204

Complaint Case #               11110992

Consumer:                            ********* *******

Case Opened:                      February 22, 2016

Dear Ms. *******,

This is in response to your email received on February 22, 2016, forwarding the rebuttal to our original response provided on February 13, 2016, on behalf of our member, ******* ********. The member is requesting that his health plan premium account discrepancies, invoice errors, and wife’s inaccurate service charges be fixed.

We value the opportunity to review and respond to their grievance and apologize for the member’s dissatisfaction.

Being that Mr. ********** Kaiser Permanente (KP) health coverage was purchased through Connect for Health Colorado, all billing must go through our third party vendor (HPS). I assure you that Mr. ********** coverage was correctly reinstated, and the remaining technical issues have been forward to HPS, as to ensure that the account numbers and mailed invoices reflect accurately. KP has this request escalated to HPS. The Member Issues Resolution Team (MIRT) continues to follow the case progress and provide me with updates. I am very sorry that the remaining issues have not being resolved in a timelier manner, and this is a known issue diligently being analyzed by KP leadership.

I submitted for a full 2015 account audit for ******* ******** and **** *******. I was advised that there are not any overages found on the account; please see the attached account audit for more details.

I would be more than happy to personally follow through with Mr. ******** until the account issues are satisfactorily resolved, and he is receiving accurate invoice statements. I am also able to provide Patient Financial Services (PFS) or Claims Department phone numbers, should further assistance be needed with bills. Again, my sincere apologies for any frustration caused to Mr. ********, and I do hope that he will choose to contact me directly for his health plan questions/concerns moving forward.

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

2500 South Havana Street

Aurora, Colorado  80014

Written requests will be reviewed by Member Services Administration who will respond to you in writing within 14 calendar days of the receipt of the member’s request. We may extend this timeframe up to an additional 14 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 BBB or the member has any questions, please contact me at ***** ********.

Also, you may contact Member Services:

Denver/Boulder members may call ************, toll free at 1-800-632-9700, between 8 a.m. to 5 p.m., Monday through Friday.  Deaf, hard of hearing, or speech impaired members who use a TTY may call ************. 

Colorado Springs members please call 1-888-681-7878 or deaf, hard of hearing or speech-impaired members who use TTY may call 1-800-521-4874.  You may also contact our department through our Web site at kaiserpermanente.org.

Please thank our member for their understanding in this matter. We know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente.

Sincerely,

**** ** *****

Complex Case Resolution Specialist

Member Experience

3/2/2016 Billing/Collection Issues | Read Complaint Details
X

Additional Notes

Complaint: I have been trying to resolve a billing issue since May 2014. In May 2014, my daughter was born and Kaiser billed some of her care toward a family deductible. However, my daughter was NEVER added to my plan (she went on a plan through her father within 30 days of birth), so the charges should apply to my individual deductible. In Jan. 2015, I received a letter and spoke with a Kaiser representative, both of which noted the issue and indicated that it was resolved. In October 2015, I suddenly started receiving bills again for the exact same charges. I have been calling and following up diligently and the issue is still not resolved. Billing has let me know that I will be sent to collections. Again, a representative from Member Services (Angelica) has described the exact same mistake that was noted previously, but the correction has not been communicated to billing.

Desired Settlement: I would like Kaiser to simply correct the error in their system, which Member Services has acknowledged, so that Billing stops billing me and the charges are removed.

Business Response:

February 28, 2016

* **** *******

Trade Practice Specialist

Denver/Boulder BBB

P.O. Box 48179

Denver, Colorado 80204

Complaint Case #                11137943

Consumer:                             ***** *****

Case Opened:                       February 15, 2016

Dear Ms. ********

This is in response to your email received on February 17, 2016, forwarding concerns on behalf of our member, ***** ****, regarding lingering claim discrepancies.  We value the opportunity to review and respond to their grievance and apologize for the member’s dissatisfaction.

We have formally documented and shared Ms. ****** concerns with the appropriate Claims Department leadership, to include the Supervisor. Please apologize to the member, on behalf of Kaiser Permanente (KP), for any frustration caused by previously requesting assistance, yet never having the issues satisfactorily resolved.

I also submitted for an account audit from 2012 through current, which I have attached to the BBB case for Ms. ****. Each year benefits are summarized, and 10 claims were reprocessed, as to go toward the Individual Deductible/OPM, rather than the Family Deductible/OPM.

Should Ms. **** have any remaining account questions, please ask her to contact the Claims Department, as they will be able to assist with audit clarifications, specific claim inquiries, and requests to have any claim Explanation of Benefits (EOB) mailed. Please thank Ms. **** for her patience with this overall matter, as I realize that she has been waiting for requested claim assistance and information for some time now. I am also available, should the member like to contact me directly.

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

2500 South Havana Street

Aurora, Colorado  80014

Written requests will be reviewed by Member Services Administration who will respond to you in writing within 14 calendar days of the receipt of the member’s request. We may extend this timeframe up to an additional 14 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 BBB or the member has any questions, please contact me at ***** *********

Also, you may contact Member Services:

Denver/Boulder members may call ************, toll free at 1-800-632-9700, between 8 a.m. to 5 p.m., Monday through Friday.  Deaf, hard of hearing, or speech impaired members who use a TTY may call ************. 

Colorado Springs members please call 1-888-681-7878 or deaf, hard of hearing or speech-impaired members who use TTY may call 1-800-521-4874.  You may also contact our department through our Web site at kaiserpermanente.org.

Please thank our member for their understanding in this matter. We know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente.

Sincerely,

**** ** *****

Complex Case Resolution Specialist

Member Experience


Consumer Response:  
Better Business Bureau:

I have reviewed the response made by the business in reference to complaint ID 11137943, and find that this resolution is satisfactory to me.

Sincerely,

***** ****

 

2/26/2016 Problems with Product/Service | Read Complaint Details
X

Additional Notes

Complaint: On October 7, 2015 I cancelled a new account and requested a refund. I never received coverage, an account or any other services. It is now February 2, 2015 and I have not received the refund. Every time I call, it takes at least an hour for them to either not be able to find my record, or if they do, they tell me to "give it some more time to process".

Desired Settlement: I would like my refund immediately.

Business Response:

February 18, 2016

**** *******

Dispute Resolution/Helpline Specialist

Denver/Boulder BBB

P.O. Box 48179

Denver, Colorado 80204

Complaint Case #               11118025

Consumer:                            ********* ******* **

Case Opened:                      February 2, 2016

Dear Ms. *******,

This is in response to your email received on February 3, 2016, forwarding concerns on behalf of, ******* ********, regarding an awaited refund of premium overpayment in 2015. We value the opportunity to review and respond to their grievance and apologize for the member’s dissatisfaction.

Appropriate Consolidated Service Center/On-Exchange Issues Department leadership, to include the Manager, has been notified of Ms. ********** continued issue in not receiving her requested refund. Please apologize to Ms. ******** for the inconvenience caused and lack of resolution timeliness.

On February 3, 2016, I reviewed the account and opened a case with our Member Issues Resolution Team (MIRT). MIRT specifically handles issues relating to plans purchased through Connect for Health Colorado (C4). MIRT communicates accordingly with C4 and our third party billing vendor, SLP, in an attempt to solve member experienced problems. In this scenario, MIRT submitted the refund to SLP on the same date that the case was opened. Up until today, there was not an update provided as to where the refund stands in the entire refund process. Just today, MIRT was able to confirm the following information:

-MIRT had initially requested a $652.98 refund from C4, which was denied on 11/14/2015 (C4 needed more information).

-Per my outreach, MIRT again verified the refund amount due and submitted the request to C4.

-The refund was approved, and a $652.98 check is now in line to be issued and   mailed to the member

I realize that it is quite frustrating for the member to have to wait so long for monies to be returned to her. Unfortunately, more issues with On-Exchange purchased plans have presented than ever expected or planned for. This is absolutely not the problem of Ms. ********, nor should it affect her as it has. KP, C4, and SLP management continues to work through the trending issues, as well as with bettering their communication process, which is currently slowing down the reaching of satisfactory resolution for our members.

Please assure the member that her refund has been submitted and approved. I am also able to personally assist with reaching out for updates, should she like to contact me directly. Please thank Ms. ******** for her appreciated patience, and I will be following through with this case until her refund is 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

Member Services

2500 South Havana Street

Aurora, Colorado  80014

Written requests will be reviewed by Member Services Administration who will respond to you in writing within 14 calendar days of the receipt of the member’s request. We may extend this timeframe up to an additional 14 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 BBB or the member has any questions, please contact me at ***** ********.

Also, you may contact Member Services:

Denver/Boulder members may call ************, toll free at 1-800-632-9700, between 8 a.m. to 5 p.m., Monday through Friday.  Deaf, hard of hearing, or speech impaired members who use a TTY may call ************. 

Colorado Springs members please call 1-888-681-7878 or deaf, hard of hearing or speech-impaired members who use TTY may call 1-800-521-4874.  You may also contact our department through our Web site at kaiserpermanente.org.

Please thank our member for their understanding in this matter. We know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente.

Sincerely,

**** ** *****

Complex Case Resolution Specialist

Member Experience

2/25/2016 Problems with Product/Service | Read Complaint Details
X

Additional Notes

Complaint: I have made several request to obtain a copy of my 2016 Evidence of Coverage. Kaiser has not made this available on their website up to this current point in time. When I have called Member Services they indicated they would send the 2016 EOC through the mail. I have since received 1 copy of my 2015 EOC. By denying me access to my current EOC they are indirectly denying me affordable access to a vital medication I have been taking for 7 plus years. My complaint is solely about not having access to this documentation that would allow me to obtain my prescribed medication at an affordable cost. I use this medication for a chronic condition. When I do not take said medication my quality of life is diminished greatly.

Desired Settlement: I would prefer an electronic copy of my 2016 EOC so that I may work on obtaining my medication as soon as possible. I would settle and be happy with a hard copy, mailed to my home address. I just want to be able to purchase my vital medication.

Business Response:

February 12, 2016

**** *******

Dispute/Helpline Specialist

Denver/Boulder BBB

P.O. Box 48179

Denver, Colorado 80204

Complaint Case #                11133083

Consumer:                             ********** ******

Case Opened:                       February 11, 2016

Dear Ms. ********

This is in response to your email received on February 12, 2016, forwarding concerns on behalf of our member, ****** *********, regarding documents which he has been trying to retrieve from Kaiser Permanente (KP).  We value the opportunity to review and respond to their grievance and apologize for the member’s dissatisfaction.

We have formally documented and shared *********** concerns with the appropriate Member Services Contact Center (MSCC) Department leadership. I reviewed the January 20, 2016 call documentation, and was able to confirm that the MSCC representative intended to mail him his 2016 Evidence of Coverage (EOC) packet. Please apologize to the member for inconveniently being mailed the 2015 EOC. Today, February 12, 2016, I did personally print/mail Mr. ********* his requested 2016 EOC. Should he not received the packet within a week, he is welcome to contact me directly for follow through.

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

2500 South Havana Street

Aurora, Colorado  80014

Written requests will be reviewed by Member Services Administration who will respond to you in writing within 14 calendar days of the receipt of the member’s request. We may extend this timeframe up to an additional 14 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 BBB or the member has any questions, please contact me at ***** *********

Also, you may contact Member Services:

Denver/Boulder members may call ************, toll free at 1-800-632-9700, between 8 a.m. to 5 p.m., Monday through Friday.  Deaf, hard of hearing, or speech impaired members who use a TTY may call ************* 

Colorado Springs members please call 1-888-681-7878 or deaf, hard of hearing or speech-impaired members who use TTY may call 1-800-521-4874.  You may also contact our department through our Web site at kaiserpermanente.org.

Please thank our member for their understanding in this matter. We know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente.

Sincerely,

**** ** ***** Complex Case Resolution Specialist

Member Experience

2/25/2016 Problems with Product/Service | Read Complaint Details
X

Additional Notes

Complaint: For an unknown reason my coverage via Connect For Health with Kaiser Colorado was cancelled retro dated 12/31/15. To date, Kaiser has $1,500 of funds to pay for coverage starting on 01/01/16 - Current. Upon contacting Kaiser, I have been told that they are unsure as to why my coverage was cancelled. I have attempted to contact Connect for Health customer service (1-855-752-6749) multiple times to resolve this issue without any resolution. I have been hung up on, told to wait two weeks for it to correct itself from a system issue. I have waited, called and asked for updates, and still no resolution. The coverage has been paid for, the Connect for Health website shows I have coverage; however, Kaiser does not have this information, is holding my funds, has cancelled my coverage, and is unwilling to provide immediate resolution. Upon my most recent call, I was advised to wait another 15-day for them to research. I find this completely unacceptable.

Desired Settlement: Find out why my policy was terminated, correct my policy and apply the paid funds to my agreed coverage via Connect for Health within a timely manner. Provide an explanation as to what happen and how it is being avoided / corrected in the future.

Business Response:

February 23, 2016

**** *******

Trade Practice Specialist

Denver/Boulder BBB

P.O. Box 48179

Denver, Colorado 80204

Complaint Case #               11129150

Consumer:                            ******* *******

Case Opened:                      February 9, 2016

**** *** ********

This is in response to your email received on February 10, 2016, forwarding concerns on behalf of our member, ******* ******, regarding the termination of his paid 2016 Kaiser Permanente (KP) healthcare plan purchased through Connect for Health Colorado (C4). We value the opportunity to review and respond to this grievance and apologize for the member’s dissatisfaction.

We have formally documented and shared Mr. ******** concerns with the appropriate Consolidated Service Center/On-Exchange Issues Department leadership team, to include the overseeing manager. I am very sorry for any frustration that has been caused to Mr. ****** by this overall matter, as well as for the time awaited for the enrollment issue to be resolved.

C4, KP, and HPS (our third party billing vendor), all 3 communicate member problems with their accounts by way of a posted case and review of the added notes by a representative of each party. For KP, the Member Issues Resolution Team (MIRT), is the case owner, and the Case Resolution Team (CRT) acts as the liaison between our members and MIRT to provide members with relevant information and case updates. I realize that the timeliness of resolving issues that pertain to healthcare plans purchased through C4, have NOT been ideal. For this, I am sincerely apologetic, as I understand the urgency of needing to settle issues affecting an individual’s healthcare insurance. 

MIRT has unfortunately been greatly affected in its ability to resolve these cases quickly for 2 reasons. They are dealing around the clock with more cases than ever planned for or expected; new MIRT representatives continue to join the team in an attempt to resolve cases. Secondly, they must (via the posted case) outreach C4 to confirm any eligibility/benefit discrepancies, as KP is not able to change any information for plans purchased through C4 until advised to do so by them. Any monies issues are then communicated through HPS, as they are responsible for correctly updating the billing system. Though MIRT is able to ensure that KP’s system reflects eligibility, once confirming the information with C4, they are unable to personally change monetary figures. None of this is an excuse for Mr. ****** being inconvenienced by our processes, but rather an explanation as to provide a clearer picture of the situation. Upper management is very aware of the excessive amount of problems that KP is currently attempting to assist members with, and will hopefully come up with an effective resolution, so that our members do not have to worry about persistent account discrepancies.

MIRT reviewed Mr. ******** 2015 and 2016 account and provided the following summarized audit:

Premiums due:

August – December 2015: $712.42 x 5 = $1,451.88 + CO Assessment Fee October – December $3.75, TOTAL is $1,455.63

January – March 2016: $483.96 x 3 = $3,562.10 + CO Assessment Fee January – March $5.40, TOTAL is $3,567.50

TOTAL due for 2015 & 2016: $5,023.13 (after below listed adjustments are made)

TOTAL paid by member for 2015 & 2016: $4,439.97 (after below listed adjustments are made)

Balance due: $583.16

Next necessary steps include:

  1. Change 2015 effective date from 9/1/2015 to 8/1/2015, as systems do not match.

  2. Balance forward a payment that did not transfer from previous billing vendor (Conexis) to current billing vendor (HPS).

  3. Reinstate member for 2016 plan immediately

*CASE HAS BEEN SUBMITTED AS URGENT*

I ask that Mr. ****** contact me directly for the case updates as often as he would like, until ultimately and satisfactorily resolved. Again, my apologies for the frustration and inconvenience caused to our member, and I am diligently following up with checking the status of this case daily.

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

2500 South Havana Street

Aurora, Colorado  80014

Written requests will be reviewed by Member Services Administration who will respond to you in writing within 14 calendar days of the receipt of the member’s request. We may extend this timeframe up to an additional 14 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 BBB or the member has any questions, please contact me at ***** ********.

Also, you may contact Member Services:

Denver/Boulder members may call ************, toll free at 1-800-632-9700, between 8 a.m. to 5 p.m., Monday through Friday.  Deaf, hard of hearing, or speech impaired members who use a TTY may call ************. 

Colorado Springs members please call 1-888-681-7878 or deaf, hard of hearing or speech-impaired members who use TTY may call 1-800-521-4874.  You may also contact our department through our Web site at kaiserpermanente.org.

Please thank our member for their understanding in this matter. We know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente.

Sincerely,

**** ** *****

Complex Case Resolution Specialist

Member Experience

Consumer Response:
Better Business Bureau:

I have reviewed the response made by the business in reference to complaint ID 11129150, and find that this resolution is satisfactory to me; pending follow up on the actions outlined by Ms. Brown with Kaiser.

Sincerely,

******* ******

 

2/17/2016 Billing/Collection Issues | Read Complaint Details
X

Additional Notes

Complaint: I have a long history of dealing with Kaiser billing for my daughter's health insurance. I paid her premium since she signed up on the exchange two years ago. After helping her sign up for a plan we quickly realized that it was not going to work for her and upgraded her plan from a bronze to a silver plan. What happened though is that Kaiser took her off the bronze plan but never enrolled her in the silver plan. This went on for about 4 months, while they automatically debited my checking account for the premium payment. When I finally corrected the situation they took out more money out of my account for the difference in the premium retroactive to the first of the year. Even though technically she had no health insurance for most of those months at all. Then they sent me a notice that they were taking out even more money out of my account. I called to figure out what was going on. They could not explain to me what had not been paid. They actually while I was on the phone came up with several different numbers of what I owed. I de-enrolled in the automatic debit and mailed the premium payment from then on. My daughter and I made a complaint to the company. We never heard ANYTHING. This was a year and a half ago. Recently, I spent another ungodly length of time on the phone with someone who finally explained to me that there was a month missing from back in early 2014 that wasn't paid and there was a small amount of money that I owed for an increase in premium that I didn't know about in January 2015. But they also had not any record of checks I had sent over the summer even though they had been cashed by my bank and they had de-enrolled my daughter as of November of 2015. I faxed verification of the money that Kaiser had actually cashed and they re-enrolled her. As of the first of this year, my daughter's employer is helping her with the premium. My daughter has sent Kaiser checks. They have de-enrolled her again last week because supposedly she owes $1000.00.

Desired Settlement: I have told Kaiser that I am willing to make up the difference in premium payments that happened in early 2015 when I was not aware of the premium increase, but I am not willing to pay them money that they say I owed back in 2014. They took money out of my account when there were no services provided. They had every opportunity in 2014 to explain to me what was owed and they still can't reconcile the amounts taken from my account during this time. They need to make this right and re-enroll

Business Response:

February 8, 2016

**** *******

Trade Practice Specialist

Denver/Boulder BBB

P.O. Box 48179

Denver, Colorado 80204

Complaint Case #               11126608

Consumer:                            ********* ********* **

Case Opened:                      February 8, 2016

Dear Ms. *******,

This is in response to your email received on February 8, 2016, forwarding concerns on behalf of ********* ******** and continued account issues experienced with her daughter’s health insurance plan.  We value the opportunity to review and respond to their grievance and apologize for the member’s dissatisfaction.

I am unable to locate a Kaiser Permanente (KP) Colorado Health Plan under the name of ********* ******** in our KP system or in the system of plans purchased through Connect for Health Colorado (C4). My assumption is that the member is Ms. ********** daughter as the subscriber, though this must be confirmed and additional information provided, before I’m capable of reviewing the matter. Please ask Ms. ******** to contact me directly for further discussion. The case details needed are as follows and can left on my voicemail, if I’m not able to answer:

  1. Name of subscriber

  2. MRN if available

  3. Member address

  4. Confirmation that the requested resolution is to have the account monies reconciled and be re-enrolled?

     

    -Please advise as to the date re-enrollment is requested for

    -Also, please keep in mind, that premiums are not refundable, and I will not be able to waive any part of the premiums for months of coverage.

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

2500 South Havana Street

Aurora, Colorado  80014

Written requests will be reviewed by Member Services Administration who will respond to you in writing within 14 calendar days of the receipt of the member’s request. We may extend this timeframe up to an additional 14 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 BBB or the member has any questions, please contact me at (303) 338-3073.

Also, you may contact Member Services:

Denver/Boulder members may call 303-338-3800, toll free at 1-800-632-9700, between 8 a.m. to 5 p.m., Monday through Friday.  Deaf, hard of hearing, or speech impaired members who use a TTY may call 303-338-3820. 

Colorado Springs members please call 1-888-681-7878 or deaf, hard of hearing or speech-impaired members who use TTY may call 1-800-521-4874.  You may also contact our department through our Web site at kaiserpermanente.org.

Please thank our member for their understanding in this matter. We know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente.

Sincerely,

**** ** *****

Complex Case Resolution Specialist

Member Experience

1/28/2016 Problems with Product/Service | Read Complaint Details
X

Additional Notes

Complaint: I do volunteer work for the Denver Dumb Friends League and on 08-06-2015 I was bitten by a cat. I contacted the Kaiser appointment center. They in turn contacted my doctors office at the Aurora Centrepoint location. A nurse contacted my by phone and prescribed Augmentin (an antibiotic) which I picked up that same day at the Aurora Centrepoint pharmacy. The cost was $20.00. The insurance carrier for the Dumb Friends League will reinburse me for any out of pocket medical expenses I incur while volunteering. I obtained a form from the Dumb Friends League to fill out and submit to their insurance carrier which is Hartford Life and Accident Insurance Company. I phoned Kaiser Member Services because I needed a receipt for the prescription. They advised me to got the the Aurora Centerpoint pharmacy and they could print me out a screen shot from their computer. I submitted this to the Hartford. At the end of Oct my claim was denied. the letter said "We have received the pharmacy receipt and printout submitted but are in need of a diagnosis code." At that point I phoned member services a total of 15 times until this past week. I was promised callbacks and mailed receipts which I never got. They instructed me to go in person to Centerpoint which I did a total of 5 times. Each time I went the person I spoke with did not know how to resolve my problem. I asked to speak with a supervisor on many of these calls I made, but was never permitted to speak with one. All I want is reimbersement for my prescription.

Desired Settlement: I would like Kaiser to supply me with the their insurance billing (CMS1500 with diagnosis and CPT codes and corresponding Primary Explanation of Benefits) so that Hartford can process my claim

Business Response:

January 22, 2016

**** *******

Trade Practice Specialist

Denver/Boulder BBB

P.O. Box 48179

Denver, Colorado 80204

Complaint Case #                11080653

Consumer:                             ***** *******  

Case Opened:                       January 9, 2016

Dear Ms. *******,

This is in response to your email received on January 12, 2016, forwarding concerns on behalf of our member, ******* ****. The member’s issue is regarding Kaiser Permanente assistance needed for prescription medication reimbursement from an outside insurance carrier for the date of August 6, 2015. We value the opportunity to review and respond to their grievance and apologize for the member’s dissatisfaction.

Ms. *****s initial grievance was filed within the Case Resolution Department on December 8, 2015. Please apologize to the member that the response received from the Case Resolution Specialist (CRS) was not within our timely 30 day fashion.

The member’s grievance details have been appropriately documented and shared with the Aurora Centrepoint Pharmacy leadership. The CRS did not receive the emailed assistance requested, and I’m very sorry for the inconvenience that the wait has ultimately caused Ms. ****. The Pharmacy Supervisor has advised that the receipt copy for the medication provided should suffice as payment proof needed for reimbursement by the insurance carrier. The CRS, ******* *********, left the member a telephone message with explanation on January 15, 2016, and mailed a response letter with the prescription medication receipt copy enclosed. Per the member’s BBB request, the following information is being provided pertaining to the August 6, 2015 date, in which she had called and spoken with an AACC Advice Nurse:

Diagnoses

CAUSE OF INJURY, CAT BITE, INIT - Primary

ICD-9-CM:
E906.3
ICD-10-CM:
W55.01XA

Should Ms. **** be additionally in need of any further information, please ask her to contact me directly.

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

2500 South Havana Street

Aurora, Colorado  80014

Written requests will be reviewed by Member Services Administration who will respond to you in writing within 14 calendar days of the receipt of the member’s request. We may extend this timeframe up to an additional 14 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 BBB or the member has any questions, please contact me at ***** ********.

Also, you may contact Member Services:

Denver/Boulder members may call ************, toll free at 1-800-632-9700, between 8 a.m. to 5 p.m., Monday through Friday.  Deaf, hard of hearing, or speech impaired members who use a TTY may call ************. 

Colorado Springs members please call 1-888-681-7878 or deaf, hard of hearing or speech-impaired members who use TTY may call 1-800-521-4874.  You may also contact our department through our Web site at kaiserpermanente.org.

Please thank our member for their understanding in this matter. We know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente.

Sincerely,

**** ** *****

Complex Case Resolution Specialist

Member Experience

Consumer Response:

 
Complaint: 11080653

I am rejecting this response because:

      I did receive the prescription receipt from Kaiser Permanente, however the claim filed with the Hartford was denied because they require a diagnosis code as well as the name of the provider.  I have mailed Kaiser a copy of the denial from The Hartford along with a request for further assistance.
Sincerely,

******* ****

1/28/2016 Problems with Product/Service | Read Complaint Details
X

Additional Notes

Complaint: I've been trying to cancel my policy since october. I've been on the phone with them for many hours. Unfortunately I'm always transferred to other people. It seems they do have some kind of note indicating my request dating back to October however I'm unable to get records of this from them. I have resorted to blocking their charges on my credit card, However the policy is still active. I have other insurance and have lived out of state since October. It seems that there is no way to get this policy canceled. I submitted the cancellation form with the information requested via fax and regular post mail. There's no way to cancel policy online. I've dealt with two individuals directly whom I have their full name. They are **** ********** and ******** *******. Neither has actually resolved the issue. I just wanted them out of my life however it seems impossible. They claim to have tried contacting me. I have zero emails from them. I also zero voicemails from them. Both my email and voice mail accounts receive regular traffic from all kinds of sources. I don't know what to do. I've filed multiple formal grievances using their process here is one: grievance number S 194 071 344. I've also reached out via phone email Facebook and twitter.

Desired Settlement: All I want is for them to cancel my policy, and to have an email record of the correspondence as I am unable to get a good record that can be cited using other methods. It's the 21st Century sending an email shouldn't be that hard.

Business Response:

January 26, 2016

BBB

Denver/Boulder BBB

P.O. Box 48179

Denver, Colorado 80204

Complaint Case #                11083952

Consumer:                             ********* *** **

Case Opened:                       January 12, 2016

Good morning,

This is in response to your email received on January 13, 2016, forwarding concerns on behalf of our member ******** ********, regarding the termination failure of his KPIF/Off-Exchange healthcare plan.  We value the opportunity to review and respond to their grievance and apologize for the member’s dissatisfaction.

We have formally documented and Mr. ********’s complaint details with the appropriate Consolidated Service Center/KPIF Membership Administration Department, to include the overseeing Manager. My sincere apologies for the frustration Mr. ******** has expressed pertaining to the matter.

The Membership Administration Department has agreed to retro the health plan cancelation to reflect December 31, 2015. I realize that the member is seeking a cancelation date of October 31, 2015, as he has been attempting to cancel for some time now. Though we are unable to locate any previously submitted cancelation forms, the member has explained to me that he did in fact fax them to the number that a Kaiser Permanente employee had provided him with. I am currently in the process of reviewing calls between the member and the Member Service Contact Center, as well as with the Membership Administration Department. Should I find any misinformation provided, I will submit the retro date change request according to the information he was given and contact him immediately. Again, I am very sorry for this inconvenience, and Mr. ********’s is encouraged to contact me with any additionally related questions.

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

2500 South Havana Street

Aurora, Colorado  80014

Written requests will be reviewed by Member Services Administration who will respond to you in writing within 14 calendar days of the receipt of the member’s request. We may extend this timeframe up to an additional 14 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 BBB or the member has any questions, please contact me at (**** ********.

Also, you may contact Member Services:

Denver/Boulder members may call ************, toll free at 1-800-632-9700, between 8 a.m. to 5 p.m., Monday through Friday.  Deaf, hard of hearing, or speech impaired members who use a TTY may call ************. 

Colorado Springs members please call 1-888-681-7878 or deaf, hard of hearing or speech-impaired members who use TTY may call 1-800-521-4874.  You may also contact our department through our Web site at kaiserpermanente.org.

Please thank our member for their understanding in this matter. We know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente.

Sincerely,

**** ** *****

Complex Case Resolution Specialist

Member Experience

Consumer Response:  
Better Business Bureau:

I have reviewed the response made by the business in reference to complaint ID 11083952, am waiting to hear back regarding their review of the call records

Sincerely,

*** ********

1/14/2016 Advertising/Sales Issues | Read Complaint Details
X

Additional Notes

Complaint: Kaiser has a 90 day grace period on policy I have NEVER reached 90 days yet they cancelled my policy 8 days before a big surgery When I started with Kaiser in 2014 I had a ton of problems getting it started as a result when it got corrected I was 30 days behind on my payment. Being a single earner for a family of 4 that put me in a very bad spot. I continued to make payments every single month (leaving me 30 days behind) I have records that show I made payments every single month. Kaiser approved a big surgery for my husband 10/7/2015 & 10/8/2015 we found out Dec 22,2015 that the policy had been cancelled back to 9/30. We didn't receive any calls or notification regarding this. They continue to tell me that a letter dated for 11/12/2015 says I had to pay $582.40 by 11/30 otherwise it would be cancelled. HOWEVER I never got the letter they wont provide me with a copy AND they admit that they had a payment posted to their account 11/10/2015 for $291 that was NOT included on the letter. if they had included that payment I would have owed $291 (1 month payment)they admit the payment was included they also admit it doesn't appear I was every 90 days behind. I have been told it will corrected and I have been told it wont be corrected - The policy clearly states a 90 day grace period in which I have never reached that 90 days! this will financially devastate our family as we now owe $100K in medical bills when we made our premium payments every single month. This policy needs to be reinstated - Kaiser also admits that the policy says its paid through 10/30 yet it cancelled 9/30? I have been making premium payments to the company in which they have been holding - I need help with this ASAP!

Desired Settlement: my policy to be reinstated and corrected this error is causing our family financial hardship and preventing my husband from continuing the care that he desperately needs.

Business Response:

January 12, 2016

**** *******

Dispute Resolution & Helpline Specialist

Denver/Boulder BBB

**** *** *****

Denver, Colorado 80204

Complaint Case #               ********

Consumer:                            ****** ********

Case Opened:                      December 23, 2015

Dear Ms. *******,

This is in response to your email received on December 24, 2015, forwarding concerns on behalf of our member, ****** ********, regarding the termination of her Kaiser Permanente (KP) healthcare plan purchased from Connect for Health Colorado (C4).  We value the opportunity to review and respond to their grievance and apologize for the member’s dissatisfaction. Additionally, I have noted that a case response was emailed to the BBB on January 6, 2016, though I am unable to locate it as being attached. I am very sorry for the inconvenience of awaiting information about this issue.

The Case Resolution Team has formally documented and shared Ms. ********’s concerns with the appropriate leaders at the Consolidated Service Center/KPIF Plans purchased via C4; notification includes the Operations Manager. Please sincerely apologize to the member for the frustration experienced with this matter thus far.

Coverage has been reinstated from the date of January 1, 2015 through current. The premium payment breakdown is as follows:

06/01/2014 - 12/31/2014, $163.23 x 7mos = $1,142.61

01/01/2015 - 12/31/2015, $290.95 x 12mos = $3,491.40

2014/2015 Total Premium: $4,634.01 Member Actual Paid: $4,052.61

Member Balance Due for 2015: $581.40

Member Balance Due for 2016: $180.44

Member Grand Total Due: $761.84

Payment can either be mailed or called in to:

Kaiser Foundation Health Plan, Inc.

** *** *****

City of Industry, CA **********

************

Now that coverage is reflecting accurately, I have submitted for an audit of claims during the cancelled time frame of October 1, 2015 through the end of 2015. As I am not able to provide an explanation as to why this cancellation occurred without the member receiving any mailed information, I assure you that such issues are being addressed accordingly between KP, C4, and our third party billing vendor. The member’s patience throughout has been much appreciated, as she is a valued KP member. The Explanation of Benefits (EOB) for any reprocessed claims will be mailed to the member’s home. Should any further questions arise for Ms. ********, please ask her to contact me, as I will gladly be her direct contact for any future plan issues.

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

**** ***** ****** ******

Aurora, Colorado  *****

Written requests will be reviewed by Member Services Administration who will respond to you in writing within 14 calendar days of the receipt of the member’s request. We may extend this timeframe up to an additional 14 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 BBB or the member has any questions, please contact me at ***** *********

Also, you may contact Member Services:

Denver/Boulder members may call ************, toll free at 1-800-********, between 8 a.m. to 5 p.m., Monday through Friday.  Deaf, hard of hearing, or speech impaired members who use a TTY may call ************. 

Colorado Springs members please call 1-888-******** or deaf, hard of hearing or speech-impaired members who use TTY may call 1-800-********.  You may also contact our department through our Web site at kaiserpermanente.org.

Please thank our member for their understanding in this matter. We know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente.

Sincerely,

**** ** *****

Complex Case Resolution Specialist

Member Experience

Consumer Response:


Better Business Bureau:

I have reviewed the response made by the business in reference to complaint ID ********* and find that this resolution is satisfactory to me. I do however have a couple additional questions. I have left a message for ****.

 

thank you

Sincerely,

****** ********

1/11/2016 Advertising/Sales Issues | Read Complaint Details
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Additional Notes

Complaint: Enrolled in new health insurance with said company. Company charged ten times the amount way before payment was due without notice. My previous health insurance company was shut down by the government, forcing me to apply for new coverage. I used connectforhealthco.com to enroll in new state benefits to help me provide personal health insurance. Became enrolled with Kaiser Permanente (KP) where the state pays a credit and I only pay about $41.12 after a total premium of $228.48. I was charged unknowingly and without notice by KP on December 15th, 2015, in the amount of $458.76. I had not noticed until today (December 18th, 2015) when trying to buy Christmas gifts for my family and friends. I had called and spoken with an employee (male) from member services who had assured me that a refund had been applied in the amount of $417 and some change, but that it would not be in until 6-8 weeks. He said he may be able to have this process time expedited since I'm practically broke now until the season is over, but required more information which I didn't have on me at the time. I requested to call back once I had the information and the first call ended. After gathering the other information, I called back and received a different agent, female. I do not remember names. She looked up my account and even spoke with other "back of house" workers who actually process the payments, all of whom confirmed that my refund hadn't even been requested and there was no history or notes of another agent viewing my profile. Luckily, she was able to work with the other employees in processing to get the refund processed, but confirmed that because of the holidays, I would certainly have to wait 6-8 weeks. I calmly expressed my disdain for not having any money to hold me over, but also expressed that I was thankful for her help and attention in getting the refund requested.

Desired Settlement: A refund has been processed, but my problem was that this was UNAUTHORIZED and without notice. I knew I would receive a notice eventually about when payment was due, but only the payment was taken and I am now left without a way to afford necessities until my next paycheck in two weeks. While it would be nice to also receive payment for my troubles, I simply want better protocols regarding payments and notifications to be put in place. I'm not upset that this has happened as I understand "**** happens," but am very displeased that now I must wait to get groceries and buy Christmas gifts while the heads of the company sit high and mighty without a worry on their mind. The fact that this money was technically stolen unrightfully from me and that I had to call to have them notice and apply the refund is unprofessional and violates my financial security and the pursuit of happiness, so I guess this was technically unconstitutional as well. Did I mention I was displeased with the timeliness of this major error?

Business Response:


December 31, 2015

**** *******
Dispute Resolution & Helpline Specialist
Denver/Boulder BBB
P.O. Box 48179
Denver, Colorado 80204



Complaint Case # 75272337
Consumer: ******* ********
Case Opened: December 18, 2015


Dear Ms. ********

This is in response to your email received on December 21, 2015 forwarding concerns on behalf of, ******** ******, regarding an incorrect premium deduction. We value the opportunity to review and respond to their grievance and apologize for the member's dissatisfaction.

Ms. ****** explained her dissatisfaction with $458.76 being deducted from her account in error. She states that the requested refund has been addressed, though the much needed money would take a lengthy 6-8 weeks before receiving.

I am very sorry for the understandable frustration experienced, and for the expressed inconvenience caused. I have thoroughly researched this matter and have additional questions, as to ensure that Ms. ******'s complaint is appropriately filed and she is satisfactorily assisted. I called Ms. ****** on December 28, 2015, and on December 31, 2015, though I've regretfully been unsuccessful at connecting with her.

I'd be more than happy to file the formal complaint on behalf of Ms. ******, as well as follow through until the discussed refund issue is completely resolved. Please ask the member to contact me directly, should she seek to move forward with this case. Again, additional information is necessary for clarification purposes. I look forward to further discussion with Ms. ******, as quality customer service is my goal.

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
2500 South Havana Street
Aurora, Colorado 80014

Written requests will be reviewed by Member Services Administration who will respond to you in writing within 14 calendar days of the receipt of the member's request. We may extend this timeframe up to an additional 14 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 BBB or the member has any questions, please contact me at ***** ********.

Also, you may contact Member Services:

Denver/Boulder members may call ************, toll free at 1-800-632-9700, between 8 a.m. to 5 p.m., Monday through Friday. Deaf, hard of hearing, or speech impaired members who use a TTY may call *************

Colorado Springs members please call 1-888-681-7878 or deaf, hard of hearing or speech-impaired members who use TTY may call 1-800-521-4874. You may also contact our department through our Web site at kaiserpermanente.org.

Please thank our member for their understanding in this matter. We know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente.



Sincerely,


**** ** *****
Complex Case Resolution Specialist
Member Experience

1/9/2016 Advertising/Sales Issues | Read Complaint Details
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Additional Notes

Complaint: We were in Kaiser insurance for 2014. All the premiums were paid in time. Now we have changed insurance and after a year of service they sent us a bil after a year later they have sent us a bill saying that we were not covreded at the time of medical service? How can someone not be covereed for one day of medical service when premiums for that month has already been charged? Then they sent us a bill for 2327.56 dollars

Desired Settlement: Removal of unwanted billing and harrasment

Business Response:


December 30, 2015

**** *******
Dispute Resolution & Helpline Specialist
Denver/Boulder BBB
P.O. Box 48179
Denver, Colorado 80204



Complaint Case # 75272338
Consumer: ***** ******
Case Opened: December 18, 2015


Dear Ms. ********

This is in response to your email received on December 21, 2015, forwarding concerns on behalf of our member, ****** ****, regarding a disputed service bill received. We value the opportunity to review and respond to their grievance and apologize for the member's dissatisfaction.

We have formally documented and shared Mrs. ****** concerns with the appropriate leaders at the Patient Financial Services (PFS) Department, to include the PFS Supervisor. On behalf of Kaiser Permanent (KP), I am very sorry for any frustration and inconvenience that may have been caused to the member by this matter. I 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 complaint. Feedback received from PFS confirms that the $2,327.56 bill was mailed in November and December 2015 to the member for services received from November 12, 2014 through November 15, 2014. The charges, however, were corrected on December 15, 2015, which is why I was not able to locate the amount. Apparently, there were issues with Connect for Health Colorado (C4), causing a discrepancy in the member's health plan coverage details. Therefore, the bills mailed were being processed as a non-member. The 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 **** ********). The Claims Department (*** ********) will be able to assist with questions about services received outside of. KP.

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
2500 South Havana Street
Aurora, Colorado 80014

Written requests will be reviewed by Member Services Administration who will respond to you in writing within 14 calendar days of the receipt of the member's request. We may extend this timeframe up to an additional 14 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 BBB or the member has any questions, please contact me at ***** *********

Also, you may contact Member Services:

Denver/Boulder members may call ************, toll free at 1-800-632-9700, between 8 a.m. to 5 p.m., Monday through Friday. Deaf, hard of hearing, or speech impaired members who use a TTY may call ************.

Colorado Springs members please call 1-888-681-7878 or deaf, hard of hearing or speech-impaired members who use TTY may call 1-800-521-4874. You may also contact our department through our Web site at kaiserpermanente.org.

Please thank our member for their understanding in this matter. We know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente.



Sincerely,


**** ** ***** Complex Case Resolution Specialist
Member Experience

1/4/2016 Problems with Product/Service
12/23/2015 Advertising/Sales Issues | Read Complaint Details
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Additional Notes

Complaint: Since June of 2015 upon receiving a notice of Kaiser Health Insurance cancellation, despite timely consistent payment of premium through 12/31/15. Kaiser Silver Plan, my Kaiser health record number is XXXXXXXXX and my wife *****'s is XXXXXXXXX. purchased 2/1/15 with the assist of Connect for Health Colorado. Colorado supplement (APTC), coverage was for my self and my wife. Our portion of payment 803.18 with the APTC supplemental amount of 476.88 monthly. All our premium payments were consistently made in a timely manner via credit card to keep a paper trail using the Kaiser payment web site. The last payment for December of this year had to be made by mail/check as the system had locked us out for nonpayment, despite personal records indicating payments accepted and processed. In June of this year we received a notice our coverage had been terminated due to nonpayment, in the months since June we have been sent various announcements from Kaiser, et. terminated coverage, resumed coverage, new cards confirming coverage, late payment notices. With each occurrence for six months I have been in touch with Kaiser billing by phone speaking to various represenatives staring in June of 2015 with Todd case # XXXXXX account notes SXXXXXXXXX,Parnel case #XXXXXX, ***** and ***. M her supervisor ET#XXXXXXXX, on 11/9/2014 ******* no ET # on this communication, on 11/17/2015 spoke to a supervisor ******* ET#XXXXXXXXX, 11/18/2015 ***** (male) who was no help, 11/19/15 ********* who established a three way conference call with Connect for Colorado to verify our APTZ (Advanced Premium Tax Credit) payment which established as valid case #XXXXXX, on 11/19/15 spoke with ***** tried to pay bill terminated yet again could not pay bill this is where I had to mail it in. Dec 1st of 2015 spoke with **** because check was in "lockbox payment" though payment was sent 11/19/15 and cleared our bank on 11/25/15 and as of today 12/4/2015 we are considered four days past du. In this time again we received letter two separate letters from Kaiser terminating our coverage, and then one that stated the January bill for 2016 which we had also paid was considered nonpayment and we again were overdue on our new policy for 2016. Today 12/4/15 spoke with ******* who transferred it up the chain to her supervisor ******** who was essentially no help at all, nor was she empathetic in regards to this ongoing nightmare, her advice heard for the very first time today was "file a complaint with Kaiser" which was done today with ******* who was the very first person we talked to in regards to this problem back in June of 2015. In the meantime we were told to continue to access medications, treatments, diagnostics using the "BELIEVE ME POLICY." So each time we went for a physician visit, used the Kaiser pharmacy, completed labs, or diagnostics had to explain our problem each time to different people using the "BELIEVE ME POLICY." At times we were asked to pay the full amount for services since we were "not in the system" very expensive for us as we are retired on a fixed income. Normally we would order our medications through the online pharmacy to save money, but now we could not at times because we were again not in the system, costing us more money on top of paying our portion of the premium in a timely manner consistently. Frequently we could not access our health site on Kaiser web to communicate with our physicians, who also could not communicate with us. We did decide to continue with Kaiser for 2016 as the issue was not a care issue, but a billing issue. We are now coming up on 2016 with a new policy where our premium payment is again supplemented by Connect for Health Colorado, on which we have already made the January 2016 payment and have a letter confirming approval for supplement and payment by Connect for Health Colorado for 2016. This has been an ongoing battle for six months with no resolution to date, we have been beyond patient. Unfortunately we are now needing to request outside help from the BBB for resolution.

Desired Settlement: Balnce due on Kaiser account for 2015 should be $0.00. Consistent membership verified on Kaiser member web site, the ability to access our plan appropriately without the need for explanation or made to feel as if we are somehow at fault with criminal intent. The year 2015 corrected to reflect member in good standing, with the year 2016 to reflect same with continued timely premium payment by both myself and Connect for Health premium tax credit. Member services supervisors with the real ability to be helpful, and working toward an active resolution with the adage of "customer service" being a real commitment to same and not just lip service with continuing to give resolution dates that are never met with the excuse "we just changed to a new system" for SIX MONTHS.

Business Response: Initial Business Response /* (1000, 6, 2015/12/21) */ ... December 21, 2015 **** ******* Dispute Resolution & Helpline Specialist Denver/Boulder BBB P.O. Box XXXXX Denver, Colorado XXXXX Complaint Case # XXXXXXXX Consumer: ******, ****** Case Opened: December 4, 2015 Dear Ms. ******** This is in response to your email received on December 4, 2015, forwarding concerns on behalf of our member, ****** ******, regarding issues pertaining to his health 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. Mr. ******'s concerns have been filed as a formal complaint through Kaiser Permanente's (KP) internal process, with notification to the Manager of the Consolidated Service Center for On-Exchange Issues Department. I have reached out to KP's Member Issues Resolution Team (MIRT) in California, as they specifically manage issues, such as experienced by Mr. ******, with On-Exchange plan detail discrepancies. Mr. ******'s account has been thoroughly reviewed, in an attempt to confirm as to why it does not reflect a $0.00 outstanding balance for the 2015 year. Please sincerely apologize to our member, on behalf of KP, for the continued frustration and inconvenience caused by this matter. Mr. ****** and myself have also had personal conversation, in which I've been able to further explain that he has unfortunately been included with the members affected by receiving cancelation warning letters and inaccurate premium monies due advisements. The member is aware of the change in third party billing vendors, though much of his frustration lies with the extended amount of time it has taken to resolve the consequential account errors. I have offered myself as a direct contact to provide case updates, as they are provided by MIRT. The communication between KP, C4, and our current billing vendor, HPS, are posted to the progress notes within the open case. I am in agreement that these cases are not being ideally resolved in a timely manner; KP and C4 are admittedly backlogged with needed fixes and assure that they are working as quickly as possible. The latest case review and summary update for Mr. ****** is as follows: 2015 Breakdown coverage (case id F47K99) 03/01/2015 to 12/31/2015 $803.18 x 10 months: 8,031.80 Total Premium: $8,031.80 Member ACTUAL PAID: $9,826.51 (In CONEXIS $6,902.32 + $2,924.19 of additional payment in HPS) ***only $1,280.06 was transferred to HPS on 8/24*** CREDIT: $1,794.71 Summary: KP originally received the 834 file from C4 Exchange on 8/29/15 with an effective date of 2/1/15. When the effective date was changed to 3/1/15, KP did not receive the 834 file from C4 Exchange to update the billing. Therefore, HPS still shows the member's incorrect effective date if 2/1/15, rather than the accurate effective date of 3/1/15. Next Steps: 1. Requesting change effective date from 2/1/15 to 3/1/15 thru 12/31/15 in HPS 2. Missing payment of 5,622.26 from CNX to HPS account, requesting transfer payment of 5,622.26 to case id F47K99. 3. And then will request split payments of 1,794.71 toward 2016 case id J9304K. On 12/18/2015, MIRT requested HPS to update the member's coverage. This has not been accomplished thus far. Meanwhile, I've been asked to advise the member to make sure that any payments made moving forward are toward the 2016 case ID J9304K (premium $512.85). This complaint will be filed, and I am opening a new case to follow through with the member, until all necessary changes are made to the member's account. The member's feedback is essential to our commitment of continuous improvement in delivering the highest quality, most appropriate and compassionate ***** 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 2500 South Havana Street Aurora, Colorado XXXXX Written requests will be reviewed by Member Services Administration who will respond to you in writing within 14 calendar days of the receipt of the member's request. We may extend this timeframe up to an additional 14 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 BBB 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 8 a.m. to 5 p.m., Monday through Friday. Deaf, 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-XXXX. You may also contact our department through our Web site at kaiserpermanente.org. Please thank our member for their understanding in this matter. We know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente. Sincerely, **** M. ***** Complex Case Resolution Specialist Member Experience Initial Consumer Rebuttal /* (2000, 8, 2015/12/23) */ (The consumer indicated he/she ACCEPTED the response from the business.) It appears account information is being updated and corrected. As of today 12/23/2015 both the 2015 and 2016 show "termed" on the Kaiser website dashboards that I have access to however it does appear that funds are being processed to correct this. Thank you so very much.

12/18/2015 Problems with Product/Service | Read Complaint Details
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Additional Notes

Complaint: We cancelled our membership with kaiser prior to may 2015, bit had already mailed premium check for may. They owe us refund but have not delivered. After over a year with kaiser my wifes job offered her group benefits so we cancelled our membership with kaiser in April of 2015 to be effective may 1. We had already mailed our premium fee for may, but we were told that we would receive a refund check once everything had been processed in roughly 4-6 weeks. It's now been 6 months and I have called asking about the check over and over, and each time I have been told that they absolutely should send us a check. They can see my last day of membership as April 30th and they see that u paid for may, but for some reason they just can't get the check issued. It's been extremely frustrating. I finally called again today and was told there is no timetable for resolution and they have no idea how long it will take for me to get a refund. I need the money now and I can't wait another 6 months. It's getting very ridiculous.

Desired Settlement: I would like the refund check that I am owed sent to me immediately.

Business Response: Initial Business Response /* (1000, 6, 2015/11/19) */ November 19, 2015 **** ******* Trade Practices & Helpline Specialist Denver/Boulder BBB P.O. Box XXXXX Denver, Colorado XXXXX Complaint Case # XXXXXXXX Consumer: *******, ******* Case Opened: November 4, 2015 Dear Ms. ******** This is in response to your email received on November 4, 2015, forwarding concerns on behalf of our member, ******* *******, regarding an awaited healthcare premium refund. We value the opportunity to review and respond to their grievance and apologize for the member's dissatisfaction. The member case scenario has been forwarded to our Consolidated Service Center/KPIF Department that assists with issues pertaining to plans purchased through Connect for Health Colorado. The details were thoroughly researched, as to confirm the refund amount due back to Mr. *******. The payment premium calculation confirms that the member is due a refund of $768.39, once the correct termination date is reflected of April 30, 2015. Kaiser Permanente (KP) has submitted to the Connect for Health Colorado vendor that the December 31, 2015 end date be appropriately changed. Once the termination date is corrected, the requested refund will process. Unfortunately, KP is not able to provide a date as to when this will be complete, though I welcome the member to contact me directly for progress updates. Please apologize to the member for any consequential inconvenience and frustration experienced. Should any related issues or concerns arise pertaining to Mr. *******'s plan, I'd be happy to personally assist, as to avoid continued inconsistent information being provided. The member's feedback is essential to our commitment of continuous improvement in delivering the highest quality, most appropriate and compassionate ***** 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 **** ***** ****** Street Aurora, ******** XXXXX Written requests will be reviewed by Member Services Administration who will respond to you in writing within 14 calendar days of the receipt of the member's request. We may extend this timeframe up to an additional 14 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 BBB 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 8 a.m. to 5 p.m., Monday through Friday. Deaf, 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-XXXX. You may also contact our department through our Web site at kaiserpermanente.org. Please thank our member for their understanding in this matter. We know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente. Sincerely, **** M. ***** Complex Case Resolution Specialist Member Experience Initial Consumer Rebuttal /* (3000, 8, 2015/11/20) */ (The consumer indicated he/she DID NOT accept the response from the business.) There is still no resolution in sight. I have been given this answer for months...they admit they owe a refund but give every excuse out there as to why they can't send me a refund. They have been holding onto almost 800 dollars, of my money, for 6 months. Its not theirs and they need to issue the refund check immediately or my next step is to hire an attorney. I've contacted connect for health Colorado on multiple occasions and they have confirmed that they have sent the correct termination date to kaiser months ago. Final Business Response /* (4000, 10, 2015/12/04) */ December 4, 2015 **** ******* Dispute Resolution & Helpline Specialist Denver/Boulder BBB **** Box XXXXX ******* Colorado XXXXX Complaint Case # XXXXXXXX Consumer: *******, **** Case Opened: November 18, 2015 Dear Ms. ******** This is in response to your email received on November 18, 2015, forwarding the rebuttal to our original, on behalf of our member **** *******. The member is requesting a more immediate refund of premiums be received. On December 4, 2015, the Member Issues Resolution Team (MIRT) advised that the Mr. *******'s expected refund will go out early next week. There was a delay with the Kaiser Permanente Finance Department, due to a new procedure being implemented to handle the influx of recent refund requests. Please apologize to the member for the inconvenience experienced, and he is welcome to contact me with any further questions or concerns relating to this matter. The member's feedback is essential to our commitment of continuous improvement in delivering the highest quality, most appropriate and compassionate ***** 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 **** South ****** Street ******* Colorado XXXXX Written requests will be reviewed by Member Services Administration who will respond to you in writing within 14 calendar days of the receipt of the member's request. We may extend this timeframe up to an additional 14 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 BBB 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 8 a.m. to 5 p.m., Monday through Friday. Deaf, 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-XXXX. You may also contact our department through our Web site at kaiserpermanente.org. Please thank our member for their understanding in this matter. We know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente. Sincerely, **** ** ***** Complex Case Resolution Specialist Member Experience

12/14/2015 Advertising/Sales Issues | Read Complaint Details
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Additional Notes

Complaint: Incorrectly billed $148.30 for an appointment covered under my health insurance member#XXXXXXXXX am writing this letter in an effort to clear up a $148.30 billing error from Kaiser Permanente due to them coding my office visit improperly as a infertility appointment which is not a covered service instead of the actual visit made due to my Dysmenorrhea (painful periods). I was having very painful periods along with nausea so I made an appointment for X-XX-XXXX to see an OBGYN doctor ********* S ******** at the Kaiser Lone Tree location. The doctor prescribed Ibuprofen 600 mg which is just a stronger dose of the same over the counter medication. As the months passed the pain and nausea did not subside so I made another appointment on XX-XX-XXXX for the same symptoms, very painful periods along with nausea, with the same doctor at the same location. We talked about the Ibuprofen really not working so the doctor suggested putting me on birth control to relieve the painful periods and nausea. I told the doctor that was not possible as my husband and I were trying to have a baby. The doctor started the conversation of how long we have been trying to have a baby, which was about 1 year at the time. We then received a bill for $148.30 as Kaiser Permanente as they said we discussed infertility services which is not a covered benefit. I made the appointment to discuss my very painful periods along with nausea not infertility concerns which was a conversation started by the doctor. I am not responsible for this $148.30 bill as a OBGYN is a covered benefit. The fact that the doctor brought up fertility issues is not my fault and I am allowed to answer questions asked by my doctor without having to invoke my 5th amendment right because it is not a covered benefit.

Desired Settlement: Kaiser Permanente to stop incorrect billing for $148.30 for services which were covered by my health insurance and stop the collection letters.

Business Response: Initial Business Response /* (1000, 6, 2015/12/02) */ December 2, 2015 **** ******* Dispute Resolution & Helpline Specialist Denver/Boulder BBB P.O. Box XXXXX Denver, Colorado XXXXX Complaint Case # XXXXXXX Consumer: ***********, ******** Case Opened: November 25, 2015 Dear Ms. ******** This is in response to your email received on November 26, 2015, forwarding concerns on behalf of our member, ******** ***********, regarding a disputed December 26, 2015 service charge. We value the opportunity to review and respond to their grievance and apologize for the member's dissatisfaction. I confirmed that Ms. ***********'s concerns were appropriately documented and shared with Lone Tree Medical Office Obstetrics and Gynecology Department leadership. The member's initial complaint was filed on September 24, 2015, and the notification included the department Chief. Please apologize to Ms. *********** for any miscommunication that may have occurred with the provider at her visit, and ultimately, resulted in a charge for a test that was not related to her clinical care needed. Though the disputed charge was appropriately billed in accordance with the member's Evidence of Coverage, Kaiser Permanente has removed the outstanding balance. As of today, the member's account has a $0 balance. Should there be any additional questions, please do not hesitate to contact me directly. 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 2500 South Havana Street Aurora, Colorado XXXXX Written requests will be reviewed by Member Services Administration who will respond to you in writing within 14 calendar days of the receipt of the member's request. We may extend this timeframe up to an additional 14 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 BBB 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 8 a.m. to 5 p.m., Monday through Friday. Deaf, 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-XXXX. You may also contact our department through our Web site at kaiserpermanente.org. Please thank our member for their understanding in this matter. We know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente. Sincerely, **** M. ***** Complex Case Resolution Specialist Member Experience Initial Consumer Rebuttal /* (2000, 8, 2015/12/11) */ (The consumer indicated he/she ACCEPTED the response from the business.)

12/7/2015 Advertising/Sales Issues | Read Complaint Details
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Additional Notes

Complaint: My insurance has been terminated by Kaiser as of July 31, 2015 for non-payment. I have proof that I am paid in full up to Oct 2015 by 9/30 due date. I purchased Kaiser Permanente Health Insurance through the connect for health co marketplace for 2014 and 2015. I have been sending my payment each month and got a notice that my account was behind. I have called numerous times to get this resolved and have offered to send my bank statements each time. Each time I call, no notes have been taken about my previous call and the billing resource has to re-research the issue. Once we go through each of my payments then they say they will refer it to tier2 and will call back and help me to correct my account billing errors. This has never happened. Each time I let some time pass and when I call back then again no notes are available for the billing person and we have to go over payments again. I have paid in total 11702.61 since January 1 2014 until now. As of September 30, 2015 I have paid 11008.76. I have faxed my bank statements from my bank that show all of the payment premiums made to Kaiser. When I called to confirm that the fax has been received, they stated that they didn't know what I was talking about but maybe give it a day and hopefully something would be posted. My account should not have been terminated since I am paid in full to November 2015 and paid in full to October 2015 by the 9/30 due date.

Desired Settlement: I would like my Kaiser billing errors to be resolved and to have my insurance plan re-instated for the full year of 2015.

Business Response: Initial Business Response /* (1000, 7, 2015/11/23) */ November 23, 2015 **** ******* Trade Practices & Helpline Specialist Denver/Boulder BBB P.O. Box XXXXX Denver, Colorado XXXXX Complaint Case # XXXXXXXX Consumer: *****, **** Case Opened: November 11, 2015 Dear Ms. ****** This is in response to your email received on November 11, 2015, forwarding concerns on behalf of our member, **** *****, regarding discrepancies of her health 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. We have formally documented and shared Ms. *****'s concerns with the appropriate leaders at the Consolidated Service Center/KPIF Issues Department, to include the Manager. I additionally requested an account audit and complete research of its details from the Kaiser Permanente (KP) Member Issues Resolution Team in California. The investigation concluded with the member having 3 Exchange IDs in error. The 2 missing 2014 payments for $598.32 ($299.16 x 2) have been located in one of the wrong accounts and been transferred over accordingly. The accurate and currently active 2015 health plan account is Exchange ID# XXXXXXXXXX, and it now shows to be paid in full. Please sincerely apologize to the Ms. ***** for the issues experienced with her plan thus far and for the consequential inconvenience caused. KP and C4 continue to work with our new third party vendor to resolve all problems arising and affecting member's accounts. One of the occurring situations is that the 3 systems must all ultimately reflect the same benefit details. While this action (which has often taken longer than initially expected) is being processed, varying information is being provided to our members from different individuals referencing a different system. This has caused a great deal of confusion, and I would like to offer the member my personal assistance with any further questions or concerns that may present with her health plan. I believe that this will limit contradictory information being given and hopefully lessen the frustration as well. Please advise Ms. ***** that I may be contacted directly by calling (XXX) XXX-XXXX, and thank her for her continuing to be a valued KP member. 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 2500 South Havana Street Aurora, Colorado 80014 Written requests will be reviewed by Member Services Administration who will respond to you in writing within 14 calendar days of the receipt of the member's request. We may extend this timeframe up to an additional 14 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 BBB 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 8 a.m. to 5 p.m., Monday through Friday. Deaf, 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-XXXX. You may also contact our department through our Web site at kaiserpermanente.org. Please thank our member for their understanding in this matter. We know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente. Sincerely, **** M. ***** Complex Case Resolution Specialist Member Experience

12/7/2015 Advertising/Sales Issues
12/3/2015 Advertising/Sales Issues
11/13/2015 Problems with Product/Service
11/9/2015 Billing/Collection Issues | Read Complaint Details
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Additional Notes

Complaint: The 1095A tax form stating my insurance coverage for 2014 was incorrect. After repeated requests to KP Member Services, they have not fixed problem. When filing my 2014 personal income tax return in April 2015, I realized that there was an error on my 1095A tax form, the form issued by Connect for Health Colorado and other state insurance exchanges, which states the dates of health insurance coverage and the amounts paid for that coverage. The 1095A I received stated that I had insurance coverage through Kaiser Permanente for two months during 2014, when I actually had been insured with Kaiser for nine months. Seeing the error, I requested an extension to file my state and federal tax returns through the IRS, which gave me until October 15th to file my taxes. I then began (in early May) calling both Kaiser Permanente and Connect for Health Colorado to try and resolve the issue. In the last five months, I have called Kaiser more than thirty times. Initially, it was unclear if the error was caused by Connect for Health Colorado, or by Kaiser Permanente. The first ten times I spoke to Kaiser's Member Service Representatives, they told me I needed to call Connect for Health. I would call Connect for Health and they would tell me to call Kaiser. Eventually it became clear that the error was on Kaiser Permanente's part. The ordeal that has followed has been almost unbelievable. On four or five occasions over the summer, I called Kaiser Permanente Member Services and requested to speak with a supervisor, only to be told by the representative that the available supervisor was on another call, or out of the office, and that they would call me back with answers to my questions. Without fail, I would never hear back from the supervisor, and would call back the next day and request to speak to the supervisor who was supposed to have called me, only to be told that they could find no record of that in my file, or that they were unable to locate what department the supervisor worked in. I have a running list of six KP Member Service employees who were supposedly going to call me to follow up on my issue, and who I never heard from. At three different times over the summer, I spoke with someone in member services who told me that they saw what the problem was, that a file had to be updated and sent to Connect for Health Colorado, so that they could then issue a new 1095, and that within five to ten business days, or two to three weeks (depending on who I spoke with), this would all be cleared up. I would wait the suggested amount of time and call back to follow up, only to be told that there was no record that anyone had done anything to try and resolve my issue. I recently was able to get through to a higher level of customer service, and was assured (again by a supervisor who never called to follow up like she said she would), that my issue was being handled and would be resolved by Wednesday, October 7th. As the October 15th extension filing deadline approaches, I have become increasingly anxious about this situation. I called Kaiser today (Friday, October 9th), to check on the progress. I was told by a customer service representative that my request is still being processed, and that requests of this nature typically take thirty to sixty days to process, and that my request is still within this timeframe. Furthermore, they stated that there is nothing they can do to try and expedite this for me, regardless of the amount of time that I have been trying to resolve this issue. This was the first I've heard of this timeline, and considering that I began requesting help with this issue in May, it seems that the thirty to sixty day window would have elapsed long ago. At this point I know it's very unlikely that I will receive a corrected 1095A form in time to file my taxes, and because of that, my tax refund will be significantly smaller than it would be if I were able to claim the full amount that I paid for health insurance through Kaiser. Additionally, I estimate that I have spent between fifteen and twenty-five hours on the phone with Kaiser in trying to resolve this.

Desired Settlement: I just want a correct 1095A tax form! Preferably before my October 15th tax filing deadline.

Business Response: Initial Business Response /* (1000, 9, 2015/10/28) */ October 28, 2015 **** ******* Trade Practices Specialist Denver/Boulder BBB **** *** XXXXX Denver, Colorado XXXXX Complaint Case # XXXXXXXX Consumer: ****** ***** Case Opened: October 12, 2015 Dear Ms. ******** This is in response to your email received on October 13, 2014, forwarding the concerns on behalf of our member; ****** *****. 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. On October 9, 2015, Mr. ***** contacted Kaiser Permanente's Member Services Contact Center and filed a formal concern requesting Kaiser Permanente correct his 2014 enrollment in our Bronze 4500/50 health plan as he was enrolled in this health plan from January 1, 2014, through September 30, 2014. He also filed a subsequent complaint with the Better Business Bureau (BBB), which we received October 13, 2015. He still needed a corrected 1095A tax form prior to filing your taxes on October 15, 2015. He has been trying to resolve the issue since May to no avail. He expressed frustration in trying to remedy this concern and obtain the documentation needed. As part of the formal complaint process, I documented Mr. *****'s concerns and reviewed them with Kaiser Permanente's California Service Center OnExchange Operations Manager and Kaiser Permanente's Member Services Contact Center Operations Manager. Based upon further review of the available documentation, below is a summary of the events related to your 2014 coverage: From October 27, 2014, through August 12, 2015, Kaiser Permanente's Member Services Contact Center Tier 2 Team requested the corrected coverage information to remedy the 2014 coverage from Connect for Health Colorado. Please note that Kaiser Permanente cannot make any changes, including enrollment or cancellation, to a health plan purchased through Connect for Health Colorado without Connect for Health Colorado's authorization and documentation. Kaiser Permanente's Member Services Contact Center call records document Mr. ***** initiated contact on June 25, 2015, requesting assistance for a corrected 1095A tax form. Since this time, he has consistently and routinely contacted Kaiser Permanente regarding this issue until the present day. On August 20, 2015, Kaiser Permanente's Member Services Contact Center escalated his request for a corrected 1095A tax form. On August 25, 2015, Kaiser Permanente received the necessary information to correct his coverage from Connect for Health Colorado as follows: Connect for Health Colorado Exchange ID#: XXXXXXXXXX Member: ****** ***** Effective Dates: 1/1/2014-8/31/2014 Total Premium: $222.01 Advanced Premium Tax Credit (APTC): $162.96 Member's responsible amount: $59.05 Effective Dates: 9/1/2014-9/30/2014 Total Premium: $221.01 Advanced Premium Tax Credit (APTC): $30.61 Member's responsible amount: $191.40 As Mr. ***** may already be aware some of our members who were enrolled with Kaiser Permanente through Connect for Health Colorado received incorrect 1095A forms and there was a delay in processing the corrected 1095A forms. Kaiser Permanente partnered with Connect for Health Colorado in order to provide our members with a corrected 1095A form. It is a two-step processKaiser Permanente corrects the information for the 1095A form through a Special Tax Unit and the Special Tax Unit sends the corrected information to Connect for Health Colorado. Please be aware that according to the Affordable Care Act (ACA), Connect for Health Colorado is required to send the 1095A tax form to individuals who enrolled in qualified health plans on the Exchange. The documentation provided by Connect for Health Colorado was not received in enough time to fully remediate Mr. *****'s account and meet the deadline for Connect for Health Colorado's last 1095A tax form production. Unfortunately, Connect for Health Colorado ceased production on correcting 1095A tax forms in early September and Mr. *****'s request for a corrected 1095A tax form was requested during this time frame. I contacted Connect for Health Colorado's Carrier Research Team on his behalf and confirmed they are unable to do a manual corrected 1095A tax form for Mr. ***** as there was no guarantee that the Internal Revenue Service (IRS) would have the same information that was already provided. If Mr. ***** has concerns around the timing of filing his taxes, he may want to seek help from a tax professional regarding options. On October 28, 2015, a call was placed to Mr. ***** to talk about possible options for resolution, we are awaiting his call back. If the BBB or the member has any questions, please contact me at (XXX) XXX-XXXX. Sincerely, ****** ******* Complex Case Resolution Specialist Case Resolution Team Customer Experience Department Kaiser Foundation Health Plan of Colorado Initial Consumer Rebuttal /* (2000, 11, 2015/11/08) */ (The consumer indicated he/she ACCEPTED the response from the business.) A representative from Kaiser Permanente contacted be and helped to resolve my situation. They have now updated my information and I will be able to received a corrected 1095-A. The case resolution specialist, ******* has been very helpful and apologized for the delay in getting the matter resolved.

10/13/2015 Advertising/Sales Issues | Read Complaint Details
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Additional Notes

Complaint: 1. Diagnosed by *** ***** still Kaiser with ***** *********** requiring surgery and need to stay over night at *** ***'s ******** 2. Advised to contact financial services to find out cost. Called on 7/06/15 and spoke to ****** who told me my one night stay would cost me $500.00 per night with a maximum out of pocket of $2000.00. Called back again later that day and verified with another representative. The same cost was quoted to me. 3. I budgeted $500.00 for surgery and had the surgery done on 7/08/15 and was discharged in 7/09/15 at 8 am. 4. Received 2 bills from Kaiser totaling $2700.00 dollars owed to Kaiser 5. Received another bill from ********* that I have no idea who they are charging me $185 and change for tests I did not authorize them to run and who Kaiser already charged me for. They said my doctor ordered them and they had the right to bill me. I was never consulted or authorized any of these charges including the $2700 and change charge from Kaiser that I am not budgeted for based on their quite. 6. This will cause me incredible financial difficulty. 7. I have filed a complaint with Kaiser as they advised. Their investigator called and did not listen to a word I explained to him. ******* told me he would have this complete by 8/25/15 which will cause my bills to go to collection. Product_Or_Service: Health insurance billing negligence Account_Number: XXXXXXXXX

Desired Settlement: DesiredSettlementID: Billing Adjustment Honor the quote I was given twice for $500.00 or cause me to go bankrupt

Business Response: Initial Business Response /* (1000, 5, 2015/08/28) */ August 28, 2015 **** ******* Trade Practices & Helpline Specialist ********@denver.bbb.org XXX XXX-XXXX XXX XXX-XXXXFax Complaint Case # XXXXXXXX Consumer: ******* ***** ******** Case Opened: August 20, 2015 Dear Ms. ******** This is in response to your email received on August 20, 2015, forwarding concerns on behalf of our member; ******* ***** ********, regarding his July 8, 2015 ******* Saint ******'s procedure cost dispute. We value the opportunity to review and respond to his grievance and apologize for the member's dissatisfaction. We have formally documented and shared Mr. ********'s concerns with the appropriate leaders at the Kaiser Permanente (KP) Medical Financial Counseling (MFC) department, to include the Supervisors. I 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. ******** requesting/receiving a cost estimate for his July 8, 2015 procedure, nor do they have an employee by the name of ******. 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 provided. She did confirm, however, that St. ***'s does typically contact patients prior to a scheduled hospital visit. The Supervisor also stated that Mr. ******** was initially checked in for his procedure as "inpatient" surgery; inpatient surgery falls under the $500/day member benefit. The procedure type changed to "outpatient", which she explained is usually due to coding changes prompted by physician driven orders. Outpatient falls under the 30% member responsibility benefit. The member disputed July 8, 2015, Exempla Saint ****** 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 request. Please sincerely apologize to Mr. ******** on behalf of KP, as it is disappointing to have a valued member express frustration. The St. ***'s MFC Supervisor provided me with the following contact, should Mr. ******** 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 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 **** ***** ****** ****** Aurora, Colorado XXXXX Written requests will be reviewed by Member Services Administration who will respond to you in writing within 14 calendar days of the receipt of the member's request. We may extend this timeframe up to an additional 14 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 BBB 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 8 a.m. to 5 p.m., Monday through Friday. Deaf, 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-XXXX. You may also contact our department through our Web site at kaiserpermanente.org. Please thank our member for their understanding in this matter. We know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente. Sincerely, **** ** ***** Complex Case Resolution Specialist Member Experience Initial Consumer Rebuttal /* (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 illegal. This is what is referred to as a shell. Stating 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 /* (4000, 9, 2015/09/17) */ September 17, 2015 **** ******* Trade Practices & Helpline Specialist ********@denver.bbb.org XXX XXX-XXXX XXX XXX-XXXXFax Complaint Case # XXXXXXXX Consumer: ******* ***** ******** Case Opened: August 20, 2015 Dear Ms. ******** This is in response to your email received on September 15,2015 forwarding the rebuttal to our original response provided on August 28,2015 on behalf of our member; ******* ***** ********, regarding his July 8, 2015 Exempla Saint ******'s procedure cost dispute. We value the opportunity to review and respond to his grievance and apologize for the member's dissatisfaction. We regret his continued dissatisfaction. However, Mr.Bishcoff request for review of these concerns was completed on July 27, 2015 and again on August 28, 2015 when a final resolution was rendered. Therefore, he has exhausted all internal grievance options offered by Kaiser Permanente. However, we have formally documented and shared Mr. ********'s concerns with the appropriate leaders at the Kaiser Permanente (KP) Medical Financial Counseling (MFC) department, to include the Supervisors. In addition we had all calls that were made to our Member Services Department pulled and reviewed. The call completed by Mr.Bishcoff on July 6, 2015 at 8:46am was to cancel an appointment. The member did not discuss or request any cost estimates in regards to any upcoming procedures. Please thank our member for their understanding in this matter. We know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente. Sincerely, ********* ***** Complex Case Resolution Specialist Member Experience Department Kaiser Foundation Health Plan of Colorado Final Consumer Response /* (4200, 11, 2015/09/18) */ (The consumer indicated he/she DID NOT accept the response from the business.) The call on July 6 was NOT TO CANCEL AN APPOINTMENT. Kaiser 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, 2016 in the afternoon. Not in the morning. I have repeatedly ask you to honor your quote and you repeatedly lie about the quote. How would I know all these details if I did not call? This is just a shame in the way you treat your members. I have not exhausted all my requests to remedy this matter because I was given the opportunity to appeal the August 28. 2015 decision which I sent a certified letter to the department, so that would be yet another questionable statement by Kaiser. Thank you Kaiser for taking care of your patients with such care.

10/9/2015 Advertising/Sales Issues | Read Complaint Details
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Additional Notes

Complaint: Two payments were taken out of my bank account in December 2014 even though my coverage was cancelled 11/2014. I only owed for one payment. Account number XXXXXXXXXX Payment 347.98 taken from my bank account 12/1 and payment 347.98 taken from my bank account 12/2. Coverage was cancelled effective 11/30/2014. I have tried to talk to someone about this multiple times and no one has been able to provide any explanation or even confirm that they also show Kaiser received the two payments. This was through Connect For Health Colorado and they confirmed that Kaiser does the billing. My bank statement confirms payment made to Kaiser Dues MP

Desired Settlement: Payment of 347.98 returned with appropriate interest since I have been trying to recover this money for nearly a year.

Business Response: Initial Business Response /* (1000, 6, 2015/09/23) */ September 23, 2015 **** ******* Trade Practices & Helpline Specialist Denver/Boulder BBB **** *** XXXXX Denver, Colorado XXXXX Complaint Case # XXXXXXXX Consumer: ******* ****** Case Opened: September 14, 2015 Dear Ms. ******** This is in response to your email received on September 14, 2015, forwarding concerns on behalf of our member, ******* ******, and her expressed frustration pertaining to an awaited premium refund. We value the opportunity to review and respond to their grievance and apologize for the member's dissatisfaction. We have formally documented and shared Ms. ******'s concerns with the appropriate leaders at Service Link/Consolidated Service Center for On-Exchange Issues Department. This notification includes the overseeing department manager. Research of the matter, confirms that Ms. ****** is due a refund of $347.98 for overpayment of premium. I am very sorry that this issue occurred, as well as that it has taken much of Ms. ******'s own time/effort to resolve. On September 18, 2015, I was advised by the Kaiser Permanente On-Exchange Issues team that the refund request has been submitted and will be processed. The estimated timeframe until the member receives the mailed check for $347.98 is within 30 days. The member may feel free to contact me directly, should any questions persist or additionally related issues arise. The member's feedback is essential to our commitment of continuous improvement in delivering the highest quality, most appropriate and compassionate ***** 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 **** ***** ****** Street ******* Colorado XXXXX Written requests will be reviewed by Member Services Administration who will respond to you in writing within 14 calendar days of the receipt of the member's request. We may extend this timeframe up to an additional 14 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 BBB 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 8 a.m. to 5 p.m., Monday through Friday. Deaf, 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-XXXX. You may also contact our department through our Web site at kaiserpermanente.org. Please thank our member for their understanding in this matter. We know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente. Sincerely, **** M. ***** Complex Case Resolution Specialist Member Experience

9/23/2015 Problems with Product/Service | Read Complaint Details
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Additional Notes

Complaint: My wife and I were using Kaiser's fertility clinic. They abruptly announced it was closing with no further services. All $ spent has been wasted. Kaiser sent us a form letter through the mail -- no phone call, no personalized email, nothing -- telling us that they were no longer doing business with the fertility clinic housed in their Skyline offices. They have provided NO NEW CLINIC within Kaiser to which they can transfer us. My wife called to gain clarification and they simply said that we are on our own. Obviously Kaiser has a right to close its clinic,and obviously there's nothing requiring them to be professional or considerate about doing so. However, we insist upon a full refund of all money paid them in relation to their now defunct fertility clinic, since we are now entirely back to square one with a new, outside clinic. This sort of behavior has been, in our experiences over 10 years, typical of Kaiser's disorganized lack of professionalism. Unfortunately, neither of us has any other option for insurance companies through our employers.

Desired Settlement: We want a full refund of the $840 we have paid in June as a result of consultation, lab-work etc... We will need to pay for a new initial consultation, new lab work etc... with whatever new fertility clinic we choose to patronize.

Business Response: Initial Business Response /* (1000, 6, 2015/06/26) */ June 26, 2015 ******** ***** Trade Practices & Helpline Specialist Denver/Boulder BBB P.O. Box XXXXX Denver, Colorado XXXXX Complaint Case # XXXXXXXX Consumer: *******, **** Case Opened: June 25, 2015 Dear Ms. ****** This is in response to your email received on June 22, 2015, forwarding concerns on behalf of our member, **** *******, regarding a refund request for services his wife received at ******* ************ ********** and ********** Department. We value the opportunity to review and respond to their grievance and apologize for the member's dissatisfaction. Unfortunately, an Appointment of Representative (AOR) form is required to be completed and placed on file, in order for Mr. ******* to speak on behalf of his wife. I have mailed the necessary document to Mr. and Mrs. ******* and included a brief explanation letter including my contact information. This will allow Mrs. ******* to call me directly. If she would like to place the complaint in her name, I will be happy to follow through on the formal complaint process and monetary request. Otherwise, I will be able to reach out to Mr. ******* for further complaint and requested resolution clarification, upon receipt of the completed AOR. I am sincerely sorry that the member and his wife are experiencing the issues described, and I look forward to the opportunity to appropriately address the matter. 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 **** ***** ****** ****** Aurora, Colorado XXXXX Written requests will be reviewed by Member Services Administration who will respond to you in writing within 14 calendar days of the receipt of the member's request. We may extend this timeframe up to an additional 14 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 BBB 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 8 a.m. to 5 p.m., Monday through Friday. Deaf, 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-XXXX. You may also contact our department through our Web site at kaiserpermanente.org. Please thank our member for their understanding in this matter. We know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente. Sincerely, **** ** ***** Complex Case Resolution Specialist Member Experience Initial Consumer Rebuttal /* (3000, 8, 2015/07/08) */ (The consumer indicated he/she DID NOT accept the response from the business.) After receiving an email from BBB asking me to respond, I called Kaiser (who still hadn't contacted either my wife or me) and spoke with **** ****** While pleasant, *** ***** said she still couldn't move forward with handling anything since she had yet to receive the AOR form. We completed this form and mailed it back to the address listed on the instructions the day after we received it in the mail. I can almost guarantee that it is sitting in a pile somewhere in Kaiser's mailroom. *** ***** spoke with my wife for a few moments on the phone, but did not offer any solution to our problem whatsoever. She promised she will be back in touch with us, but obviously we cannot accept Kaiser's response so far, since they effectively have provided us none. It is difficult to say whether Kaiser simply has a policy of stalling in hopes that customers will simply get fed up and give up, or if their internal systems are so disorganized and slow that they honestly don't really know what is going on. As I was typing this, *** ***** called again. She said that another woman was "working on" my wife's claim and we will hear back no later than 30 days from the date of our initial complaint. She also said that the reason my first complaint was never addressed was that it was transferred over to my wife's health record, and that I should have been notified that that had taken place. So, to reiterate, we still have received no refund of any kind from Kaiser (nor any formal apology or offer to help us moving forward with treatments) and so I do not accept their response. Final Business Response /* (1000, 22, 2015/09/21) */ The Case Resolution Specialist assisting the member advised that she picked up the check here at Waterpark I in Aurora, yesterday August 19, 2015. Again, I apologize for the overall inconvenience that has been caused. Please let me know if I may be of any further assistance relating to this matter. **** ** ***** XXX XXX-XXXX KP Case Resolution Team Final Consumer Response /* (2000, 24, 2015/09/22) */ (The consumer indicated he/she ACCEPTED the response from the business.) The customer service has generally been slow and inconsistent. However, we finally did receive a full refund.

9/14/2015 Advertising/Sales Issues | Read Complaint Details
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Additional Notes

Complaint: Kaiser continues to submit faulty bills regardless of my accurate disputes and their glaring errors. Kaiser continues to bill me regarding a claim (my wife/daughters delivery) on 8/31/14. I was insured by Aurora Public Schools until 8/31/14 and then was insured by my new employer, Singing Hills, on 9/1/14, both plans were with Kaiser. Because the claim event happened on 8/31/14 the delivery and hospital visit should be covered by my APS policy, with subsequent preventative care covered by my new singing Hills policy. I paid the claim bill in full soon after receiving the bill- however Kaiser continues to charge for services that are covered or already been paid. I have contacted Kaiser 1-2 times each month since the claim, every time Kaiser says the issue will be taken care of, but another bill comes a week or two later. The hospital has now billed me 8 months later even though I paid them in full in September (before receiving a bill).Kaiser is continually unresponsive, difficult to deal with, and each department says a different thing. They have billed for the same service a handful of times and each time the account representative has found that the bill is not my responsibility and will be cleared. I feel harassed by the a bureaucratic company.

Desired Settlement: I would like to meet with representatives of Kaiser, St Josephs, and the insurance division to come to a final agreement on what I owe or should be credited. I have tried to do this independently with Kaiser, but the continually faulty billing has eroded my confidence in their ability to find the problem, solution, and conclusion. I would like a third party involved to ensure the solution/resolution is carried out.

Business Response: Initial Business Response /* (1000, 6, 2015/07/01) */ July 1, 2015 *** ******** ***** **** ***** ********* ********** ************** *** **** *** XXXXX ******* ******** XXXXX Complaint Case # XXXXXXXX Consumer: ***** ********** Case Opened: June 17, 2015 Dear *** ****** This is in response to your email received on June 18, 2015 forwarding concerns on behalf of our member; ***** ********** regarding the billing of services from August 31,2014. We value the opportunity to review and respond to their grievance and apologize for the member's dissatisfaction. We have formally documented and shared *** ********** grievance with the appropriate leaders in the claims department. The member's claims are in the process of being corrected. *** & **** ********** had contacted our Member Services Call Center and requested the following to be completed. The new born claim should be effective under Mrs.**********'s plan for the first 30 days. The new born was not showing covered the under **** ********** plan for the first 30 days. This effected the member's accumulations. *** ********** states that his wife met the deducible on family account. Upon research we confirmed that the accumulations were not reflecting accurately. The following steps have been taken to correct the enrollment and claims errors: 1. The Newborn should have shown eligible from date of birth - 08/31/2014. Coverage now shows as the following: Aurora Public School coverage: 8/31/XXXX-X/31/2014 Singing Hills Inc. coverage: 09/01/XXXX- XX/30/2014 CHP + Coverage: 03/01/XXXX- XX/31/2015 Eligibility was corrected on June 12, 2015 2. Claims were sent back for processing correctly for Date of Service August 31, 2014 on June 15, 2015 and in process of completion. Upon the claims being reprocessed, the member will receive a new explanation of benefits with his correct amount owed for services on August 31, 2014. 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 **** ***** ****** ****** Aurora, Colorado XXXXX Written requests will be reviewed by Member Services Administration who will respond to you in writing within 14 calendar days of the receipt of the member's request. We may extend this timeframe up to an additional 14 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 BBB 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 8 a.m. to 5 p.m., Monday through Friday. Deaf, 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-XXXX. You may also contact our department through our Web site at kaiserpermanente.org. Please thank our member for their understanding in this matter. We know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente. Sincerely, ********* ***** Complex Case Resolution Specialist Member Experience Complaint Response Date bumped because: Holiday Initial Consumer Rebuttal /* (3000, 8, 2015/07/10) */ (The consumer indicated he/she DID NOT accept the response from the business.) *** ****** I appreciate Kaiser's response, it does seem like they have finally started to analyze my claim and rectify the problem. However, *** ***** seems to be mistaken. In her second bullet point she claims that the bills have been resubmitted and are in the process of being corrected. Unfortunately Kaiser continues their faulty billing as signified by another incorrect bill with a June 16th statement date. *** ***** also never mentioned whether the claim should be covered entirely under my wife's insurance and what insurance will be billed because the claim fell at the end of one insurance and the beginning of another. These questions need to be addressed and referenced with my insurance benefits. I also do not accept Kaiser's timeline. The original claim date was August 31,2014. I had brought the errors to their attention multiple times each month since then, why is there a continued delay? The most recent bill I received threatened collections- Kaiser's continued delay is only endangering my credit, time, and livelihood. I would like a timeline on the EOB/Bill. I would also like a detailed account of my charges and what I already paid. Finally, *** ***** did not acknowledge my request for a meeting with a third party. The meeting would help accelerate the process and allow a mediator to ensure follow through. Previous communication with Kaiser directly proved futile and repetitious. Electronic communication allows for documentation but continues the slow process. I appreciate your help in the matter and look forward to a conclusion, ***** Final Consumer Response /* (4200, 12, 2015/08/02) */ (The consumer indicated he/she DID NOT accept the response from the business.) Ms Davis, Thank you for your response. Unfortunately I can not accept the resolution at this time. Many of the EOB/Bills/credits you describe have not come through yet. I still need to see the final billing of my daughters birth that also reflects the full amount of payments that I have made. Bills that I have received in the last month do not show the adjustments that you mention or the payments (to Kaiser and to St. ***** that I have receipt of. Also, I believe some of the charges that you mention continue to be inaccurate. The charge of $68.81 on 9/3/14 has been billed previously to my daughter and now to my wife. In addition, this claim comes from a Home Health visit for my daughter that should be defined as preventative care and covered at no charge- this visit was not optional. This continued issue can not be resolved until I receive the final EOB and bills to the issues that Kaiser claims to have addressed. Please address my new concerns and provide an update on when I should expect this matter to be resolved in your billing/claims department. Thank you, ***** Final Business Response /* (4000, 14, 2015/08/27) */ August 27, 2015 Ms. ******** ***** Lead Trade Practices Consultant Denver/Boulder BBB P.O. Box XXXXX Denver, Colorado XXXXX Complaint Case # XXXXXXXX Consumer: ***** ********** Case Opened: June 17, 2015 Dear Ms. ****** This is in response to your email received on August 17,2015 forwarding a third rebuttal on behalf of our member; ***** ********** regarding the billing of services from August 31,2014. We value the opportunity to review and respond to their grievance and apologize for the member's dissatisfaction. We reprocessed his daughter's hospital claim on July 08, 2015 to pay $2,647.90 directly to Exempla Saint Joseph Hospital. The remaining balance of $183.10 was applied to the coinsurance, and will need to be paid directly to the hospital. I have mailed out a copy of the updated billing and Explanation of Benefits to the member. Note: Because the member's health plan's out-of-pocket maximum was not met, the remaining balance of $183.10 was applied to the coinsurance requirement and will need to be paid directly to Exempla Saint Joseph hospital. In accordance with Kaiser Permanente's well-newborn benefit, if the mom and the newborn are released from the hospital at the same time, the deductible is waived on the newborn's claims. When this occurs, if the mother of the newborn has not yet met the individual OPM, the charges for the newborn's hospital claims would apply to the mother's coinsurance. The member also indicated that Kaiser Permanente continues to charge him for the services that are covered or have already been paid. I reviewed the most recent billing statement in the amount of $104.64. Please note that two of his daughter's claims, in the amount of $89.58 and $10.42, have been adjusted off the account as result of the claims audit. As a one-time service gesture to the member Kaiser Permanente has removed the remaining $4.64 charge from his account. The account now has a zero balance. Claim Number XXXXXXXXXXXXXXXX for services provided to Mrs. ********** by ****** ****** on September 3, 2014, was processed on September 14, 2014. $68.81 was applied to the family deductible. We have adjusted this claim off the members account as well. Please note, this concludes the members review rights regarding these specific complaint issues. In the event the member would have a new concern, please have them contact the Member Services Department at XXX-XXX-XXXX or toll free at X-XXX-XXX-XXXX. Deaf, hard of hearing, or speech impaired people who use a TTY may call XXX-XXX-XXXX. Please thank our member for their understanding in this matter. We know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente. Sincerely, ********* ***** Complex Case Resolution Specialist Customer Experience Department Kaiser Foundation Health Plan of Colorado

9/7/2015 Billing/Collection Issues | Read Complaint Details
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Complaint: Due to Kaiser closing their reproductive department in the middle of my care, I wasted taking time off of work, money, and now I did not even receive the end result due to my care through Kaiser. I had started in the reproduction department in May of 2015. In May, the doctor and I created a fertility plan for me to follow. I was aware that the office was going to close and that I would need to switch clinics, but was told that my care would pick up where it left off. After going through testing for my husband and myself, I was told that the clinic was closed and that I would have to start over at CCRM-Colorado Center for Reproductive Medicine. My next step was to start Clomid. The Clomid was to be prescribed once all of my testing was complete. I had just finished the last test and then told that the Clomid would not be prescribed and that I would need to contact CCRM. After contacting CCRM, I was told that to even move forward with any sort of care, I will need over $600 on top of the money that I have already spent to this point. My insurance only covered 50% of fertility costs. I have been cheated by Kaiser and would not have started this process if I knew this. Paying for another initial appointment and more testing is a waste of time and resources. These are things that I have already done. CCRM does not have any other packages available for Kaiser patients other than this package including new testing. This is my only option. I now owe money to Kaiser for reproductive services that did not result in following the plan that was initially created by myself and the doctor in May. It has now been almost a year since my husband and I have been trying to conceive and we have lost a lot of time and money due to Kaiser. I am still not pregnant and do not have the resources to spend over $600 after insurance to receive any further care. I would like a refund on all of the testing and for the appointment that I have done with Kaiser in the reproductive clinic. Product_Or_Service: Reproductive Services

Desired Settlement: DesiredSettlementID: Other (requires explanation) I would like to complete the initial plan made my the doctor and myself. I was due to start un-monitored Clomid immediately following my HSG test . The plan was to try this for two months and then further discuss the next steps if it was not successful or I want a refund for all services from this clinic.

Business Response: Initial Business Response /* (1000, 6, 2015/08/18) */ August 18, 2015 **** ******* Trade Practices & Helpline Specialist Denver/Boulder BBB P.O. Box XXXXX Denver, Colorado XXXXX Complaint Case # XXXXXXXX Consumer: *******, ***** Case Opened: August 13, 2015 Dear Ms. ****** This is in response to your email received on August 14, 2015, forwarding concerns on behalf of our member; ***** *******, regarding a regarding a refund she is seeking for reproductive services received. We value the opportunity to review and respond to their grievance and apologize for the member's dissatisfaction. This case was filed as an initial grievance with Kaiser Permanente (KP) on July 21, 2015, and the Case Resolution Specialist mailed a response letter to Ms. ******* on August 6, 2015. I have ensured that the member's concerns were appropriately documented and shared with the Skyline Medical Office leadership, to include the Nurse Manager and Director of Women's Health Services. Please offer my sincere apologies to Ms. ******* for her continued frustration experienced as a result of the Skyline Medical Office Obstetrics/Gynecology-Reproductive Department closure. The KP Case Resolution Team is unable to address her reimbursement request for costs incurred/paid during her time as a patient in the department. For refund consideration, her specific charge refund request(s) must be outlined and submitted via the process stated in her August 6, 2015 response letter. Should the member require an additional copy of that letter to be mailed to her, please ask her to contact me directly at the number listed below. Again, I am sorry for how this has made the member feel, and I am available to answer any related questions. 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 2500 South Havana Street Aurora, Colorado 80014 Written requests will be reviewed by Member Services Administration who will respond to you in writing within 14 calendar days of the receipt of the member's request. We may extend this timeframe up to an additional 14 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 BBB or the member has any questions, please contact me at (XXX) XXX-XXXX. Also, you may contact Member Services: Denver/Boulder members may call 303-338-3800, toll free at X-XXX-XXX-XXXX, between 8 a.m. to 5 p.m., Monday through Friday. Deaf, 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-XXXX. You may also contact our department through our Web site at kaiserpermanente.org. Please thank our member for their understanding in this matter. We know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente. Sincerely, **** ** ***** Complex Case Resolution Specialist Member Experience

7/13/2015 Advertising/Sales Issues | Read Complaint Details
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Additional Notes

Complaint: Please see attachment

Desired Settlement: Please see attachment

Business Response: Initial Business Response /* ****** ** *********** */ May 29, 2015 Ms. ******** ***** Lead Trade Practices Consultant Denver/Boulder BBB P.O. Box XXXXX Denver, Colorado XXXXX Complaint Case # XXXXXXXX Consumer: ******* ****** Case Opened: 04/24/2015 Dear Ms. ******, This is in response to your email received on May 18, 2015, forwarding concerns on behalf of our member; ******* ****** regarding her request to have his past due premiums be waived for his Kaiser Permanente Senior Advantage Plus Option 1 plan. In addition requesting financial compensation for time spent time on his enrollment concerns. We value the opportunity to review and respond to their grievance and apologize for the member's dissatisfaction. We have formally documented and shared Ms. ************* grievance with the appropriate leaders in the Consolidated Service Center I have reviewed the initial grievance filed with the Case Resolution Team on April 16, 2015. I have confirmed your grievance was appropriately documented and shared with the appropriate managers and a detailed resolution letter was mailed to you on May 1, 2015. In addition, I have reached out to our ******** Operations Manager and requested a complete audit of the billings and payments regarding your premiums for the years 2014 and 2015. I requested to have all the communication regarding your enrollment, premium notices, dis-enrollment, re-enrollment and responsibility of premium payments. Upon review of all the above mentioned documents, I have created a time line of events: 12/9/2014- Letter issued to member stating SSA was not successful and member will be billed directly for premiums for enrollment 1/7/2015- Letter issued regarding no premium payment received and payment needed to be received by 3/31/2015 or will be disenrolled 2/5/2015- Letter issued regarding no premium payment received and payment needed to be paid by 3/31/2015 or will be disenrolled 3/17/2015- Letter issued reminding member that member is responsible for premium and the SSA will not be paying premiums for the entire 2015 year. 3/28/2015- Member contacted member services regarding premium and payments, the representative, read the letters regarding payment and disenrollment notices to the member and resent them out to the member. 4/2/2015- Letter issued to the member regarding disenrollment due to nonpayment. 4/3/2015- Letter issued to the member with Medicare approval for disenrollment. 4/16/2015- Member arrived at KP and was assisted by ****** ********* in regards to getting re-enrolled. It was discovered that the member was enrolled in a new Medicare Advantage Plan with Advantage Plus Option 1 in December 2014 instead of January 2015. 4/18/2015- Letter issued to the member confirming re-enrollment in Senior Advantage health Plan with Advantage plus option 1 with the premium of $226.00 stating that member must pay premium each month to remain enrolled. 4/20/2015- Letter issued regarding re-enrollment of Senior Advantage with premium is $191.00 (Option 1 not listed, this was an error, the letter dated 4/18/2015 is the correct letter. 5/7/2015- Letter issued verifying that the member has selected Senior Advantage Plus option 1 and requested that the monthly premium be withheld from SSA benefit check. The effective date will be July 1, 2015. The letter states that the member must pay premiums up to July directly to Kaiser Permanente. After reviewing the audit, I have created the following summary of billing and payments: January 2014 through November 2014 billed: $99.00 * 11 = $1,089.00 December 2014 billed at new policy rate of $229.00 (Received a payment from SSA of $99.00 leaving a balance of $130.00) On December 24, 2014 SSA retracted $99.00 December payment which rolled back into the next month's billing. New balance for January 2015 is $455.00 ($226.00 + $99.00 + 130.00) February 2015 billed $226.00 new balance due $681.00 March 2015 billed $226.00 (KP received a payment from SSA in the amount of $226.00 leaving the balance $681.00) March balance $681.00 April 2015 - Plan was termed and an adjustment removing of the balance owed of $681.00 April 18, 2015 plan was reinstated, billed the monthly premium of $226.00 May 2015 billed $226.00 - balance owed $452.00 June 2015 billed $226.00- balance owed $678.00 May 2015 reversed the adjusted balance from Jan-Mar and rebilled $681.00 making new balance due $1359.00 May 2015 adjusted off December premium of $229.00 as courtesy leaving a balance of $1,130.00 Calculations $99.00 * 11= $1,089.XX (XXXX) $229.00 * 1= $229.XX (XXXX) $226.00 * 6= $1,356.XX (XXXX) Total Premiums billed from January 2014 through June 2015 = $2,674.00 Total payments made by SSA: $1,315.00 12 payments of $99.XX ( XXXX) 1 payment of $226.XX (XXXX) 1 deduction of $99.XX ( XXXX) Total adjustment made by Kaiser Permanente: $229.00- based on the returned voided check in the amount of $226.00 that you submitted to Kaiser Permanente on May 18, 2015. Total amount due: $1,130.00 Based on the written communication provided to Mr. ****** via mail explaining his premiums and their due dates we are unable to honor the request to have all back premiums waived. Regarding his request for financial compensation we are unable to address this request in the case resolution department. If the BBB 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 8 a.m. to 5 p.m., Monday through Friday. Deaf, 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-XXXX. You may also contact our department through our Web site at kaiserpermanente.org. Please thank our member for their understanding in this matter. We know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente. Sincerely, ********* ***** Complex Case Resolution Specialist Member Experience Initial Consumer Rebuttal /* ****** ** *********** */ (The consumer indicated he/she DID NOT accept the response from the business.) I DO NOT ACCEPT THE RESPONSE FROM THIS BUSINESS I attended the October 29, 2014 for Kaiser Permanente Senior Advantage, and signed up for the gold option to begin January 1, 2015. Kaiser purposely cancelled my December 2014 payment and tried to incorrectly implement the gold option for December 2014 instead of waiting for January 1, 2015. This was very confusing to Social Security, and triggered an anomaly in their computer to stop payments to Kaiser. Trying to fix this problem manually, Kaiser forced a payment of $229.00 for December 2014 which should have been $226.00 for January 2015. Then Kaiser forced a reimbursement of $99.00 Kaiser sent two identical letters fraudulently stating "...Medicare has notified us that your request for premium withholding is not successful..." which I never requested All these discrepancies prompted Social Security to force Kaiser to reconcile, but they did not respond in a timely manner. Kaiser made all of these errors,I was not responsible for any of these errors, and Kaiser should be penalized, and I should receive monetary compensation for all the problems that Kaiser has caused me. Final Business Response /* ****** *** *********** */ June 22, 2015 Ms. ******** ***** Lead Trade Practices Consultant Denver/Boulder BBB P.O. Box XXXXX Denver, Colorado XXXXX Complaint Case # XXXXXXXX Consumer: ******, ******* Case Opened: March 16, 2015 Dear Ms. ****** This is in response to your email received on June 15, 2015, forwarding the rebuttal to our original response provided on May 29, 2015 on behalf of our member; ******* ****** to provide evidence of insurance. The member additionally is requesting instructions on paying his premiums. We value the opportunity to review and respond to their grievance and apologize for the member's dissatisfaction. I have confirmed that on December 9, 2014, Kaiser Permanente sent the member a letter advising that the Center for Medicare and Medicaid Services (CMS) was not able to successfully withhold your premium payments from his Social Security benefit check. This is a request that was processed by the member upon completing his enrollment in his Health Plan with Kaiser Permanente. I have confirmed that on May 1, 2015 after filing the member had filed a formal complaint, a resolution letter was issued via mail to the member by ****** *********. In this letter the member was informed if his premium remains unpaid he could become dis-enrolled for non-payment. Also, the member must submit payment for January and February 2015 premiums to avoid cancellation. The member was advised that his premium due monthly is $226.00 with the Advantage Plus options he have added to his account. I have confirmed with Kaiser Permanente ******** Operations Manager, that Kaiser Permanente did process a good will gesture, due to an our error in enrolling the member in his new plan choice for 2015, starting December 2014, rather than starting January 01,2015. Kaiser Permanente did an adjustment of $229.00 for the premium for December 2014 and is not asking the member for this premium payment. Regarding the members request for financial compensation we are unable to address this request in the case resolution department. The member's feedback is essential to our commitment of continuous improvement in delivering the highest quality, most appropriate and compassionate ***** 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 2500 South Havana Street Aurora, Colorado XXXXX Written requests will be reviewed by Member Services Administration who will respond to you in writing within 14 calendar days of the receipt of the member's request. We may extend this timeframe up to an additional 14 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 BBB 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 8 a.m. to 5 p.m., Monday through Friday. Deaf, 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-XXXX. You may also contact our department through our Web site at kaiserpermanente.org. Please thank our member for their understanding in this matter. We know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente. Sincerely, ********* ***** Complex Case Resolution Specialist Member Experience

7/7/2015 Problems with Product/Service | Read Complaint Details
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Additional Notes

Complaint: Extremely poor member care service. Inappropriate and unacceptable timeline for medical services. My wife is having extreme back pain due to a herniated disc. The care plan has been to wait for her to heal instead of proactively addressing her pain. When she finally insisted on an injection, she was informed that the next available appointment was one month out. I experienced this same issue when I discovered I had a blood clot and asked to speak to a specialist. I was informed that I had to wait two months. We both have constantly experienced delays in care as well as uninformed or inexperienced medical advice. To be specific, my wife needs an injection today or tomorrow, not one month from now.

Desired Settlement: My wife needs to receive an injection in her back sooner, rather than later. It is unacceptable to schedule a procedure one month out for a patient who is in severe and debilitating pain. We want her scheduled for an appointment no later than the end of this week.

Business Response: Initial Business Response /* ****** ** *********** */ June 18, 2015 Ms. ******** Adams Trade Practices & Helpline Specialist Denver/Boulder BBB P.O. Box XXXXX Denver, Colorado XXXXX Complaint Case # XXXXXXXX Consumer: ******, **** Case Opened: 06/05/2015 Dear Ms. Adams, This is in response to your email received on June 05, 2015, forwarding concerns on behalf of our member; **** ******, regarding his wife's medical needs. We value the opportunity to review and respond to their grievance and apologize for the member's dissatisfaction. I contacted Mr. ******'s wife directly, as we are unable to file complaints or work complaints through a spouse, without written consent of the member. I spoke to Emily ****** regarding her experience and the complaint filed by her husband. Mrs. ****** confirmed that she was able to obtain an earlier appointment and that she has received the injection for her back pain. She states she is feeling better and that she is unsure of what steps to take next. We spoke a while about being her own best advocate for her care and that if she is ever uncomfortable with a suggestion made by a physician, she always has the right to a second opinion. I encouraged Mrs. ****** to touch base with her Primary Care Physician about some of her concerns and see if they have any suggestions. I also told her that the kp.org website is useful to email her doctors with any questions or concerns. I told her that I was troubled that she felt she had to become a different person, become rude, to obtain assistance. We talked about what it means to advocate for her best interests and how important it was to communicate with her doctors. I also informed her that if she ever has a poor experience with a department at Kaiser Permanente or a physician, that she can file a complaint directly with the Member Services Department by phone (XXX-XXX-XXXX) or through the kp.org website. I asked if Mrs. ****** would like to proceed with a formal complaint against the Neurosurgery Department regarding the difficulty obtaining appointments, and she said she did not want to file a complaint. I apologized for the frustrations and I informed her that when she files a complaint directly with Member Services, that the Case Resolution Department has a staff of physicians and nurses who assist with trying to get earlier appointments and address medical concerns. The member's feedback is essential to our commitment of continuous improvement in delivering the highest quality, most appropriate and compassionate ***** 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 2500 South Havana Street Aurora, Colorado XXXXX Written requests will be reviewed by Member Services Administration who will respond to you in writing within 14 calendar days of the receipt of the member's request. We may extend this timeframe up to an additional 14 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 BBB 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 8 a.m. to 5 p.m., Monday through Friday. Deaf, 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-XXXX. You may also contact our department through our Web site at kaiserpermanente.org. Please thank our member for their understanding in this matter. We know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente. Sincerely, Tina K.C. Kimpo Complex Case Resolution Specialist Member Experience

7/7/2015 Advertising/Sales Issues | Read Complaint Details
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Additional Notes

Complaint: Balance remains at $2500.00 regardles of payments made over the last year. Customer Service can not resolve the issue, but have proof of payments. Reconcile payment history and apply to original balance.

Desired Settlement: reconcile all payments and apply to the original balance.

Business Response: Initial Business Response /* ****** ** *********** */ March 31, 2015 Ms. Monique Nelson Trade Practices & Helpline Specialist Denver/Boulder BBB P.O. Box XXXXX Denver, Colorado XXXXX Complaint Case # XXXXXXXX Consumer: ******, *********** Case Opened: March 16, 2015 Dear Ms. Nelson, This is in response to your email received on March 16, 2015, forwarding concerns on behalf of our member; *********** ******, regarding balance and payment history for services rendered at Kaiser Permanente. We value the opportunity to review and respond to their grievance and apologize for the member's dissatisfaction. We have formally documented and shared Mr. ******'s grievance with the appropriate leaders in Patient Financial Services Department. I also contacted a Patient Representative from the Escalated Billing team to inquire about the billing situation brought forth by Mr. ******. Patient Financial Services confirmed the following: Kaiser Ambulatory Surgical Center at Lone Tree experienced issues with their billing for services - surgeries were calculated at an incorrect rate. A corrected Professional Bill Summary was sent to the Mr. ****** on November 15, 2014, to notify him of the correct charges for medical services provided at the Lone Tree Ambulatory Surgical Center. Patient Financial Services identified the issue on October 2, 2014 and acted upon the error quickly. Mr. ****** had two claims that had to be reprocessed on November 15, 2014: o Date of Service: 2/18/14 - Claim #XXXXX Originally processed at $195.44 Reprocessed to $654.89 Difference was $459.45 more than original charge. o Date of Service: 2/18/14 - Claim #XXXXX Originally processed at $278.75 Reprocessed to $629.68 Difference was $350.93 more than original charge Mr. ******'s charges for the two items surgery service items went up by $810.38. Mr. ******'s payments toward these two claims totaled $558.19 (the original quoted cost of $474.19 plus one additional payment in the amount of $84.00. Mr. ******'s account balance is currently: $726.38 (2 claims totalling $1284.57 - payments applied: $558.19 = $726.38). This letter confirms that a balance of $726.38 will remain Mr. ******'s responsibility, for the surgery services rendered on February 18, 2014, at the Lone Tree Ambulatory Surgery Center. We regret that the billing system caused Mr. ****** frustration and confusion. The member's feedback is essential to our commitment of continuous improvement in delivering the highest quality, most appropriate and compassionate ***** 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 **** South Havana Street Aurora, Colorado XXXXX Written requests will be reviewed by Member Services Administration who will respond to you in writing within 14 calendar days of the receipt of the member's request. We may extend this timeframe up to an additional 14 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 BBB 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 8 a.m. to 5 p.m., Monday through Friday. Deaf, 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-XXXX. You may also contact our department through our Web site at kaiserpermanente.org. Please thank our member for their understanding in this matter. We know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente. Sincerely, **** K.C. Kimpo Complex Case Resolution Specialist Member Experience Initial Consumer Rebuttal /* ****** ** *********** */ (The consumer indicated he/she DID NOT accept the response from the business.) I have still have not received a new invoice with the appropriate balance. That will end the dispute. Looking forward to an invoice reflecting the proper balance of $726.35. I have spent will over 48 hours on hold, being hung up on and being told that I still owed $2500.00 for various reasons, but know one could explain why my payments were not reflected in the invoices that have been sent since November. Final Consumer Response /* ****** *** *********** */ (The consumer indicated he/she DID NOT accept the response from the business.) I was told my payments were not applied. They told me they would correct it. Please have someone contact me immediately with the adjusted balance and a new invoice with correct balance. Final Business Response /* ****** *** *********** */ June 18, 2015 Ms. ******** Adams Trade Practices & Helpline Specialist Denver/Boulder BBB P.O. Box XXXXX Denver, Colorado XXXXX Complaint Case # XXXXXXXX Consumer: ******, *********** Case Opened: June 05, 2015 Dear Ms. Adams, This is in response to your email received on June 05, 2015, forwarding concerns on behalf of our member; *********** ******, regarding balance and payment history for services rendered at Kaiser Permanente. We value the opportunity to review and respond to their grievance and apologize for the member's dissatisfaction. On May 22, 2015, I had advised that Kaiser Permanente would honor a one-time service gesture, in goodwill. I informed the Better Business Bureau in my last correspondence that Kaiser Permanente would adjust $810.38 off from Mr. ******'s account balance. I also stated that it would take between 4-6 weeks for the adjustment to be applied to Mr. ******'s account. Our systems indicate that our Patient Financial Services Department adjusted Mr. ******'s account balance on May 27, 2015, waiving $810.38. I also note that the Patient Financial Services Department restructured Mr. ******'s payment plan according to the new balance on June 5. 2015. If Mr. ****** requires further assistance regarding his account balance, his payments, or payment questions in general, he is advised to contact the Patient Financial Services Department directly, at XXX-XXX-XXXX. This concludes the member's review rights regarding this specific complaint issue. If the BBB or the member has any questions or concerns regarding this particular case, please feel free to call me directly at XXX-XXX-XXXX. In the event that the member has a new concern, not related to this particular experience, they may contact the Member Services Department at XXX-XXX-XXXX or toll free at X-XXX-XXX-XXXX. Deaf, hard of hearing, or speech impaired people 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-XXXX. You may also contact our department through our Web site at kaiserpermanente.org. Please thank our member for their understanding in this matter. We know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente. Sincerely, **** K.C. Kimpo Complex Case Resolution Specialist Member Experience

7/1/2015 Advertising/Sales Issues | Read Complaint Details
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Additional Notes

Complaint: extortion letters and phone calls for incorrect charge. Keep getting bills for a 2015 premium of $46. Call every month and the representative all say it's a incorrect bill for the January 2015 premium. My 2015 monthly premium is $0. 2014 was $49. Now we are getting letters and automated phone calls demanding payment by June 30th or they will drop me from the plan. Obviously they have opted to use extortion to collect money that they are not entitled to. Kaiser has never called back to explain why this accounting error cannot be resolved. I paid the black mail payment of $46 to hopefully prevent kaiser from screwing up my medicare deduction that they collect each month.

Desired Settlement: $46 and notification that my account is up to date.

Business Response: Initial Business Response /* ****** ** *********** */ June 25, 2015 ******** Adams Trade Practices & Helpline Specialist Denver/Boulder BBB P.O. Box XXXXX Denver, Colorado XXXXX Complaint Case # XXXXXXXX Consumer: *******, ********* Case Opened: June 17, 2015 Dear Ms. Adams, This is in response to your email received on June 23, 2015, forwarding concerns on behalf of our member, ********* *******, regarding premium bills received in the amount of $46. We value the opportunity to review and respond to their grievance and apologize for the member's dissatisfaction. We have formally documented and shared Ms. *******'s concerns with the Consolidated Service Center Medicare Issues Department, to include the Operations Managers. I have reached out to Kaiser Permanente's Medicare Issues Department explaining Ms. *******'s dissatisfaction with being billed for $46.00 premiums, though her 2015 premium is $0. The case research is concluded with the following account information provided: The member was issued a refund for overpayment of $46.00 received on December 22, 2014. However, the member also requested that the payment be refunded back to the credit card by their Credit Union. This had left a $46.00 balance on the member's account. Currently, the member's 2014 Kaiser Permanente account is paid in full, and her balance for 2015 is $0. The member's dunning cycle has been reset. This will stop the sending of dunning notices. Please apologize to the member for any frustration or confusion that may have been caused to her by this matter, and I hope that the resolution is satisfactory. The member's feedback is essential to our commitment of continuous improvement in delivering the highest quality, most appropriate and compassionate ***** 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 **** South Havana Street Aurora, Colorado XXXXX Written requests will be reviewed by Member Services Administration who will respond to you in writing within 14 calendar days of the receipt of the member's request. We may extend this timeframe up to an additional 14 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 BBB 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 8 a.m. to 5 p.m., Monday through Friday. Deaf, 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-XXXX. You may also contact our department through our Web site at kaiserpermanente.org. Please thank our member for their understanding in this matter. We know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente. Sincerely, **** M. Brown Complex Case Resolution Specialist Member Experience Initial Consumer Rebuttal /* ****** ** *********** */ (The consumer indicated he/she ACCEPTED the response from the business.)

6/26/2015 Advertising/Sales Issues | Read Complaint Details
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Additional Notes

Complaint: When switching from coverage through connect for care colorado to an individual policy purchased through Kaiser, billing has been messed up. Kaiser acct# XXXXXXXXXX and #XXXXXXXXXX medical record number XXXXXXXXX I have spoken many times to various employees of Kaiser trying to resolve these issues since Jan. 2015. Everyone seems only able to see part of any of my accounts and no one has access to every thing they need to figure this out. I was told I was dropped on Dec. 31, 2014 on the exchange even though I had paid for Jan, 2015 in Dec. and began coverage bought directly from Kaiser beg. Mar 2015 I was told for some reason I had two accounts but oone health record number. I was told the Jan. ccredit from the old acct. would post to the new aacct. for Jan. I was never billed for Feb. nor cwould my card work to fill prescriptions, etc. sso I did not pay for Feb. I paid for my first mmonth of coverage with my individual application llate Jan/Feb with a credit card and same pmt. has been lost by Kaiser by posted to my bank on 2/2/15 In Dec 2014, I sent check ***** in the amount of $714.78 for coverage for Dec 2014 $357.39 and Jan 2015 (new pmt was $360.10 but I paid $357.39) I later paid $2.71 for the difference. Instead of continuing my coverage automatically, I was cancelled and am now being told I had NO coverage in Jan/Feb 2015. Originally, I was told that the excess was showing as a credit on acct# XXXXXXXXXX. I was told that would be rolled over to my new account # XXXXXXXXXX. I applied to coverage directly through Kaiser in late Jan/Feb for coverage effective Mar 1, 2015. I included at that time payment for $360.10 for the month of March. X-XX-XX I had received a bill for $1080.30 and spoke to Brenda in payments and Kevin in billing. Brenda said she thought they had sent me a check for the Jan. pmt. which was an overpayment and it might take 6 weeks but she wasn't sure the check was sent. Kevin said I had NO coverage in Jan and Feb due to the cancellation. I was unable to fill any prescriptions or obtain medical care because I was listed as not covered for these months. No one seems to know what has happened to the pmt. sent for Jan. except possibly it was used to make the mar 2015 pmt which was paid for with my credit card. They can find no record of this credit card payment which posted to my bank on 2-2-15. Kevin in billing today told me my account was paid for March (but not with the credit card payment) and would automatically be billed to the same credit card tomorrow on 3/31/15. To the best of my understanding, since I was not covered for Jan. and Feb. no money was owed although I did make two payments of $357.39 and $2.72 for a total of $360.10 which is one full month of coverage in 2015. It appears that I am now overpaid by $360.10 for January, I made no payment in Feb. nor do I feel I owe one for Feb 2015 and they have lost the credit card payment that was supposed to go to March 2015

Desired Settlement: I would like them to find the credit card payment listed as: Bill Payment Ln Adv: #XXXXXX KAISER PERMANENTE XXX-XXX-XXXX CO Card 8731 as well as my check #9533 which covered Dec. and Jan. From either the half of the check above that was for Jan. or the missing credit card payment, I feel I am owed a refund of $360.10 that I overpaid. I can prove I paid for Jan. and Mar 2015 and did NOT get billed nor did I pay for nor was I covered for Feb. 2015 and nothing should be owed for that month.

Business Response: Initial Business Response /* ****** ** *********** */ April 22, 2015 Ms. Ashleigh Adams Trade Practices & Helpline Specialist Denver/Boulder BBB P.O. Box XXXXX Denver, Colorado XXXXX Complaint Case # XXXXXXXX Consumer: ******, ****** Case Opened: April, 9, 2015 Dear Ms. Nelson, This is in response to your email received on April 9, 2015, forwarding concerns on behalf of our member; ****** ****** regarding her health plan premium payment issue and her request to account for her payments, and her refund request for overpayment in the amount of $360.10. We value the opportunity to review and respond to their grievance and apologize for the member's dissatisfaction. We have formally documented and shared Ms. ******'s grievance with the appropriate leaders in our Membership Administration Department for plans purchased through Connect for Health Colorado, and with our leadership for plans purchased directly through Kaiser Permanente. I made a phone call to Ms. ****** on April 17, 2015 to clarify the direction she wanted to take regarding her health plan through Connect for Health Colorado. Ms. ****** confirmed that she wants to keep her direct plan with Kaiser Permanente and she does not want to work with Connect for Health Colorado. She wants to terminate the plan with Connect for Health as though it were never active, because when she needed prescriptions at the beginning of the year, she was told she did not have coverage - this is the reason she purchased a plan directly through Kaiser Permanente. I relayed Ms. ******'s request through our Membership Administration Department for On-Exchange health plans, and I was informed that Ms. ****** would need to contact Connect for Health personally to request that her 2015 plan be cancelled as though it were never active. Connect for Health shows Ms. ******'s 2015 plan active through February 28, 2015 and that she currently owes a premium for the month of February. I can confirm that Ms. ******'s direct plan with Kaiser Permanente started on March 31, 2015, and that Membership Accounting received her payment in the amount of $360.10 on January 30, 2015, and another payment in the amount of $360.10 on March 31, 2015 (the amount paid covers March and April premiums). The next payment of $360.10, for May premium, will be auto-drafted at the end of this month, on April 30, 2015. The member's feedback is essential to our commitment of continuous improvement in delivering the highest quality, most appropriate and compassionate ***** 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 2500 South Havana Street Aurora, Colorado XXXXX Written requests will be reviewed by Member Services Administration who will respond to you in writing within 14 calendar days of the receipt of the member's request. We may extend this timeframe up to an additional 14 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 BBB 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 8 a.m. to 5 p.m., Monday through Friday. Deaf, 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-XXXX. You may also contact our department through our Web site at kaiserpermanente.org. Please thank our member for their understanding in this matter. We know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente. Sincerely, Tina K.C. Kimpo Complex Case Resolution Specialist Member Experience Initial Consumer Rebuttal /* ****** ** *********** */ (The consumer indicated he/she DID NOT accept the response from the business.) Yes, during our phone call I thought we had resolved the matter. I was told by Ashleigh that SHE would request that connect for Health Colorado cancel me retroactively to Jan 1 and issue a refund in the amount of $360. I was at no time told that I needed to contact them. I also received a letter a few days later saying Connect couldn't process my request or something to that effect. I left a phone message with Ashleigh telling her about the letter and asking her to call me if I needed to do anything else. I never heard anything. Currently, it looks like from this response not only is the account not cancelled but my refund is not in process and further, I still owe for Feb. Final Business Response /* ****** *** *********** */ June 18, 2015 Ms. Ashleigh Adams Trade Practices & Helpline Specialist Denver/Boulder BBB P.O. Box XXXXX Denver, Colorado XXXXX Complaint Case # XXXXXXXX Consumer: ******, ****** Case Opened: 06/05/2015 Dear Ms. Adams, This is in response to your email received on June 05, 2015, forwarding concerns on behalf of our member; ****** ****** regarding her request to retro terminate her plan contract with Connect for Health Colorado. We value the opportunity to review and respond to their grievance and apologize for the member's dissatisfaction. We have formally documented and shared Mr. Barrett's grievance with the appropriate leaders who work with Connect for Health Colorado for the Kaiser Permanente On-Exchange plans. I was informed that the reason that Connect for Health did not honor the request to terminate Ms. ******'s plan as though never active, was due to the fact that she contacted Connect for Health Colorado and had requested a termination date of February 28, 2015. It is unclear why Connect for Health Colorado would request Kaiser to contact them to affirm the request to retro terminate Ms. ******'s plan, as I had made a request for Connect for Health Colorado to terminate the 2015 On Exchange plan as though it were never active at the inception of Ms. ******'s request through the Better Business Bureau. We are sorry for the frustration experienced throughout this third party transaction. This letter confirms the cancellation of Ms. ******'s On-Exchange Plan through Connect for Health Colorado. The cancellation was accomplished through a conference call held with Connect for Health Colorado today, June 18, 2015. Any payments made toward the 2015 On-Exchange plan will be processed as a refund. The refund process can take up to six weeks. The member's feedback is essential to our commitment of continuous improvement in delivering the highest quality, most appropriate and compassionate ***** 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 2500 South Havana Street Aurora, Colorado XXXXX Written requests will be reviewed by Member Services Administration who will respond to you in writing within 14 calendar days of the receipt of the member's request. We may extend this timeframe up to an additional 14 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 BBB 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 8 a.m. to 5 p.m., Monday through Friday. Deaf, 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-XXXX. You may also contact our department through our Web site at kaiserpermanente.org. Please thank our member for their understanding in this matter. We know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente. Sincerely, Tina K.C. Kimpo Complex Case Resolution Specialist Member Experience Final Consumer Response /* ****** *** *********** */ (The consumer indicated he/she ACCEPTED the response from the business.) I thank Kaiser for working so hard to resolve this. Sounds like it is finally on track for completion

6/8/2015 Advertising/Sales Issues | Read Complaint Details
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Additional Notes

Complaint: My effective coverage, purchased through Connect for Colorado, is for 2/1/15. Kaiser charged me for January and refuses to credit me. Summary: My effective date for insurance purchased through the Exchange is February 1, 2015. TWICE Kaiser has acknowledged receipt of the paperwork with this date. Yet Kaiser continually denies this whenever I attempt to get a refund, stating my date is January 1. 12/17/14: I purchased health insurance through Connect for Colorado Exchange. Since it was after 12/15, (the cut-off for obtaining insurance for January) my effective date was February 1. However, something occurred and my begin date was January 1. 1/4/15: I contacted Kaiser about my January bill asking how to fix it. Kaiser told me to contact the Exchange because Kaiser's record showed a 1/1 start date. Sometime between the 4th and the 17th, I contacted the Exchange and fixed the error. 1/17/15: I e-mailed Kaiser to confirm that it was fixed. 1/27/15: Kaiser (Christian DeShazer) said it would take about a week for them to get the file and update. 2/9/15: I paid my February premium of $238.36 from my checking account. 2/11/15: I e-mailed Kaiser to check the status of my file. 2/17/15: Kaiser (Robert Childress) spoke to its processing center and it confirmed they received the file showing a February 1 start date. Kaiser said it would take an additional 7-10 days to complete the process in its system. 2/27/15: I paid my March premium of $238.36 on my Discover. Sometime in March (around the 10th or so) I received a letter stating that my insurance had been revoked due to failure to pay. I had paid my premiums for February, March, and April. However, Kaiser continually was charging me for January so there was an outstanding balance. I called Kaiser and they told me I needed to call Connect for Colorado to be reinstated and to yet again fix the effective date (even though Kaiser had already said they had received the correct paperwork in February). I called the Exchange and they sent the paperwork over and told me it could take about 21 days for Kaiser to update everything. 3/24/15: I paid $476.72 on my Discover. This was the outstanding balance for January (a month I never agreed to pay) and April's premium. I decided to finally pay for January because I got scared when I receive the insurance revocation letter and wanted to protect myself. 4/8/15: I e-mailed Kaiser to see if the system had been updated and my insurance reinstated. 4/9/15: Kaiser (Christian DeShazer) received the reinstatement and it showed the effective date of 2/1/15. Kaiser then told me I was paid through April 30. I never owed a bill in January so actually I should be paid through May. 4/21/15: I asked for the contact information of someone who can fix my billing error. 4/23/15: I was again told by Kaiser (Sara Baker) that my effective date was January 1, 2015 and told me to contact the Exchange to fix this error.

Desired Settlement: I would like a credit for May.

Business Response: Initial Business Response /* ****** ** *********** */ May 18, 2015 Ms. Ashleigh Adams Lead Trade Practices Consultant Denver/Boulder BBB P.O. Box XXXXX Denver, Colorado XXXXX Complaint Case # XXXXXXXX Consumer: ******* ********** Case Opened: 04/24/2015 Dear Ms. Nelson, This is in response to your email received on May 05, 2015, forwarding concerns on behalf of our member; ******* ********** regarding her request to have 2015 KP CO Silver 2500/30 health plan effective date corrected to February 01, 2015 from January 1, 2015. In addition to ensure that members premium payments are applied correctly. We value the opportunity to review and respond to their grievance and apologize for the member's dissatisfaction. We have formally documented and shared Ms. **********'s grievance with the appropriate leaders in the Consolidated Service Center. I have reached out to Kaiser Permanente's Exchange Relationship Manager, and I have confirmed that the effective date of Ms. **********'s 2015 KP CO Silver 2500/30 health plan, was January 1, 2015, however it has been updated to February 1, 2015. Kaiser Permanente does not have the ability to make changes on plans enrolled through Connect for Health Colorado. Connect for Health Colorado will send Kaiser Permanente a file with updated member information, if a member has changed their plan and Connect for Health Colorado has approved it. Once Kaiser Permanente receives the file, the updated information is loaded into Kaiser Permanente systems. I apologize for the length of time this takes, I have also requested a refund of the January 2015 premium, in the amount of $192.23 and have been advised by Kaiser Permanente Individual and Family On-Exchange Operations, that a refund takes 30-45 days to process, so by the time the refund is authorized, the June 2015 premium will be due, the refund will be applied to your June 2015 premium. The member's feedback is essential to our commitment of continuous improvement in delivering the highest quality, most appropriate and compassionate ***** 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 2500 South Havana Street Aurora, Colorado XXXXX Written requests will be reviewed by Member Services Administration who will respond to you in writing within 14 calendar days of the receipt of the member's request. We may extend this timeframe up to an additional 14 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 BBB 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 8 a.m. to 5 p.m., Monday through Friday. Deaf, 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-XXXX. You may also contact our department through our Web site at kaiserpermanente.org. Please thank our member for their understanding in this matter. We know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente. Sincerely, Christine Davis Complex Case Resolution Specialist Member Experience

6/1/2015 Advertising/Sales Issues | Read Complaint Details
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Additional Notes

Complaint: Kaiser continues to bill me for insurance that I no longer have. I was previously enrolled in Kaiser Permanentes KP CO Bronze 5000/30%/HSA Plan through Connect for Health Colorado. My plan started on May 1, 2014 and was supposed to be cancelled at the end of December 2014 as I got onto my current employers health insurance plan at this time. When I signed up for Kaiser's plan I was having a direct ACH (automatic payments)taken from my account to pay the monthly premium. After contacting Kaiser at the beginning of November 2014 I informed them of my request to cancel the plan effective at the end of December 2014. The representative at Kaiser informed me that I needed to contact Connect for Health Colorado to notify them of my cancellation. After contacting Connect for Health Colorado I was told they would notify Kaiser of the cancellation which would take about a month or so for them to receive. I contacted Kaiser once again and let them know I had notified Connect for Health Colorado of my cancellation and that they should be receiving the notice soon. The representative at Kaiser told me that they would put a note on my account to be aware the policy was cancelled. After my last premium bill was paid for the month of December 2014 I contacted Kaiser and told them to make sure my ACH would be stopped. The representative said the billing would be stopped and no more ACH payments would be coming out of my account. In the month of January 2015 I received another bill stating that I owe the premium for the month of January 2015 for the amount of $158.26. I immediately called Kaiser to inquire why I was receiving this bill. I was told that my notification of cancellation from Connect for Health Colorado had not been received but I should disregard the bill since the notice should be on its way. I continued to receive bills every month after this and every time I would contact Kaiser to inquire why I was still receiving these bills. The representative each time I called told me the same information, and told me to disregard the bill. There were numerous times that I was on hold for over 45 minutes, only to be hung up on. I then contacted Connect for Health Colorado and they had confirmed that the notification had been sent to my health provider (Kaiser). My most recent bill I have received from Kaiser as of April 30, 2015 states that I currently owe $791.30 for coverage that I had cancelled in December of 2014. I would like this to get taken care of so this does not get turned in to collections.

Desired Settlement: I would like Kaiser to stop billing me for insurance premiums that I don't even have coverage for. I would like it to be clear that I do not owe Kaiser any premiums and that I no longer have any type of coverage through Kaiser.

Business Response: Initial Business Response /* (1000, 5, 2015/05/18) */ May 18, 2015 Ms. ******** ***** Trade Practices & Helpline Specialist Denver/Boulder BBB P.O. Box XXXXX Denver, Colorado XXXXX Complaint Case # XXXXXXXX Consumer: **********, ***** Case Opened: May 5, 2015 Dear Ms. ****** This is in response to your email received on May 5, 2015, forwarding concerns on behalf of our member, Mr. ***** **********. Mr. ********** expressed his concerns that Kaiser Permanente continues to bill him for insurance that he no longer has through Connect for Health Colorado. Mr. ********** states that he requested a termination of his coverage effective the end of December 2014, through Connect for Health Colorado, and he states that he continues to receive bills from Kaiser Permanente. I regret that Mr. **********'s request has taken so long to process. I contacted our lead representative, who works directly with Connect for Health Colorado and I was advised that Mr. **********'s 2015 plan, is cancelled as of December 31, 2014 in both Connect for Health Colorado systems and Kaiser Permanente's systems. I was informed that this request was not updated in the Connect for Health systems until April 2, 2015, Connect for Health Colorado sent the update to Kaiser Permanente, and we updated in our systems on April 17, 2015. I am sorry that Mr. ********** has continued to receive invoices. I was advised to inform Mr. ********** that it can take 2-3 billing cycles for the invoices related to this account to cease. Mr. ********** is advised to disregard the invoices that are sent, his premiums for 2014 are paid in full, and he owes nothing more for his plan through Connect for Health Colorado. 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 2500 South Havana Street Aurora, Colorado XXXXX Written requests will be reviewed by Member Services Administration who will respond to you in writing within 14 calendar days of the receipt of the member's request. We may extend this timeframe up to an additional 14 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 BBB 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 8 a.m. to 5 p.m., Monday through Friday. Deaf, 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-XXXX. You may also contact our department through our Web site at kaiserpermanente.org. Please thank our member for their understanding in this matter. We know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente. Sincerely, **** **** ***** Complex Case Resolution Specialist Member Experience

5/26/2015 Advertising/Sales Issues | Read Complaint Details
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Complaint: Called numerous times since Dec 2014 to remove daughter from health plan. Still being billed for daughter 4 months later. Kaiser Account number XXXXXXXXX. I have called 1-2 times a month since December 10th, 2014 to remove my daughter from our health plan. She is now being covered under CHP+. Every time I call they say it is taken care of, but every month I get a new bill it includes the charges for my daughter. I have paid these bills to maintain health coverage, but I do not believe I should be billed for January-April since Kaiser takes so long to process any kind of changes and I have had this removal request in process since December.

Desired Settlement: I would like a refund for the excess amount billed for medical insurance for the months of January, Feb, March, and April. This amount is $135.26 per month. I would also like assurance that my daughter is actually removed from my medical plan.

Business Response: Initial Business Response /* ****** ** *********** */ May 11, 2015 Ms. ******** Adams Trade Practices & Helpline Specialist Denver/Boulder BBB P.O. Box XXXXX Denver, Colorado XXXXX Complaint Case # XXXXXXXX Consumer: ***** ******* Case Opened: April 27, 2015 Dear Ms. Adams, This is in response to your email received on April 27, 2015, forwarding concerns on behalf of our member; ***** ******* regarding her policy through Connect for Health Colorado. Ms. ******* states that she made a request to remove her daughter from her health coverage and stated that she is still being billed for her daughter. Ms. ******* states that she does not believe she should be billed for premiums that included her daughter in 2015. In summary, Ms. ******* stated that she would like a refund for the excess amount billed for medical insurance premiums for her daughter at a rate of $135.26 per month, and Ms. ******* asked for assurance that her daughter is actually removed from her medical plan. We value the opportunity to review and respond to their grievance and apologize for the member's dissatisfaction. We have formally documented and shared Mr. Barrett's grievance with the appropriate leaders in our Membership Administration Department for contracts through Connect for Health Colorado. I also contacted our in-house specialist who works with Connect for Health to assist with Ms. *******'s concerns. The process to remove Ms. *******'s daughter from her 2015 health coverage purchased through Connect for Health Colorado, began on April 29, 2015. It is unclear why it took Connect for Health Colorado so long to process the plan change. Kaiser Permanente, although we are the providers of the health care coverage, we are not the entity who oversees the contract or changes to the contract. Contract changes are all handled by Connect for Health Colorado. After outreach to Connect for Health Colorado, we are able to confirm that Ms. *******'s daughter, Audrey *******, is no longer insured through Connect for Health Colorado. Connect for Health Colorado accomplished this measure by terminating the original contract, as though it were never active. Please see the data below for confirmation of cancellation of the original 2015 plan through Connect for Health Colorado (#XXXXXCOXXXXXXXXX): Name Relationship Premium Effective Ending ***** ******* Subscriber $251.99 01/01/2015 12/31/2014 Audrey ******* Child $135.26 01/01/2015 12/31/2014 NOTE: This cancellation will trigger the refund process for the amount overpaid. This letter confirms that Ms. ******* was placed on a new individual plan for 2015 through Connect for Health Colorado (#XXXXXCOXXXXXXXXX), without her daughter: Name Relationship Premium Effective Ending ***** ******* Subscriber $251.99 01/01/2015 12/31/2015 NOTE: Member, ***** *******, needs to pay the binder payment to complete her enrollment for a 05/01/15 effective date, with no coverage for her daughter. The member's feedback is essential to our commitment of continuous improvement in delivering the highest quality, most appropriate and compassionate ***** 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 2500 South Havana Street Aurora, Colorado XXXXX Written requests will be reviewed by Member Services Administration who will respond to you in writing within 14 calendar days of the receipt of the member's request. We may extend this timeframe up to an additional 14 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 BBB 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 8 a.m. to 5 p.m., Monday through Friday. Deaf, 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-XXXX. You may also contact our department through our Web site at kaiserpermanente.org. Please thank our member for their understanding in this matter. We know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente. Sincerely, Tina K.C. Kimpo Complex Case Resolution Specialist Member Experience

4/20/2015 Advertising/Sales Issues | Read Complaint Details
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Complaint: Kaiser has made my life miserable for the entire year of 2014. The premium billing department is a wreck. Hold on to your hats. I've been a Kaiser Permanente customer since 2007. I signed up with Kaiser through the Colorado health care exchange to begin 2/01/2014 and received a subsidized 1500/30 Silver Policy($347/mo.) Shortly after I was informed my son was no longer eligible for medicaid (ACA glitch) and we put him on the SAME policy($355/mo). The original policy was cancelled through the health exchange on 4/30/2014 and I paid the Feb. and March premiums. The new policy was supposed to start 5/01/2007 but Kaiser claims it was 4/01/2014. Either way The bill's for the new policy never came on time and sometimes not at all. I called every single month to get my balance and sometimes I had to pay with a credit card because I was late. THE BILL'S FOR THE OLD POLICY NEVER STOPPED COMING AND ADDED UP TO $2500 as of the last bill. I was told each time I called to ignore the old policy bill and pay the new one(the one that never came on time. I kept calling and calling and one day the woman told me that the only policy I have on record is the old one which I owe $2500 and there was no record of the new one. So I gathered the papers I needed and sent them to 2 offices in California to try to get some attention (minimum hold time on Kaiser's line is 45 minutes.) I received an email that said Kaiser was sending my information to the Denver office to hopefully get my problem fixed. I received a bill in the meantime for the correct policy for 2 months premiums and promptly paid it. I've not received a bill for the correct policy since early October. I received a call from someone in the Denver office and she admitted it was a huge mess, that the person in charge was fired and they were working on my problem and might know more in a few weeks. She even gave me her direct number. Well, 2 days ago I received a letter from Kaiser that said I had not paid my bills and they were going to terminate my policy by January 31, 2015 if I didn't pay. I looked up my balance on my account web site and it said I owed $3600. I called the person who contacted me earlier but have not heard back yet. I need insurance desperately but I refuse to give Kaiser any money that I know I don't owe them and I know they will never pay back. I am very satisfied with their medical services but the billing issues have turned me into raving lunatic. I don't know why something so simple could become more and more screwed up as time goes on. If I billed them like lawyers do for my time hassling with them they would be the one's who owe me $3600.

Desired Settlement: It's sooooooooooo simple. Give me the policy YOU AGREED TO SELL ME. The premium is $351. Send me an ACTUAL BILL. I owe for November so far as I know. CANCEL THE POLICY THAT IS SUPPOSED TO BE CANCELLED AND ERASE THE DEBT THAT I NEVER OWED YOU. That premium is $347. I have proof of all this on my Connect for Health Colorado site. If this is not resolved by the ACA deadlines I will have to sign up with Rocky Mountain Health Plans. I will not pay you money that I do not owe you. Why is this so hard to do?

Business Response: Initial Business Response /* ****** *** *********** */ January 15, 2015 Ms. Heather ****** Lead Trade Practices Consultant Denver/Boulder BBB P.O. Box XXXXX Denver, Colorado XXXXX Complaint Case # XXXXXXXX Consumer: *******, **** Case Opened: December 10, 2014 Dear Ms. ******* This is in response to your email received on January 12, 2014, forwarding concerns on behalf of our member; **** ******* is to de-activate the incorrect policy with the termination date of April 30, 2014. Cancel the incorrect policy and remove all balances owed on the incorrect policy. We value the opportunity to review and respond to their grievance and apologize for the member's dissatisfaction. We have formally documented and shared Mr. *******'s grievance with the appropriate leaders in the Consolidated Service Center. I have reached out to Kaiser Permanente's Exchange Relationship Manager, and I have confirmed that Mr. ******* request has been escalated. The member had three separate accounts that had been created. The Consolidated Service Center is working directly with Connect for Health Colorado to remove the accounts that is in accurate. In addition we will have the funds transferred to the correct Exchange ID number The member's feedback is essential to our commitment of continuous improvement in delivering the highest quality, most appropriate and compassionate ***** 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 **** ***** ****** ****** Aurora, Colorado XXXXX Written requests will be reviewed by Member Services Administration who will respond to you in writing within 14 calendar days of the receipt of the member's request. We may extend this timeframe up to an additional 14 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 BBB 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 8 a.m. to 5 p.m., Monday through Friday. Deaf, 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-XXXX. You may also contact our department through our Web site at kaiserpermanente.org. Please thank our member for their understanding in this matter. We know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente. Sincerely, Christine ***** Complex Case Resolution Specialist Member Experience Initial Consumer Rebuttal /* ****** *** *********** */ I fixed the closing date issue with Connect for Health Colorado and received no further billing on that particular account BUT 2 months later began receiving bills for $18000! It was another additional account now valid in 2015. Connect for Health Colorado told me not to worry and that it was not a valid account BUT now Kaiser is wiping out my current deductible amounts and starting over with this bogus account! What does this mean? Where did they get $18000 from? For the life of me I can't figure these people out. They NEVER contact me in person OR in writing. What is the matter with this company? Do I have to file a new complaint for this problem now? I have decided I'm going to start sending them bills for my time through my company. They are not living up to their contract obligations and instead of helping me "Thrive" the are destroying my mental and physical health. I am convinced they do this intentionally to see if they can catch dupes off guard who will just send them money to get them off their back. Thanks for pursuing this, **** ******* Final Business Response /* ****** *** *********** */ March 31, 2015 Ms. Heather ****** Lead Trade Practices Consultant Denver/Boulder BBB P.O. Box XXXXX Denver, Colorado XXXXX Complaint Case # XXXXXXXX Consumer: *******, **** Case Opened: December 10, 2014 Dear Ms. ******* This is in response to your email received on March 26, 2015 forwarding additional concerns on behalf of our member; **** ******* regarding receiving incorrect premium bill in the amount of $18,000.00 and concerns regarding his deductible being applied accurately for the year 2015. We value the opportunity to review and respond to their grievance and apologize for the member's dissatisfaction. We have formally documented and shared Mr. *******'s grievance with the appropriate leaders in the Consolidated Service Center. I have reached out to Kaiser Permanente's Exchange Relationship Manager, and I have confirmed that Mr. ******* accounts had many moving pieces, there were 4 active accounts for this member, and all of them had payments. We have cancelled 3 accounts and transferred all payments on them to the right account. The invoice that the member received was inaccurate, because the coverage wasn't correct and also the transfer was completed on March 23, 2015 which was after the member had received the invoice. I have attached a breakdown for the member coverage and payments. In regards to claims being applied toward the member's deducible incorrectly, I have researched and verified that the member's claims have been applied correctly. Each year the deductible re-starts new and the member is responsible for the 1500.00 Individual and 3000.00 family. The member's feedback is essential to our commitment of continuous improvement in delivering the highest quality, most appropriate and compassionate ***** 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 **** ***** ****** ****** Aurora, Colorado XXXXX Written requests will be reviewed by Member Services Administration who will respond to you in writing within 14 calendar days of the receipt of the member's request. We may extend this timeframe up to an additional 14 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 BBB 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 8 a.m. to 5 p.m., Monday through Friday. Deaf, 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-XXXX. You may also contact our department through our Web site at kaiserpermanente.org. Please thank our member for their understanding in this matter. We know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente. Sincerely, Christine ***** Complex Case Resolution Specialist Member Experience

4/6/2015 Advertising/Sales Issues | Read Complaint Details
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Complaint: My husband and I have received rudeness, long wait times, inaccurate information being entered, and dishonesty. I received Kaiser through the Colorado MArketplace in October of 2014 and ever since I have regretted my decision. I have had to call over 15 times to straighten out issues with billing, information, cards, doctor appointments, and end of coverage. Every single time I waited an hour or more only to receive extreme rudeness from the representatives. They were either unable to answer my questions, or had to transfer me several times to do so. They said they cancelled our contract but did not and we have received several incorrect bills. This is the worst company I have ever dealt with and have let everyone in my circle know never to receive coverage from Kaiser Permanente.

Desired Settlement: We need our account rectified and the bills refunded that were unfair or incorrect.

Business Response: Initial Business Response /* ****** ** *********** */ March 6, 2015 Ms. ******* ****** Trade Practices & Helpline Specialist Denver/Boulder BBB P.O. Box XXXXX Denver, Colorado XXXXX Complaint Case # XXXXXXXX Consumer: ******, ***** Case Opened: February 19, 2015 Dear Ms. ******, This letter is in response to your email received on February 19, 2015, forwarding concerns on behalf of our member, ***** ******, regarding her policy cancellation request made through Connect for Health Colorado, request for clarification of her account, and her request for refund of all incorrect charges. We value the opportunity to review and respond to her grievance and apologize for the member's dissatisfaction. We have formally documented and shared Mrs. ******'s grievance with the Operations Manager for plans purchased through the Colorado Marketplace, as well as the appropriate leaders managing issues related to Kaiser Permanente Plans purchased through Connect for Health Colorado. I received notice today, March 6, 2015, that Connect for Health Colorado confirmed the termination of Mrs. ******'s healthcare coverage. It has been determined that a refund in the amount of $798.93, for over-payment of monthly premiums, will be returned by the same process it was originally paid. If it was paid by check, a check will be cut. If payment was electronically deducted, it will be refunded electronically. I am informed that it can take up to 45 days from today to complete the refund process. The member's feedback is essential to our commitment of continuous improvement in delivering the highest quality, most appropriate and compassionate ***** 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 **** ***** ****** ****** ******* Colorado XXXXX Written requests will be reviewed by Member Services Administration who will respond to you in writing within 14 calendar days of the receipt of the member's request. We may extend this timeframe up to an additional 14 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 BBB 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 8 a.m. to 5 p.m., Monday through Friday. Deaf, 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-XXXX. You may also contact our department through our Web site at kaiserpermanente.org. Please thank our member for their understanding in this matter. We know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente. Sincerely, **** **** ***** Complex Case Resolution Specialist Member Experience Initial Consumer Rebuttal /* ****** ** 2015/03/12) */ (The consumer indicated he/she DID NOT accept the response from the business.) I cancelled my account in January, and when I spoke with a representative on the phone, I was told that my cancellation of Kaiser Permanente coverage was effective January 31, 2015. I was not informed of anything else I would need to do, and I was told that it was all taken care of. My husband and I began paying for coverage from a different company on February 1, 2015. We received a few notifications from Kaiser doctors, so my husband called to confirm that we had cancelled our coverage. When he spoke with a representative, he was told that the system might be a little slow but that WE HAD CANCELLED AND NO FURTHER ACTION WAS NEEDED. When we had paid our Kaiser bills, I had tried 1 time to pay online but the website was giving me trouble and I called a representative to confirm that I had not accidentally signed up for Autopay and to make a 1 time payment on the phone. She told me I had not, and every time afterwards I sent in a check. The last payment we made was in January. Then, out of the blue, $532 was taken out of our bank account from Kaiser- which we had cancelled in JANUARY. I called and after speaking to multiple representatives, I was told by a billing specialist that I was stupid and had obviously enrolled in autopay and it was not their fault that WE HAD NOT TURNED IT OFF. I told her we had NEVER used it, but she said once again that it was my fault and there was nothing she could do. She also hung up on me. My husband called and was told the same thing- it was our fault. He was also told that they could see our confirmation but because it hadn't gone all the way through they would continue taking the monthly premiums until we either turn off Autopay or it finally goes through. We are OUTRAGED that a company can keep taking our money KNOWING that we don't even have coverage! They told us that they KNOW WE ARE NOT COVERED but will still take our money? And the fact that we will be refunded in 2 months or less does not help AT ALL because that money WAS NOT KAISER'S TO TAKE- EVER! Even in our outrage we went to the kp.org website to cancel autopay which we have never even used and the ONLY option is to enroll. And when I call to ask representatives they say that they have no control over the bill pay. Also, if we had enabled autopay why had none been withdrawn in February and then double in March? This is absolutely unacceptable. We do not have any money, so when Kaiser took our money for premiums that we do not even need because we are not covered we had to BORROW FROM CREDIT CARDS, ask family for money to cover our other bills because we are PAYING FOR OUR ACTUAL INSURANCE. This is the absolute worst business and I cannot comprehend how they can tell us we have no coverage but tell us it is our fault for not turning off autopay for an insurance that WE NO LONGER HAVE. Merely refunding us the money that you took that was not yours to take within two months does not rectify this situation AT ALL. We are scrambling to pay our bills and if it is not refunded with additional pay for our suffering, we will report you to the state insurance board and go as high as we need to go. Final Business Response /* (4000, 9, 2015/03/24) */ March 24, 2015 Ms. ******* ****** Trade Practices & Helpline Specialist Denver/Boulder BBB P.O. Box XXXXX Denver, Colorado XXXXX Complaint Case # XXXXXXXX Consumer: ******, ***** Case Opened: February 19, 2015 Dear Ms. ******, This letter is in response to the additional correspondence received on March 13, 2015, forwarding a response on behalf of our member, ***** ******, regarding her policy cancellation request made through Connect for Health Colorado, request for clarification of her account, and her request for refund of all incorrect charges, and the added request that we offer a monetary compensation for financial suffering. I am very sorry that the billing issue created a frustrating experience for Mrs. ****** and her family. I wish that the interaction with our Member Service Contact Center had been more positive, and I deeply regret that both she and Mr. ****** were treated poorly and outright blamed for the billing issue. Kaiser Permanente takes her dissatisfaction very seriously and I personally appreciate opportunity to review and respond to her concerns. In addition to notifying the Operations Manager for plans purchased through the Colorado Marketplace, and the leaders who manage issues related to Kaiser Permanente Plans purchased through Connect for Health Colorado, I plan to also notify the leadership of the Member Service Contact Center regarding the disrespect and lack of helpfulness experienced by both Mr. and Mrs. ******. I am currently working with a liaison with Connect for Health Colorado to try to find resolution for her concerns. Recently, I was informed that there was an error in the original amount sited by Connect for Health Colorado, as the overpayment/refund amount. At the time the previous response posted at the BBB website, there was a returned check that had not been documented and in turn not calculated in the amount due to the ****** household. A payment in the amount of $266.31, check number ***** intended for the February monthly premium, was returned and not applied to the member's account. When Kaiser Permanente deducted $532.62 from the member's account, it was to cover the past due February premium and the upcoming March premium. Connect for Health Colorado did not inform Kaiser Permanente that the ****** household had terminated their coverage with Kaiser Permanente (effective January 31, 2015), until after the March 2015 billing cycle began. Unfortunately our systems processed a payment that included the past due premium for February and upcoming premium due for March. I understand the financial hardship this delayed communication created for Mrs. ****** and her husband. Unfortunately, Kaiser Permanente did not have adequate notice from Connect for Health Colorado to cancel their active coverage before the next autopay date. The refund mentioned in the previous response to the Better Business Bureau was $798.93 (for January, February, and March premiums); however, due to returned payment intended for February, the amount of the refund due to the member is actually $532.62. Mrs. ****** requested monetary compensation for the financial hardship she experienced. I spoke to the management in my department and explain the situation. Although we cannot offer a monetary gift to compensate for the financial inconveniences caused by the delayed communication between Connect for Health Colorado and Kaiser Permanente, I have been authorized to process a service gesture based on the originally communicated refund. Mrs. ****** will receive a refund of $532.62 based on the amount wrongfully withdrawn from her account. I confirmed with Connect for Health Colorado that the refund is being processed. In addition to the $532.62, I have been authorized to process a separate check request in the amount of $266.31. The poor customer service experienced by Mrs. and Mr. ****** were not at all exemplary of the service level we strive to provide at Kaiser Permanente. I know my efforts cannot make up for the financial and emotional hardship experienced by the ****** household, but I hope that I have helped. 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 **** ***** ****** ****** ******* Colorado XXXXX Written requests will be reviewed by Member Services Administration who will respond to you in writing within 14 calendar days of the receipt of the member's request. We may extend this timeframe up to an additional 14 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 BBB 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 8 a.m. to 5 p.m., Monday through Friday. Deaf, 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-XXXX. You may also contact our department through our Web site at kaiserpermanente.org. Please thank our member for their understanding in this matter. We know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente. Sincerely, **** **** ***** Complex Case Resolution Specialist Member Experience

3/23/2015 Advertising/Sales Issues | Read Complaint Details
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Complaint: Improper billing from 2/14 services, 11/18/14 balance $189.56 paid in full 12/9/14. statement w/ balance $557.00 12/18/14 no additional services done I received a bill dated 12/18/14 for the amount of $557.00 for services on 2/26/14 medical services $381.89, anesthesia service $142.96. 3/27 radiology services $18.76, 10/16 for **** ******* medical services & sup $13.39. On 11/18/14 I received a statement for these same services for the balance of $189.56 which was paid on 12/9/14. These same services I had been paying for months from 2/26/14 service totaled medical services $14.45, anesthesia service $142.96, 3/27 radiology services $18.76, and 10/16 for **** ******* medical services & sup $13.39. This balance was paid on 12/9/14 via first banks online bill pay center. Which shows up on our first bank statement. I am NOT sure as to how 1 month later the bill has gone up $367.44 without any additional services being used. I filed a complaint with Kaiser and received a letter saying that the charges will remain on my account with no explanation as to why my bill increased from 1 month to another and to why the charges are still mine with the filed complaint.

Desired Settlement: I want these charges of $367.44 to be waived from my account and I want a letter apologizing for their bad/improper billing and from their Case Resolution Team saying that they were incorrect in their resolution. Kaiser's customer service is awful.

Business Response: Initial Business Response /* ****** ** 2015/02/17) */ February 17, 2015 Ms. ******* Nelson Lead Trade Practices Consultant Denver/Boulder BBB P.O. Box XXXXX Denver, Colorado XXXXX Complaint Case # XXXXXXXX Consumer: *******, ******* Case Opened: February 03, 2015 Dear Ms. Vicars, This is in response to your email received on February 04, 2015, forwarding concerns on behalf of our member; Jeffery ******* regarding his account balance for the date of service February 26, 2014. We value the opportunity to review and respond to their grievance and apologize for the member's dissatisfaction. We have formally documented and shared Mr. *******'s grievance with the appropriate leaders in the Patient Financial Services department. I have reached out to Kaiser Permanente's Patient Representative for escalated billing concerns. The charges have been reviewed and I was provided with the following explanation: Mr. *******'s charges were reprocessed by claims a second time in December 2014 changing Mr. *******'s liability. There were 3 line items for the surgery at Lone Tree Ambulatory Surgery: TR# XXX - XXXXX - Anesthesia - member owed $142.96 total- no payments have been posted to this charge yet. TR # 861 - 29877 (Professional charge) - member owed $946.18 and has paid off completely. TR # 862 - 29877 (Facility charge) - originally processed to $283.85 (coinsurance only) but was reprocessed to $651.29 in December. Member has paid $458.96 on this charge, leaving $192.33 remaining. All payments received from Mr. ******* was processed and reflects on each of his monthly statements toward charges. The member's feedback is essential to our commitment of continuous improvement in delivering the highest quality, most appropriate and compassionate ***** 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 2500 South Havana Street Aurora, Colorado XXXXX Written requests will be reviewed by Member Services Administration who will respond to you in writing within 14 calendar days of the receipt of the member's request. We may extend this timeframe up to an additional 14 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 BBB 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 8 a.m. to 5 p.m., Monday through Friday. Deaf, 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-XXXX. You may also contact our department through our Web site at kaiserpermanente.org. Please thank our member for their understanding in this matter. We know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente. Sincerely, Christine ***** Complex Case Resolution Specialist Member Experience Initial Consumer Rebuttal /* ****** ** 2015/02/18) */ (The consumer indicated he/she DID NOT accept the response from the business.) No I do not accept their response and still refuse to pay. They "by charges were reprocessed by claims and my liability was changed" that should effect my insurance etc from that point moving forward. NOT for charges I have been paying for since February. To quote $1,000 for a trip and then after you take a trip decide that the $1,000 that was paid wasn't enough doesn't work. Kaiser billed mend amount and I paid x amount which was paid in full 12/7. Kaiser needs to waiver the remaining balance. I didn't spend any additional time at their fancy facility to have my bill increased from $283.85 to $651.29. BILL YOUR CUSTOMERS CORRECTLY FROM THE START DONT INCREASES CAUSE YOU GUYS NEED THE MONEY IT ****** PEOPLE OFF!!!!! Final Business Response /* ****** *** 2015/02/27) */ February 27, 2015 Ms. ******* ****** Lead Trade Practices Consultant Denver/Boulder BBB P.O. Box XXXXX Denver, Colorado XXXXX Complaint Case # XXXXXXXX Consumer: *******, ******* Case Opened: February 03, 2015 Dear Ms. ******* This is in response to your email received on February 20, 2015, forwarding concerns on behalf of our member; ******* ******* regarding his account balance for the date of service February 26, 2014. We value the opportunity to review and respond to their grievance and apologize for the member's dissatisfaction. We have formally documented and shared Mr. *******'s grievance with the appropriate leaders in the Patient Financial Services department. I have reached out to Kaiser Permanente's Patient Representative for escalated billing concerns. The charges have been reviewed and I was provided with the following explanation: Mr. *******'s charges were reprocessed by claims a second time in December 2014 due to a system error that processed the claims incorrectly for facility service. This changed Mr. *******'s liability. No additional time or charges were added to the claim, it was an error in processing. Mr. *******'s outstanding balance remains at: $335.29 The member's feedback is essential to our commitment of continuous improvement in delivering the highest quality, most appropriate and compassionate ***** 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 **** ***** ****** ****** ******* ******** XXXXX Written requests will be reviewed by Member Services Administration who will respond to you in writing within 14 calendar days of the receipt of the member's request. We may extend this timeframe up to an additional 14 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 BBB 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 8 a.m. to 5 p.m., Monday through Friday. Deaf, 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-XXXX. You may also contact our department through our Web site at kaiserpermanente.org. Please thank our member for their understanding in this matter. We know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente. Sincerely, ********* ***** Complex Case Resolution Specialist Member Experience Final Consumer Response /* ****** *** 2015/03/03) */ (The consumer indicated he/she DID NOT accept the response from the business.) No I still do not and will not accept this "resolution" that 10 months later they figured out that there was an error in billing. I've sent kaiser my 2nd appeal. And I will continue to dispute this for as long as it takes. If kaisers finance/billing department or insurance department takes 10 months to make changes to an account that's ridiculous!!! Waive this charges or half them with me but it's ********* for them to take that ***** long to make changes to a clients account!! An apology from kaiser which is a ****** one at that still doesn't stell this.

3/16/2015 Problems with Product/Service | Read Complaint Details
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Additional Notes

Complaint: Kaiser member department has classified me as not being covered within their system. This error, has resulted in unpaid hospital bills over $11,000. The Kaiser Permanente claims department has denied my hospital bill claims. Stating that I was not a member at the time of service, 10/26/2014. I signed up to Kaiser Permanente, before the deadline in December of 2013, and have paid them every month for my coverage since. Initially I signed up for their Silver Plan but was allowed to change to the Gold Plan in March 2014 when my son, who was originally on my plan, was moved to another health insurance provider. Here's what Kaiser has explained to me. I was told that when we changed plans they needed to update their records so that medical claims can be paid. Currently, they have me as having no insurance for that period. I contacted them 4 times since being in the hospital about these claims, and each time they tell me they have escalated the problem and to call back in a week. Currently, I am still waiting for Kaiser to update my records, while at the same time I've been communicating with the 3 companies from my hospital stay, asking for patience on their part and delivering the messages from Kaiser that this will be resolved in a week. The first week of January 2015, I reached out to Kaiser again for the status of my claims, and was told by the representative that my status in there system should be up to date in a couple of days. I waited until January 20, 2015 to contact them again regarding the status again, after receiving more notices from the same unpaid invoices from the medical providers. I was told the same time "We are escalating your case, so that your record can be corrected." I asked for a date and/or time when this will be done, since it was supposed to be escalated and completed two weeks ago. The agent was not able to provide a date or time.

Desired Settlement: I want my records fixed and my hospital bills paid, and any damage to my credit removed.

Business Response: Initial Business Response /* (1000, 5, 2015/02/06) */ February 6, 2015 Ms. ******* ****** Lead Trade Practices Consultant Denver/Boulder BBB P.O. Box XXXXX Denver, Colorado XXXXX Complaint Case # XXXXXXXX Consumer: *******, ****** Case Opened: January 22, 2015 Dear Ms. ******* This is in response to your email received on January 22, 2015 forwarding concerns on behalf of our member; ****** ******* to update our membership system to reflect the following coverage's: January, 01, 2014 - February 28, 2014 - KPCO Silver 1750/25%/ HSA March 01, 2014- December 31, 2014- KP CO Gold 0/20 January 01, 2015- Current - KP CO Gold 0/20 In addition, the member is asking for Kaiser Permanente to reprocess all claims submitted including his hospital stay on October 26, 2014. We value the opportunity to review and respond to their grievance and apologize for the member's dissatisfaction. We have formally documented and shared Mr. ******* grievance with the appropriate leaders in the Consolidated Service Center. I have reached out to Kaiser Permanente's Exchange Relationship Manager, and I have confirmed that Mr. *******'s KP CO Gold 0/20 Plan with the effective date of March 01, 2014 has been activated. We have resubmitted all claims from March 01, 2014 through the current date to be reprocessed. The reprocessing of the claims can take up to 60 business days. The Consolidated Service Center is currently working on updating the system with coverage from January 01, 2014-February 28, 2014 with the correct plan. Upon confirmation of completion we will reprocess any claims from that time period as well. If there are any items that were reported to the credit bureaus, we will provide the member with a General Credit Letter. 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 2500 South Havana Street Aurora, Colorado XXXXX Written requests will be reviewed by Member Services Administration who will respond to you in writing within 14 calendar days of the receipt of the member's request. We may extend this timeframe up to an additional 14 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 BBB 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 8 a.m. to 5 p.m., Monday through Friday. Deaf, 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-XXXX. You may also contact our department through our Web site at kaiserpermanente.org. Please thank our member for their understanding in this matter. We know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente. Sincerely, ********* ***** Complex Case Resolution Specialist Member Experience Initial Consumer Rebuttal /* (3000, 7, 2015/02/12) */ (The consumer indicated he/she DID NOT accept the response from the business.) As you can see this problem has been going on for a long time. Everyone that I have spoken to at every level has asked for more time to resolve. They won't indicate what the true hold up is. This is unacceptable. The only acceptable response is that the outstanding have been paid. Thank you Final Business Response /* (4000, 9, 2015/02/24) */ February 23, 2015 Ms. ******* ****** Lead Trade Practices Consultant Denver/Boulder BBB P.O. Box XXXXX Denver, Colorado XXXXX Complaint Case # XXXXXXXX Consumer: *******, ****** Case Opened: January 22, 2015 Dear Ms. ******* This is in response to your email received on February 13,2015 forwarding the rebuttal on behalf of our member; ****** ******* in response to the reprocessing of the claims. We value the opportunity to review and respond to their grievance and apologize for the member's dissatisfaction. I have confirmed that Mr. *******'s KP CO Gold 0/20 Plan with the effective date of March 01, 2014 has been activated. We have resubmitted all claims from March 01, 2014 through the current date to be reprocessed. I have received confirmation that all of the above dates of service has been reprocessed and the member will be receiving updated explanation of benefits within the next three weeks. 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 **** ***** ****** ****** ******* ******** XXXXX Written requests will be reviewed by Member Services Administration who will respond to you in writing within 14 calendar days of the receipt of the member's request. We may extend this timeframe up to an additional 14 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 BBB 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 8 a.m. to 5 p.m., Monday through Friday. Deaf, 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-XXXX. You may also contact our department through our Web site at kaiserpermanente.org. Please thank our member for their understanding in this matter. We know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente. Sincerely, ********* ***** Complex Case Resolution Specialist Member Experience

3/13/2015 Advertising/Sales Issues | Read Complaint Details
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Additional Notes

Complaint: ****** ********** IS BILLING FOR THREE MONTHS IN ONE EFT PAYMENT AS THEY INDICATE THEY HAVE BILLING SYSTEM PROBLEMS. POLICY IS ON ***** ***** ******** MY POLICY IS SET UP TO BE PAID VIA ********** ***** ********* ****** ********** SENDS ME A EMAIL TODAY SAYING THEY ARE DEBITING THE ABOVE ALL IN ONE PAYMENT ON MONDAY - BECAUSE THEY HAVE MESSED UP THEIR BILLING FOR OVER A YEAR. FUNDS HAVE ALWAYS BEEN AVAILABLE AND PAID WHEN DEDUCTED. ******** ******* ************ ELISA ** WAS EXTREMELY UNHELPFUL AND RUDE - REFUSED TO OFFER ANY KIND OF HELP AND SUGGESTED MY POLICY BE PULLED OF *** JEAPORDIZING MY COVERAGE. THEY SENT A CONFLICTING EMAIL THREE DAYS EARLIER STATING THEY WERE GOING TO PULL THE NORMALLY SCHEDULED AMOUNT. I HAVE A WHOLE HISTORY OF CONFLICTING EMAILS FROM THEM FOR OVER A YEAR STATING THEY ARE PULLING DIFFERENT AMOUNTS AT DIFFERENT TIMES AND IT NEVER HAPPENS WHEN OR FOR THE AMOUNT THEY SAY. I HAVE SPENT HOURS WAITING ON HOLD WITH THEM ABOUT THEIR BILLING PRACTICES AND THEY KEEP SAYING THEY WILL STRAIGHTEN IT OUT AND THEY NEVER DO.

Desired Settlement: COMPLETE ANALYSIS OF BILLING CHARGES AND REMEDY FOR THEIR INCORRECT BILLING PRACTICES.

Business Response: Initial Business Response /* (1000, 6, 2015/02/24) */ ******** *** **** *** ******* ****** **** ***** ********* ********** ************** *** **** *** XXXXX ******* ******** XXXXX ********* **** # XXXXXXXX ********* ****, *********** **** ******* ******** *** **** **** Ms. ******, **** is in response to your email received on February *** 2015, forwarding concerns on behalf of our member; *********** **** regarding his premium billing for his the **** ***************** health plan effective January ** 2015. We value the opportunity to review and respond to their grievance and apologize for the member's dissatisfaction. We have formally documented and shared Mr. ****'s grievance with the appropriate leaders in the Consolidated Service Center. I have reached out to Kaiser Permanente's Exchange Relationship Manager, and I have confirmed that Mr. **** is showing an effective date of January ** 2015. The last payment posted to Mr. ****'s account was on February *** 2015 in the amount of $385.90. The member will be billed through his auto pay function on February *** 2015 for his February and March premiums. The member's feedback is essential to our commitment of continuous improvement in delivering the highest quality, most appropriate and compassionate ***** 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: ****** ********** ****** ******** **** ***** ****** ****** ******* ******** 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 request. We may extend this timeframe up to an additional 14 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 BBB or the member has any questions, please contact me at (XXX) XXX-XXXX. Also, you may contact Member Services: ************** members may call XXX-XXX-XXXX, toll free at X-XXX-XXX-XXXX, between 8 a.m. to 5 p.m., Monday through Friday. Deaf, 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-XXXX. You may also contact our department through our Web site at kaiserpermanente.org. Please thank our member for their understanding in this matter. We know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente. Sincerely, ********* ***** ******* **** ********** ********** ****** **********

3/3/2015 Advertising/Sales Issues | Read Complaint Details
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Additional Notes

Complaint: I called and called and called to try to verify that the policy with Kaiser would cover generic drugs.. I found out after I got the policy that it did not. During the application process I was told I would have a 10 day free look option toward accepting the policy.. I cancelled the policy on February 3, 2015 and was within the 10 day free look. Kaiser is saying they wont refund the premium for February.. $502.46. They say they got the cancellation letter but still refused to refund the premium.I need your help to get this back

Desired Settlement: DesiredSettlementID: Refund Please have them refund my credit card the $502.46please email me to confirm this.

Business Response: Initial Business Response /* (1000, 5, 2015/02/18) */ February 18, 2015 Ms. ******* ****** Trade Practices & Helpline Specialist Denver/Boulder BBB P.O. Box 48179 Denver, Colorado 80204 Complaint Case # XXXXXXXX Consumer: *******, **** Case Opened: February 13, 2015 Dear Ms. ******, This is in response to your email received on February 13, 2015, forwarding concerns on behalf of our member; ******* ******* regarding his policy cancellation request made on February 3, 2015, and the request to refund the amount paid toward his February premium of $502.46. We value the opportunity to review and respond to their grievance and apologize for the member's dissatisfaction. We have formally documented and shared Mr. ********** grievance with the appropriate leaders in our Membership Administration Department. Membership Administration confirmed receipt of Mr. *******'s request to cancel his policy, dated February 3, 2015. Termination requests are processed the first of the following month, unless otherwise stated. Mr. *******'s letter did not request a retro-termination effective February 1, 2015, and this caused a delay in the cancellation process. As of February 18, 2015, Mr. ******* *******'s Kaiser Permanente Enrollment has been cancelled with a termination date of January 31, 2015. Our Membership Administration Department will be issuing a refund in the amount of $502.46 back to the member's credit card. The refund process can take up to four weeks. 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 2500 South Havana Street Aurora, Colorado 80014 Written requests will be reviewed by Member Services Administration who will respond to you in writing within 14 calendar days of the receipt of the member's request. We may extend this timeframe up to an additional 14 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 BBB or the member has any questions, please contact me at (XXX) XXX-XXXX. Also, you may contact Member Services: Denver/Boulder members may call 303-338-3800, toll free at 1-800-632-9700, between 8 a.m. to 5 p.m., Monday through Friday. Deaf, hard of hearing, or speech impaired members who use a TTY may call 303-338-3820. Colorado Springs members please call 1-888-681-7878 or deaf, hard of hearing or speech-impaired members who use TTY may call 1-800-521-4874. You may also contact our department through our Web site at kaiserpermanente.org. Please thank our member for their understanding in this matter. We know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente. Sincerely, Tina **** ***** Complex Case Resolution Specialist Member Experience

2/20/2015 Problems with Product/Service | Read Complaint Details
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Additional Notes

Complaint: I cannot get Kaiser to bill me and confirm coverage and I'm going to lose my tax credit. I had Kaiser through the Colorado exchange beginning in January, 2014. In September I had to change my coverage because my eldest daughter needed to be removed. In August, 2014 the Colorado exchange canceled my old Kaiser effective 8/31/14 and started a new plan effective 9/1/14. They sent the paperwork to Kaiser. I have been calling Kaiser (and the exchange) since about 9/10/14 trying to get a bill and confirmation of my coverage. I can get neither. My concern is that I am going to get a huge bill eventually from Kaiser, even though I have not been using their services because I cannot confirm coverage, and I am going to loose my tax credit for the insurance since I have not been able to pay it and the end of the year is coming up. I cannot get anyone at Kaiser to escalate this for me. I really need help. I just want to know I have coverage and pay my bill.

Desired Settlement: I would like confirmation of coverage and a bill.

Business Response: Initial Business Response /* (1000, 5, 2014/11/26) */ November 26, 2014 Ms. Heather Vicars Lead Trade Practices Consultant Denver/Boulder BBB P.O. Box XXXXX Denver, Colorado XXXXX Complaint Case # XXXXXXXX Consumer: *******, ***** Case Opened: November 13,2014 Dear Ms. ******* This is in response to your email received on November 14, 2014, forwarding concerns on behalf of our member; ***** ******* to reinstate the KPCO Bronze 4500/50/HSA health plan effective September 1,2014 for Ms. ******* for her dependent daughter. In addition reinstate the invoicing of Ms. ******* premium statements. We value the opportunity to review and respond to their grievance and apologize for the member's dissatisfaction. We have formally documented and shared Ms. *******'s grievance with the appropriate leaders in the Consolidated Service Center. I have reached out to Kaiser Permanente's Exchange Relationship Manager, and I have confirmed that Ms. ******* has been reinstated with the accurate effective date. We have an IT ticket that is currently being worked to add Ms. ******* daughter Jordanne. According to Connect for Health Colorado, from January 1, 2014 through August 31, 2014 the premium for Ms. ******* and two dependents was $440.88 a month. From September 1, 2014 to current for Ms. ******* and one dependent the premium will now be $344.51 a month. Upon my research, no premium invoices were sent after August 2014 due to Kaiser Permanente Connector Portal who handles sending out invoices show the account was cancelled, never active after they received the incorrect file from Connect for Health Colorado. Ms. ******* has been paying the correct premium until August; she will only owe from September 2014 -November 2014 the new premium of $344.51 a month. This means for three months to be current on account, Ms. ******* will owe $1033.53. The member's feedback is essential to our commitment of continuous improvement in delivering the highest quality, most appropriate and compassionate ***** 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 **** ***** ****** ****** ******* ******** XXXXX Written requests will be reviewed by Member Services Administration who will respond to you in writing within 14 calendar days of the receipt of the member's request. We may extend this timeframe up to an additional 14 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 BBB 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 8 a.m. to 5 p.m., Monday through Friday. Deaf, 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-XXXX. You may also contact our department through our Web site at kaiserpermanente.org. Please thank our member for their understanding in this matter. We know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente. Sincerely, ********* ***** Complex Case Resolution Specialist Member Experience Initial Consumer Rebuttal /* (3000, 12, 2014/12/09) */ I have still not received a bill or evidence of insurance. I have tried to call the respondent for Kaiser several times without success, so I am in the same position as I was when I complained. This is just so frustrating, because they provide you with all the information, including the amount due, but give me no bill or instruction on how to pay and tell me to call them, but they don't respond. Final Consumer Response /* (4200, 19, 2015/01/23) */ (The consumer indicated he/she DID NOT accept the response from the business.) I did submit a payment of $1,378.04 which was cashed, attached is a copy of the cashed check. I subsequently received an outrageous bill that says my monthly premium cost is $1,784.67. So now my 2014 billing is still incorrect and my 2015 is also incorrect. This is just outrageous. I am at my wit's end!!! Final Business Response /* (4000, 26, 2015/02/20) */ February 19, 2015 Ms. Monique Nelson Lead Trade Practices Consultant Denver/Boulder BBB P.O. Box XXXXX Denver, Colorado XXXXX Complaint Case # XXXXXXXX Consumer: *******, ***** Case Opened: November 13, 2014 Dear Ms. Vicars, This is in response to your email received on January 23, 2015, forwarding the rebuttal to our original response provided on January 16, 2015 on behalf of our member; ***** ******* to stating her billing for the year 2014 and 2015 are still incorrect. We value the opportunity to review and respond to their grievance and apologize for the member's dissatisfaction. We have formally documented and shared Ms. *******'s grievance with the appropriate leaders in the Consolidated Service Center. I have reached out to Kaiser Permanente's Exchange Relationship Manager, and I have confirmed that Ms. ******* account has been updated to reflect the accurate premium for 2015. In addition I have confirmed that Ms. ******* is working together with another Case Resolution Specialist Deanna Thompson regarding her additional concerns with her premiums for both 2014 and 2015. Please thank our member for their understanding in this matter. We know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente. Sincerely, ********* ***** Complex Case Resolution Specialist Member Experience

1/26/2015 Advertising/Sales Issues | Read Complaint Details
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Additional Notes

Complaint: Despite many attempts to stop automatic billing, I received a charge for $92. I spoke to a KAISER rep who assured me that the card would be removed. Despite many attempts to stop automatic billing, I received a charge for $92 on 12/24/14. I spoke to a KAISER rep in November who assured me that the card would be removed on 12/7/14. The card on file had an expiration date of 12/14. KAISER PERMANENTE billing process is a horror. Spent over 20 hours in 2013 setting up billing and yet still received bills and payment acknowledgement every month automatically. KAISER PERMANENTE mail notices refer me to ca phone numbers that then refer me to co phone numbers saying they can't help. Many numbers many reps, but can't it right. Also received 12 months of emails from KAISER PERMANENTE saying my payments was late yet each month in 2014 money was charged automatically to my charge card. Every visit results in at least 5 pages of mail to me. Between my wife and I we received over 32+ letters of useless papers. This time I spoke to KAISER PERMANENTE reps, sent 20 fax document to 2 different fax number (keep getting different numbers each time I called), also mailed forms in the envelopes provided and although I received conformation and cards, I was still billed for a nopayment plan. KAISER PERMANENTE billing process should be F-.

Desired Settlement: $92 removed from my charge card. 46 X 2

Business Response: Initial Business Response /* (1000, 6, 2015/01/19) */ January 19, 2015 Ms. ******* ****** Lead Trade Practices Consultant Denver/Boulder BBB P.O. Box XXXXX Denver, Colorado XXXXX Complaint Case # XXXXXXXX Consumer: *******, ****** Case Opened: January 06, 2015 Dear Ms. ******* This is in response to your email received on January 16, 2015, forwarding concerns on behalf of our member; ****** ******* attempts to stop his automatic billing, which he was erroneously charge $92.00 on December 24,2014. We value the opportunity to review and respond to their grievance and apologize for the member's dissatisfaction. We have formally documented and shared Ms. Vergara's grievance with the appropriate leaders in the Membership Administration Finance department. I have reached out to Kaiser Permanente's Membership Finance Manager, and I have confirmed that Mr. ******* called in on November 07, 2014 to stop the automatic payment and according to our records the representative who took the call advised Mr.******* that the representative put an end date on the card of 12/07/2014. The final call was received on January 14, 2015 and Mr. *******'s credit card EFT was finally removed. We have confirmed that only one charge was completed on December 22, 2014 in the amount of $46.00. A manual refund of $46.00 was processed on January 16, 2014. 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 **** ***** ****** ****** ******* ******** XXXXX Written requests will be reviewed by Member Services Administration who will respond to you in writing within 14 calendar days of the receipt of the member's request. We may extend this timeframe up to an additional 14 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 BBB 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 8 a.m. to 5 p.m., Monday through Friday. Deaf, 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-XXXX. You may also contact our department through our Web site at kaiserpermanente.org. Please thank our member for their understanding in this matter. We know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente. Sincerely, ********* ***** Complex Case Resolution Specialist Member Experience Initial Consumer Rebuttal /* (2000, 8, 2015/01/24) */ (The consumer indicated he/she ACCEPTED the response from the business.)

12/16/2014 Billing/Collection Issues | Read Complaint Details
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Complaint: Kaiser cancelled my Health Insurance erroneously. I am fully paid on my account but cannot get my prescriptions ordered. When I signed up for Health insurance through the Connect For Health exchange, they mistakenly set me up with two accounts at Kaiser. Both have separate accounts number but use the same Health record number. The account numbers are ********** (real account that is paid up) and XXXXXXXXXX, which is mistaken account. Because I never paid on the mistaken account, Kaiser cancelled both policies, even though the one account is fully paid up. I have a heart condition and high blood pressure and am in need of my prescriptions. At the current time, KP refuses to fill the order, even though I have invoked their "Believe Me" policy. It is my intent to hire an attorney to pursue this through every legal means possible.

Desired Settlement: Kaiser needs to fix the problem immediately and restore my health insurance. Because of their incompentent behavior and legal fees that I have or will incur in the future, I am asking for $10,000 to settle this case.

Business Response: Initial Business Response /* (1000, 5, 2014/11/26) */ November 26, 2014 Ms. ******* ****** Lead Trade Practices Consultant Denver/Boulder BBB P.O. Box XXXXX Denver, Colorado XXXXX Complaint Case # XXXXXXXX Consumer: *****, ****** (***) Case Opened: November 12, 2014 Dear Ms. ******* This is in response to your email received on November 13, 2014, regarding our member; Leland (***) *****. Mr. ***** is requesting Kaiser Permanente reinstate his KPCO Silver HMO health plan effective January 1, 2014. In addition, Mr. ***** also requested $10,000.00 for potential legal fees. We value the opportunity to review and respond to Mr. *****'s grievance and apologize for Mr. *****'s dissatisfaction including his frustration and inconvenience. We documented and shared Mr. *****'s grievance with the appropriate leaders. I confirmed that Mr. ***** was inadvertently enrolled in two Kaiser Permanente health plans based on information provided to Connect for Health Colorado. Mr. ***** has been reinstated on the Kaiser Permanente Silver HMO health plan with an effective date of January 1, 2014. I also confirmed with our Regional Pharmacy Administrator that Mr. ***** received his prescription medications from Kaiser Permanente on November 10th and November 12th, 2014. We resubmitted Mr. *****'s pharmacy claims to be processed under his Kaiser Permanente Silver HMO health plan benefits, which resulted in a refund of $199.46 because Mr. ***** initially paid full price for the medication. A check request was sent through our National office and it may take three to four weeks for Mr. ***** to receive the refund check. In regards to Mr. *****'s request for $10, 0000.00, his Kaiser Permanente Silver HMO health plan was reinstated with an effective date of January 1, 2014, on November 17, 2014. Mr. ***** is able to obtain prescription medications and medical care under his Kaiser Permanente Silver HMO health plan. Therefore, Mr. ***** should not experience any further issues receiving care. 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 **** ***** ****** ****** ******* ******** XXXXX Written requests will be reviewed by Member Services Administration who will respond to you in writing within 14 calendar days of the receipt of the member's request. We may extend this timeframe up to an additional 14 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 BBB 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 8 a.m. to 5 p.m., Monday through Friday. Deaf, 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-XXXX. You may also contact our department through our Web site at kaiserpermanente.org. Please thank our member for their understanding in this matter. We know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente. Sincerely, ********* ***** Complex Case Resolution Specialist Member Experience

12/8/2014 Problems with Product/Service | Read Complaint Details
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Complaint: I added my newborn to my policy in March 2014. Her information was never processed and my policy was cancelled. My daughter was born on Feb XX XXXX, and I added her to our policy on March 26 through the Colorado Healthcare Exchange. This was within the allowed 30 day period, as February has only 28 days.I was told it may take several weeks to process her, that we would receive the same premium billing as we had previously until she was processed, then she would be grandfathered in. We continued to pay our premiums, then received a larger than normal bill for approximately nine hundred dollars, six or eight weeks later, and paid it, assuming it was the adjusted premium. It turns out it was a bill for services rendered for my daughter's check-up. I spoke to customer service and explained, and was told the amount would be refunded. When I called back a couple of weeks later, I was told the refund had been denied and that they still had not received her enrollment. I have gone back and forth between the Colorado Healthcare Exchange and Kaiser for months, with the Exchange telling me repeatedly that they had resent several times my daughter's enrollment information, and Kaiser repeatedly saying they had not received anything. We have continued to pay our premium bills. When we didn't receive a premium bill in June, I called Kaiser to find out why,and was told that our policy had been cancelled. I have been without health insurance since that time. I have contacted Kaiser numerous times and spent countless hours trying to resolve this problem, all to no avail.

Desired Settlement: I want my policy reinstated and my overpaid amounts refunded.

Business Response: Initial Business Response /* (1000, 5, 2014/11/20) */ November 20, 2014 Ms. ******* ****** Lead Trade Practices Consultant Denver/Boulder BBB P.O. Box XXXXX Denver, Colorado XXXXX Complaint Case # XXXXXXXX Consumer: ******, ****** Taylor Case Opened: November 04, 2014 Dear Ms. Vicars, This is in response to your email received on November 5, 2014, forwarding concerns on behalf of our member; ****** Taylor ****** to reinstate the KPCO Gold 0/20 health plan effective January 1, 2014 for Mr. ****** and his wife. As well as reinstatement of his daughter with the effective date of March 1, 2014.In addition a request to reprocess Mr. ****** daughter's claims and in turn process a refund for overpayment made for services. We value the opportunity to review and respond to their grievance and apologize for the member's dissatisfaction. We have formally documented and shared your grievance with the appropriate leaders in the Consolidated Service Center. I have reached out to Kaiser Permanente's Exchange Relationship Manager, and I have confirmed that Mr. ******'s family has been reinstated with the accurate effective dates. We have resubmitted the claims for Mr. ******'s daughter for processing. This will take approximately two to three weeks to be finalized. Upon completion of the reprocessed claims Mr. ****** will receive a refund for any overpayments he has made for services rendered. The member's feedback is essential to our commitment of continuous improvement in delivering the highest quality, most appropriate and compassionate ***** 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 **** ***** ****** ****** ******* ******** XXXXX Written requests will be reviewed by Member Services Administration who will respond to you in writing within 14 calendar days of the receipt of the member's request. We may extend this timeframe up to an additional 14 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 BBB 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 8 a.m. to 5 p.m., Monday through Friday. Deaf, 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-XXXX. You may also contact our department through our Web site at kaiserpermanente.org. Please thank our member for their understanding in this matter. We know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente. Sincerely, ********* ***** Complex Case Resolution Specialist Member Experience

11/24/2014 Problems with Product/Service | Read Complaint Details
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Complaint: Kaiser does not provide health care. They have not filled our family's medication the 7 times we have tries, despite calling the pharmacy to make sur Kaiser has been unable to fill medications. We have tried to fill medication 7 times at Kaiser pharmacy and Kaiser has failed each time, the response to our complaint is inaccurate and the resolution is for us to get medication between 8am-noon Tuesday- Thirsday. We pay for insurance to have the ability to receive medication when we are ill. When choosing insurance companies we looked at locations and should not need typ drive 90 mintures to pick up medication because Kaiser cannot provide medication. On 10/24 my son was acutely ill. My husband called wheat ridge at 8am. It was not until 2:30 pm that we received a return call. The nurse informed my husband that Zofran ODT would be called to Lakewood Pharmay and would be ready for pick up. Given the history of Kaiser's inability to fill medication My husband called Lakewood pharmacy who informed him that it would be ready, although his Vyvansse was yet again showing the prior authorization had lapsed. He contacted a behavioral health nurse who assured him she would take care of it. I entered Kaiser lakewood at 5:25 on 10/24. I waited in the check in line where a women with a paper took my name, son and husbands name and told me to take a seat. I waited 10 minutes, then got in pick up line as I had not heard anything and I was assured our medications would be ready for pick up. I spoke to the representative who had not had anything checked in by the lady who made me take a seat. The Zofran had been filled at Wheat ridge despite asking the nurse 5 times and beig are assured it would be at lakewood. I was assured my husbands medication was ready and I could pick it up when they filled my sons medication. I then sat until 6:20 when I went to inquire about my prescriptions. The tech said they were not yet done. I asked to speak to the manager ************ **** said my medications weren't checked in until 5:45, 20 full minutes after I arrived and spoke to the woman. Clearly nothing was done with that information. Only going to the desk made them fill them. When my sons medication was ready it was filled as Zonfran, not Zofran ODT. My husband reiterated 5 times it needed to be ODT as our son cannot swallow pills, and certainly can't swallow pills when he has been unable to hold down anything in 24 hours. **** said that Dr. Gillespie was out and our only option was to go to urgent care tomorrow. (despite we started this conversation at 8am that day). I decided to take the wrong medication is desperate hope to keep our son from having to go to the ER. At 6:30 I asked for my husbands medication too. At this time they realize they have "lost" my husbands prescription and I would need to wait again for them to fill it. Despite calling and being assured it was filled, asking when checking in in line, and going to he check in counter, I again had to wait for a medication to be filled. This prevented me our son's primary caregiver, from being there to take care of him, it wasted 2 1/2 of my hours after being up all night wand day with a very sick little child. Despite **** telling me there was no physician that would fix the wrong prescription I walked out, called Kaiser and was able to get he medication called to another pharmacy, something Kaiser could have done as well.

Desired Settlement: We would lie, the nuvaring covered as guarantees by the affordable care act. We would like, to fill all prescriptions at outside pharmacies as their mail order pharmacy does not take calls and despite repeated efforts and hundreds of hours of trying Kaiser will not fill our family's medication,

Business Response: Initial Business Response /* (1000, 5, 2014/11/10) */ November 10, 2014 Ms. Heather Vicars Lead Trade Practices Consultant Denver/Boulder BBB P.O. Box XXXXX Denver, Colorado XXXXX Complaint Case # XXXXXXXX Consumer: **********, ***** Case Opened: 10/27/2014 Dear Ms. Vicars, This is in response to your email received on October 28, 2014, forwarding concerns on behalf of our member; allowing the member to have her Nuvaring be a covered prescription as well as concerns with the filling of her prescriptions with our pharmacy. We value the opportunity to review and respond to their grievance and apologize for the member's dissatisfaction. We have formally documented and shared the grievance with the appropriate leaders in Pharmacy department. I have confirmed the member received an outreach call from one of our pharmacy Regional Administrator, Chad Friday on November 7, 2014, who listened to the member's complaints about the wait time associated with the pharmacy at Lakewood. The wrong prescription was called in from her provider earlier in the day. Ms. ********** ended up having to have a new prescription called into an outside pharmacy since it was after pharmacy hours. Mr. Friday will be sending a check request to cover $24.50 Ms. **********, spent on the medication. Upon completing of the phone call Ms. ********** expressed that she was thankful for the reimbursement. In addition, I have confirmed through our Regional Administrator of the Pharmacy benefits and compliance, on October 29, 2014 Ms. ********** prescription for the Nuvaring was approved through the non-formulary review process. Drugs that are not on the formulary can go through an exception process to have the drug covered for benefit based on certain criteria. 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 **** ***** ****** ****** ******* ******** XXXXX Written requests will be reviewed by Member Services Administration who will respond to you in writing within 14 calendar days of the receipt of the member's request. We may extend this timeframe up to an additional 14 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 BBB 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 8 a.m. to 5 p.m., Monday through Friday. Deaf, 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-XXXX. You may also contact our department through our Web site at kaiserpermanente.org. Please thank our member for their understanding in this matter. We know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente. Sincerely, ********* ***** Complex Case Resolution Specialist Customer Experience Department

11/12/2014 Advertising/Sales Issues | Read Complaint Details
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Complaint: Kaiser continues to charge me for insurance even after I'm now insurance through my employer on Kaiser. I was on the Connect for Colorado Health Insurance Exchange up until August 1st when I started working full time for a community college. At that point, I was paying for my Kaiser health insurance through my employer and their HMO plan. Kaiser had told me that the coverage will automatically switch over and I received my new and updated Kaiser ID card with the new plan info. However, I continued to get bills for my monthly Kaiser premiums for my old insurance exchange coverage. I then called Connect for Colorado and they terminated my coverage and said they would contact Kaiser. I continue to receive bills from Kaiser to pay those premiums at this point now totaling $534.12. I called Kaiser again and they said they cannot cancel it until they hear from Connect for Colorado, at which point they called Connect for Colorado while I was on hold and said they were informed that Connect for Colorado shows a cancellation date of 9/30/2014 which means I would still have to pay 2 months even though I was insured and paying through my employer for August and September. Kaiser said that if I pay those 2 months the billing *should* stop and not go to collections. Kaiser suggested I call Connect for Colorado and see if they could modify my end of coverage date. So I called Connect for Colorado and they told me I cannot do this, that Kaiser has to authorize it verbally to them, and suggested I call Kaiser. At this point I don't know what to do because each company is not helpful and is pointing the finger at the other. Meanwhile, I'm stuck with a bill, currently at $534.12 for coverage I was not using or even had the correct Kaiser ID card to use. I do not want this bill to go to collections as that will create even more problems for me. Please help.

Desired Settlement: Please cancel this billing that Kaiser keeps sending me for medical insurance coverage I don't have. Per the Kaiser bill: Account# 0001984801 Invoice# 1950511 KPIF Exchange Operations PO Box 23127 San Diego, CA 92193-3127 Member Services: 1-303-338-3800

Business Response: Initial Business Response /* (1000, 5, 2014/11/11) */ November 11, 2014 Ms. ******* ****** Lead Trade Practices Consultant Denver/Boulder BBB P.O. Box XXXXX Denver, Colorado XXXXX Complaint Case # XXXXXXXX Consumer: *******, ****** Furru Case Opened: October 28, 2014 Dear Ms. Vicars, This is in response to your email received on October 28, 2014, forwarding concerns on behalf of our member; ****** Furru ******* to cancel the KPCO Bronze 5000/30%/HSA health plan effective August 1, 2014 and remove any outstanding balances due. Mr. ******* has been paying for health insurance through his employer since August 1, 2014. We value the opportunity to review and respond to their grievance and apologize for the member's dissatisfaction. We have formally documented and shared your grievance with the appropriate leaders in the Consolidated Service Center. I have reached out to Kaiser Permanente's Exchange Relationship Manager, and I have confirmed that your coverage end date is July 31, 2014. Please allow for one full billing cycle to reflect this change. Please disregard any premium notices that you have or may receive. The member's feedback is essential to our commitment of continuous improvement in delivering the highest quality, most appropriate and compassionate ***** 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 2500 ***** ****** ****** Aurora, Colorado XXXXX Written requests will be reviewed by Member Services Administration who will respond to you in writing within 14 calendar days of the receipt of the member's request. We may extend this timeframe up to an additional 14 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 BBB 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 8 a.m. to 5 p.m., Monday through Friday. Deaf, 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-XXXX. You may also contact our department through our Web site at kaiserpermanente.org. Please thank our member for their understanding in this matter. We know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente. Sincerely, ********* ***** Complex Case Resolution Specialist Member Experience Initial Consumer Rebuttal /* (2000, 7, 2014/11/12) */ (The consumer indicated he/she ACCEPTED the response from the business.) Thank you for resolving this.

10/27/2014 Problems with Product/Service | Read Complaint Details
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Complaint: Kaiser is refusing to make good on their promise to allow me to see an out-of-network therapist. After seeking to begin a regular therapy session with a therapist, I found that the only facilities available to do so through kaiser are not located where I would be able to maintain a regular appointment. I filed a formal complaint at this point stating that their mental health care services were not sufficient to help me with my issues. A gentleman from Kaiser who was tasked with dealing with my complaint called me a few time to speak about the issue. At the end of our correspondence the gentleman told me that I could find an out-of-network therapist and bring them to kaiser for them to potentially include under my current health care coverage. On Monday, 9/22, After finding a therapist in my area, I contacted Kaiser to begin the process beginning therapy under my health coverage. A man named **** ****** contacted me back regarding this and told me that kaiser would under no circumstances cover therapy sessions with anyone outside of their network. Un-satisfied with this response I was told that he would escalate this issue to his supervisor who I could expect to contact me within the week. As of today 9/26, I have not heard back from Kaiser about this issue. **** ********* refusal is contrary to the instructions I was given by the gentleman who handled my initial complaint.

Desired Settlement: I would like Kaiser to do one of the following. - Allow me to see the therapist of my choice within the Louisville Boulder Area. - Provide me with a list of therapists within the Louisville/Boulder area that I can see - Provide me with another option to have a regular therapy session somewhere here within the Louisville/Boulder area.

Business Response: Initial Business Response /* (1000, 8, 2014/10/14) */ October 14, 2014 Ms. ******* ****** Lead Trade Practices Consultant Denver/Boulder BBB **** *** XXXXX ******* ******** XXXXX Complaint Case # XXXXXXXX Consumer: *******, ***** Case Opened: 9/30/2014 Dear Mr. *******, This is in response to your email received on September 30, 2014, forwarding concerns on behalf of our member; allowing the member to see a therapist of his choice within the Louisville Boulder Area. Provide the member with a list of therapist within the Louisville/Boulder area that member can see as well as provide an option to have a regular therapy session within the Louisville/Boulder are. We value the opportunity to review and respond to their grievance and apologize for the member's dissatisfaction. We have formally documented and shared the grievance with the appropriate leaders in the Behavioral Health Administration department. I have confirmed the member called in on June 30, 2014 to Behavioral Health Administration Clinic requesting therapy intake and was given an intake the next day July 1, 2014. Unfortunately, this appointment was an urgent intake slot. Behavioral Health Administration Clinic called the next day and cancelled the appointment at the request of Hidden Lake Crisis as patient was assessed as normal need and not urgent. Member called again on July 3, 2014 requesting a therapy intake. The member was called back by Hidden Lake Crisis and offered an overflow referral to Denver Family Therapy which he accepted. The member's complaint regarding the distance to the Hidden Lake clinic. From his home in *********** the Hidden Lake clinic is 13 miles away, the other location which is The Baseline clinic in Boulder is 7 miles away. Member is able to contact the Behavioral Health Line at XXX-XXX-XXXX to request a referral for outside treatment. This information was provided to the member on July 21, 2014 from our Case Resolution Team. 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 **** ***** ****** ****** ******* ******** XXXXX Written requests will be reviewed by Member Services Administration who will respond to you in writing within 14 calendar days of the receipt of the member's request. We may extend this timeframe up to an additional 14 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 BBB 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 8 a.m. to 5 p.m., Monday through Friday. Deaf, 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-XXXX. You may also contact our department through our Web site at kaiserpermanente.org. Please thank our member for their understanding in this matter. We know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente. Sincerely, ********* ***** Case Resolution Specialist-Complex Team Member Experience

10/27/2014 Problems with Product/Service | Read Complaint Details
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Complaint: 1 ***********************, not cancelled in timely manner. 2 Inadequate assistance from ****** **********. 3 Claims processed in error In May 2014, I applied for Health Insurance through "******************" and was denied for ******** due to income requirements for the program. Therefore, I selected a************ through "******************" for ****** ********** on confirmation number ******** for a **** Silver 2500/30***** Silver plan effective 07/01/2014(Group # **********)with a monthly premium of $304.02. I made the first monthly premium which was cashed by ****** on 06/25/2014. My ****** subscriber number is ************ In the meantime, I received a letter from ******** that I was re-evaluated due to a "system glitch" that misread my income therefore approved for ******** effective 07/01/14. Therefore on 07/02/2014 I contacted "******************" and requested the ****** plan be cancelled and my premium payment of $304.02 be refunded. On 07/10/2014 I received a letter from "******************" stating ****** had been notified of the cancellation. As of this date the ****** Silver Plan has not been cancelled and even though I have ******** assigned to ****** and the ******** plan is active, ****** has and continues to apply claims (seven so far) to the Silver plan. I have contacted ******'s Member Services department several times at ************ and keep getting told it takes 7 to 10 business days to cancel, but also that "right now, it's taking up to six months to cancel." On 08/12/2014 I was told it had been cancelled. But when I went to the ****** ****************************** booth on 08/14/2014, I was told it still had not been cancelled. Therefore, the representative faxed my request for cancel to*************(to be effective 07/01/2014) and also gave me a copy. I called the Claims department at ************ on 08/22/2014 and was told it was still not cancelled and when I also requested that they reprocess all of the claims toward my ******** plan I was told "We can't do that because the Silver plan is still in the system." The representative said "You just need to wait and it will be cancelled in 7-10 business days. In addition, I have attempted contacting Membership Accounting several times at ************ regarding the premium refund and all I ever get is a recording to "call back later" and I can never get through to talk to anyone.

Desired Settlement: To completely resolve this issue I request the following be done: 1) Cancel the **** Silver Plan completely back to the original effective date of 07/01/2014. 2) Reprocess all claims that have been processed to the Silver plan to be applied toward the ******** plan. 3) Fully refund the entire premium payment of $304.02 to me as plan should have been cancelled back to the effective date. If additional information is needed, I have documentation of correspondence from "******* for ******* and ******************

Business Response: Initial Business Response /* (1000, 8, 2014/09/15) */ September 15, 2014 ****************** Lead Trade Practices Consultant ****************** ************** Denver, Colorado 80204 Complaint Case # ********* Consumer: ****************** Case Opened: 08/28/2014 Dear************ This is in response to your email received on August 28, 2014, forwarding concerns on behalf of our member; to cancel the **** Silver Plan completely back to the original effective date of July 1, 2014 and refund the entire premium payment of $304.02. Additionally, reprocess all claims that have been processed to the Silver plan to be applied toward the ******** plan. We value the opportunity to review and respond to their grievance and apologize for the member's dissatisfaction. We have formally documented and shared the grievance with the appropriate leaders in the Consolidated Service Center. I have confirmed the member was cancelled on August 9, 2014 and this was retrod back to July 1, 2014. A refund and has been processed and will take up to 45 days for the member to receive. Additionally, I have confirmed that the member's claims are being reprocessed under the correct benefit plan. This will take 30-45 days to reflect on his account. The member's feedback is essential to our commitment of continuous improvement in delivering the highest quality, most appropriate and compassionate ***** 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: ***************** Member Services ************************ ******, Colorado XXXXX Written requests will be reviewed by Member Services Administration who will respond to you in writing within 14 calendar days of the receipt of the member's request. We may extend this timeframe up to an additional 14 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 *** 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 8 a.m. to 5 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 *************** You may also contact our department through our Web site at*********************** Please thank our member for their understanding in this matter. We know that they have a choice for their healthcare, and we thank them for choosing *****************. Sincerely, *************** Case Resolution Specialist Member Experience Initial Consumer Rebuttal /* (3000, 10, 2014/09/16) */ (The consumer indicated he/she DID NOT accept the response from the business.) This issue if far from being resolved and except for the above response I have received no response from******* in writing, email, phone call, or postal mail. As someone who has been in Customer Service for over 30 years and even worked for******* and even after filing complaints with the Department of Insurance and the ***, I consider this to be an extraordinarily careless and lackadaisical response and pretty shoddy service especially by*******'s own standards. First, *************** in response to my complaint filed on 08/27/2014 that the **** Silver plan was cancelled on 08/09/14, however as of the date of my complaint I was advised by Member Services that the plan was still showing active in their system. Second, I have received several new ***** showing that my claims amounts were backed off from the Silver plan and re-applied to the ******** plan that are still processed incorrectly. The claims applied to ******** state per the remarks listed that service is not covered by the contractor and that I need to send the claim(s) to ********. Since******* was the provider of the services it is their responsibility to send these claims to ********. Lastly, in regard to my refund request, I understand there is still confusion at ******* with the processing. Every time I try to call Membership Accounting at ************ all I get is due to volume "call back." I have never been able to reach them. I would very much appreciate assistance in resolving this entire issue as at this point I am considering legal action. Final Consumer Response /* (4200, 14, 2014/10/03) */ (The consumer indicated he/she DID NOT accept the response from the business.) It appears that this complaint has been partially resolved. I will consider it completely resolved once I have received the refund for 304.02. I originally notified******* to cancel my Silver plan in July and although I made several attempts to have it cancelled through******* representatives it was no cancelled till August 25th according to********* above. So I wonder was wasn't the refund processed until September 30th? And if it was processed on September 30th why do I still have to wait a few weeks for it? Based on this and because I am still not sure if it has really been processed, I am not satisfied till the refund has been received. Final Business Response /* (4000, 16, 2014/10/15) */ October 15, 2014 ****************** Lead Trade Practices Consultant ****************** ************** Denver, Colorado XXXXX Complaint Case # ********* Consumer: ****************** Case Opened: 08/28/2014 Dear************ This is in response to your email received on October 10,2014, forwarding concerns on behalf of our member;****************** to cancel the **** Silver Plan completely back to the original effective date of July 1, 2014 and refund the entire premium payment of $304.02. We value the opportunity to review and respond to their grievance and apologize for the member's dissatisfaction. We have formally documented and shared the grievance with the appropriate leaders in the Consolidated Service Center. I have reached out to *****************'s Exchange Relationship Manager; On September 30, 2014 refund request in the amount of $304.02 was requested. I have confirmed on October 10, 2014 that the refund has been issued on October 6, 2014. Member should receive this refund in the mail within the next few weeks. The member's feedback is essential to our commitment of continuous improvement in delivering the highest quality, most appropriate and compassionate ***** 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: ***************** Member Services ************************ ******, Colorado XXXXX Written requests will be reviewed by Member Services Administration who will respond to you in writing within 14 calendar days of the receipt of the member's request. We may extend this timeframe up to an additional 14 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 *** 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 8 a.m. to 5 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 *************** You may also contact our department through our Web site at*********************** Please thank our member for their understanding in this matter. We know that they have a choice for their healthcare, and we thank them for choosing *****************. Sincerely, *************** Complex Case Resolution Specialist Member Experience

10/20/2014 Advertising/Sales Issues | Read Complaint Details
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Complaint: for over 3 months, I've paid my premiums and haven't been able to even get an appointment. Now I'm being billed for things I didn't have done! No one will help me. I'm on hold for hours at a time. When I go in, a manager wont talk with me. When I call no manager will get on phone with me. I was denied even being able to see a doctor for months. Now I'm being charged for things I haven't authorized or been told about. Someone made a mistake and no one wants to do anything about it.

Desired Settlement: Update and change in my initial plan. No charge for things I wasn't advised or authorized. Company acknowledgment about my complaints and concerns in their system.

Business Response: Initial Business Response /* (1000, 5, 2014/10/08) */ October 8, 2014 Ms. ******* ****** Lead Trade Practices Consultant Denver/Boulder BBB **** *** XXXXX ******* ******** XXXXX Complaint Case # XXXXXXXX Consumer: *********, ****** Case Opened: 9/25/2014 Dear Ms. ******* This is in response to your email received on September 26, 2014, forwarding concerns on behalf of our member; to updated and change his initial plan, inform member of possible additional charges for items and to document his concerns in our system. We value the opportunity to review and respond to their grievance and apologize for the member's dissatisfaction. We have formally documented and shared the grievance with the appropriate leaders in the Smokey Hill Medical Offices Primary Care Department. I have confirmed the member was seen on the following dates by the primary care department; August 12, 2014, September 25, 2014 and October 2, 2014. On August 13, 2014 the member had a series of blood tests completed that were ordered as a result of his visit on August 12, 2014 he was seen for services that were outside of the preventive scope which caused the additional charges based on the members benefit summary. Additionally, I have confirmed that the member has not requested a plan change. The member would need to request any plan changes directly through Connect for Health Colorado at the following number: XXX-XXX-XXXX. The member's feedback is essential to our commitment of continuous improvement in delivering the highest quality, most appropriate and compassionate ***** 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: ****** ********** Member Services 2500 South Havana Street Aurora, Colorado XXXXX Written requests will be reviewed by Member Services Administration who will respond to you in writing within 14 calendar days of the receipt of the member's request. We may extend this timeframe up to an additional 14 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 BBB 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 8 a.m. to 5 p.m., Monday through Friday. Deaf, 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-XXXX. You may also contact our department through our Web site at kaiserpermanente.org. Please thank our member for their understanding in this matter. We know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente. Sincerely, ********* ***** Case Resolution Specialist-Complex Team Member Experience

9/9/2014 Problems with Product/Service | Read Complaint Details
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Complaint: I cancelled my daughters off my plan in March.******* still can't get this done correctly, and have not been able or willing to adjust their billing. I purchased my medical insurance In Feb 2014. I initially had my 3 daughters included on my plan. I removed my daughters from my plan in writing in March 2014. They were removed, and I confirmed that with a phone call to the Denver member services office. In May 2014 they were put back on my plan by an unknown individual at*******.******* refused to help remove them, and has been erroneously billing me for this entire time. My ex wife, who coincidentally also has******* on a separate plan, was ordered to put our daughters on her plan in March, which she did.******* continues to bill all of our daughters medical costs under my plan, which has a higher deductible, and then requiring her to pay the difference even though her deductible costs have been met. I still haven't even gotten a medical insurance card since I enrolled in Feb 2014. That's almost 8 months ago. I have called continually to get this, and they always state they will mail me a new one, which they never do. I have also been asking for a list of providers and a member resource guide since Feb 2014, and finally received that in the mail last week. Only took 7 months to get that. Their company website doesn't work. When I log on to look at my account, I receive an error message stating I'm not authorized to look at my own account because I am not the primary. I'm the only one on the plan...who else would be the primary. I spend 2-3 hours at a time with them on the phone to just be transferred from one person to another, and none of them help straighten out this mess. NEVER USE THIS COMPANY FOR YOUR PERSONAL INSURANCE. Their customer service is horrible.

Desired Settlement: The only resolution I want at this point is for them to straighten out the billing, recoup the costs incurred by my ex wife and myself for the extra deductibles and premiums, and an acknowledgement from them stating that they are responsible 100% . Once I receive that, I will be canceling my insurance with*******, and will look elsewhere for my medical insurance. I will also be seeking a ***** remedy through my personal**********

Business Response: Initial Business Response /* (1000, 5, 2014/08/26) */ August 26, 2014 ****************** ********************************Denver/Boulder BBB ************** Denver, Colorado 80204 Complaint Case # ******** Consumer: **************** Case Opened: 08/13/2014 Dear***********, This is in response to your email received on August 14, 2014, forwarding concerns on behalf of our member; ***************. The member has sought the assistance of the Better Business Bureau for the resolution of their concerns with******************. The member states that he was billed incorrect premiums from *** 2014 to current, stating he had removed his dependents in March 2014 and they were added back on in *** 2014. Member also states that his dependents benefits are being based on his plan instead of his ex-wife's benefit structure, which is costing his ex-wife additional co-pays and deducible amounts. We value the opportunity to review and respond to their grievance and apologize for the member's dissatisfaction. We have formally documented and shared the grievance with the appropriate leaders in the Consolidated Service Center. I have confirmed the member was cancelled on *** 13, 2013 for non-payment that was retro back to February 28, 2014. The member called in on June 9, 2014 to reinstate his plan. The member paid the premium for himself only to be reinstated paying February 2014 through June 2014. ****************** did make an error when the member was reinstated on June 29, 2014 and reinstated his dependents as well. This has since been corrected and any premium billed amount for the defendants has been removed. Additionally, I have confirmed that the member's defendant have no services billed under his benefit structure and has a zero balance on his account. The member's feedback is essential to our commitment of continuous improvement in delivering the highest quality, most appropriate and compassionate ***** 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: ***************** Member Services ************************ Aurora, Colorado XXXXX Written requests will be reviewed by Member Services Administration who will respond to you in writing within 14 calendar days of the receipt of the member's request. We may extend this timeframe up to an additional 14 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 BBB 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 8 a.m. to 5 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 *************** You may also contact our department through our Web site at********************** Please thank our member for their understanding in this matter. We know that they have a choice for their healthcare, and we thank them for choosing******************. Sincerely, *************** Case Resolution Specialist Member Experience

9/1/2014 Advertising/Sales Issues
8/11/2014 Problems with Product/Service | Read Complaint Details
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Complaint: On 2/27/14 I paid Kaiser a $321 premium. A 3rd party also made $321 payment on my behalf on 3/1/14. I am due a refund. Kaiser refuses. At the end of February 2014 I enrolled in Kaiser Permanente through the Colorado Health Exchange. I sent them a check for $321 which was cashed on 2/27/14. I am a person living with AIDS. During this time I discovered that the Southern Colorado AIDS Project (SCAP) would pay for my monthly premiums. They sent a check on 3/1/14. Kaiser received two checks to pay for my health insurance for the month of March. I have called Kaiser 6 times to request a refund. They have done nothing but give me the run around. Can you please help?

Desired Settlement: I would like to refunded $321.00

Business Response: Initial Business Response /* (1000, 5, 2014/07/30) */ July 29, 2014 Ms. ******* ****** Lead Trade Practices Consultant Denver/Boulder BBB P.O. Box 48179 Denver, Colorado 80204 Complaint Case # XXXXXXXX Consumer: ***** ***** Case Opened: July 16, 2014 Dear Ms. ******* This is in response to your email received on July 17, 2014, forwarding concerns on behalf of our member; ***** *****. The member has sought the assistance of the Better Business Bureau for the resolution of their concerns with Kaiser Permanente. On February 27, 2014 the member paid Kaiser Permanente $321.00 premium. Additionally a 3rd party also made a $321.00 payment on the member's behalf on March1, 2014. The member is requesting assistance in obtaining his refund of the duplicate payment of $321.00. We value the opportunity to review and respond to their grievance and apologize for the member's dissatisfaction. We have formally documented and shared the grievance with the appropriate leaders in the Consolidated Service Center. I have confirmed that the $321.00 refund has been approved and currently in progress, and was informed that it should only take approximately 30-45 business days to reach the member. 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 2500 South Havana Street Aurora, Colorado XXXXX Written requests will be reviewed by Member Services Administration who will respond to you in writing within 14 calendar days of the receipt of the member's request. We may extend this timeframe up to an additional 14 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 BBB 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 8 a.m. to 5 p.m., Monday through Friday. Deaf, 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-XXXX. You may also contact our department through our Web site at kaiserpermanente.org. Please thank our member for their understanding in this matter. We know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente. Sincerely, ********* ***** Case Resolution Specialist Member Experience

7/10/2014 Advertising/Sales Issues | Read Complaint Details
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Complaint: Double billing for services #****** ON 5/14 and 5/16 I had a Thallium Stress Test and paid a copay of $225. I was told on 5/14 that the total charge for the two days was $225. Now I get a bill for $225 for the second day 5/16. I returned the letter with an explanation and now I get another bill and threaten turning it over to a collection agency. I had an identical stress test on May 20, 2008 and got two bills. Upon appeal the second charge was removed. Today all I get is pay or else without any explanation or appeal process. This is a bait and switch process to me.

Desired Settlement: Removal of the second charge of $225

Business Response: Initial Business Response /* (1000, 5, 2014/07/07) */ July 7, 2014 Ms. ******* ****** Lead Trade Practices Consultant ******/******* BBB ************** ******, ******** ***** Complaint Case # ******** Consumer: ****** ****** Case Opened: June 28,2014 Dear Ms. ******, This is in response to your email received on June 30, 2014, forwarding concerns on behalf of our member; ****** ******. The member has sought the assistance of the Better Business Bureau for the resolution of their concerns with ****** **********. The member has stated that he has received an erroneous bill for $225.00 from ****** **********, after having a Thallium Stress Test completed, in which he had paid his copay of $225.00 at the time of service. He also shared that he was told his total cost for the testing which was for two different days would be $225.00. We value the opportunity to review and respond to their grievance and apologize for the member's dissatisfaction. We have formally documented and shared the grievance with the appropriate managers and physician leaders, to include the Patient Financial Services Department Supervisor. In addition, a review of the members account has determined that charges billed in the amount of $225.00 for the second day of testing received on May 16, 2014, were billed in error. We have sent an adjustment request in this amount to the Patient Financial Services Department. The member should allow additional time for her account to reflect this adjustment. 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: ****** ********** Member Services ************************ ******, ******** ****** Written requests will be reviewed by Member Services Administration who will respond to you in writing within 14 calendar days of the receipt of the member's request. We may extend this timeframe up to an additional 14 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 BBB or the member has any questions, please contact me at **************. Also, you may contact Member Services: ******/******* members may call ************, toll free at **************, between 8 a.m. to 5 p.m., Monday through Friday. Deaf, hard of hearing, or speech impaired members who use a TTY may call ************. ******** Springs members please call ************** or deaf, hard of hearing or speech-impaired members who use TTY may call **************. You may also contact our department through our Web site at ********************. Please thank our member for their understanding in this matter. We know that they have a choice for their healthcare, and we thank them for choosing ****** **********. Sincerely, ********* ***** Case Resolution Specialist Member Experience Initial Consumer Rebuttal /* (2000, 7, 2014/07/09) */ (The consumer indicated he/she ACCEPTED the response from the business.)

7/3/2014 Problems with Product/Service | Read Complaint Details
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Additional Notes

Complaint: Refused to answer simple questions about health care; very rude, refused to let me speak to a supervisor. Refused to answer simple questions about health care; very rude, refused to let me speak to a supervisor. Spent over 45 minutes on phone with "*****" from Member Services (said does not provide member ID; Denver/Boulder area - refused to say which city in particular). Refused to answer simple questions about my health care plan. Refused to let me speak with a supervisor. Kept changing her story on the information she was able to provide me. Very rude, inconsistent. Asked almost a dozen times to speak to a supervisor and was not allowed to. I have very serious health issues; what could have been a few minutes took almost an hour of my life to not get any answers to my questions and be treated very rudely, not answer my questions, kept dodging questions, etc.

Desired Settlement: Would like for executives to refine business practices to focus on customer service. I can understand if specific employees are not informed or willing to make statements regarding health care, however REFUSING to let me speak to a supervisor is completely inappropriate. ****** business executives should take disciplinary actions against this employee and refine further business practices and training to avoid this situation again in the future. People with serious health conditions should not have to take hours of their life to be treated like trash.

Business Response: Initial Business Response /* (1000, 11, 2014/05/12) */ May 12, 2014 Ms. ******* ****** Trade Practices Specialist ******/******* BBB ************** ******,********* ***** Complaint Case # ******** Consumer: **** ****** Case Opened: April 24, 2014 Dear Ms. ******, This is in response to your email received on April 28, 2014, regarding ****** ********** (KP) member, **** ******. The member has sought the assistance of the Better Business Bureau (BBB) for the resolution of his concerns with ****** ********** (KP). Mr. ****** stated in his complaint that KP Member Services representative, ***** was rude, didn't answer simple questions regarding health care and would not transfer him to a supervisor. He states he spent over 45 minutes on the phone with *****, who kept changing her story and even though he asked over a dozen times to be transferred to a supervisor she refused to transfer him. Member states he has serious health issues and he should not be mistreated or have to wait hours to be helped. Member is also concerned why he was told that KP does not have a list of approved facilities of where he can get an X-ray of his spine. He states that he was told he would have to contact PENRAD and they would have a list. He also states that the Department of Regulatory Agencies informed him that KP should have a list of providers who can perform X-rays, and KP is required to provide that list to members upon request. Mr. ****** suggested that KP executives should refine business practices to focus on customer service, and should take disciplinary action against this employee. We value the opportunity you have given us to review and respond to our member's concerns. We have also provided a direct response to our member regarding his concerns. Please note that KP has documented and shared Mr. ******'s concerns with KP's Member Services Executive Director and the Member Services Team Manager who supervises the employee who spoke with Mr. ******. KP has provided Mr. ****** with the list of providers KP contracts with related to his health care needs. KP sincerely apologizes for the inconvenience and frustration Mr. ****** experienced regarding this matter. 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, he has the right to request a second review. Please have him put the request in writing to: ****** ********** Member Services ************************ ******,********* ***** Written requests will be reviewed by Member Services Administration who will respond in writing within 14 calendar days of the receipt of the member's request. We may extend this timeframe up to an additional 14 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 BBB or the member has any questions, please contact me at (303) 338-3718. Also, you may contact Member Services: ******/******* members may call ************, toll free at **************, between 8 a.m. to 5 p.m., Monday through Friday. Deaf, hard of hearing, or speech impaired members who use a TTY may call ************. ******** Springs members please call ************** or deaf, hard of hearing or speech-impaired members who use TTY may call **************. You may also contact our department through our Web site at ********************. Please thank Mr. ****** for his understanding in this matter. Sincerely, ****** ********* Case Resolution Specialist ****** ********** Initial Consumer Rebuttal /* (3000, 13, 2014/05/13) */ (The consumer indicated he/she DID NOT accept the response from the business.) This response is very disturbing - Ms. ****** says, "KP has provided him with the list of providers KP contracts with related to his health care needs." This is a lie. I have records of every interaction I have had with ****** ********** and Ms. ******, and I have *never* been provided with a list of providers. What Ms. ****** did provide me with was a PDF file of contract codes which need a prior authorization before ****** ********** will cover the exam at Memorial Hospital. However, (a) this is NOT a list of providers, only codes for one specific provider, (b) Ms. ****** could not tell me if this information would still be valid the **next day**, (c) she said that she that in order to confirm this information, I would have to call Care Core National, as ****** ********** will not provide me with this information when I call, and finally (d) when I asked specific questions, Ms. ****** only reply was "I don't know; I just work in the complaint department. All I can do is give you the information which was provided to me". Furthermore, Ms. ****** said, "Please note that KP has documented and shared his concerns with KP's Member Services Executive Director and the Member Services Team Manager who supervises the employee". Ms. ****** had told me that the complaint had been sent to the supervisor, but said no one else was notified of this complaint. If indeed the Executive Director received this complaint, I would be surprisingly pleased, however I find it disturbing that Ms. ****** told me the exact opposite on the phone. Given the propensity of this organization to lie, I am concerned that Ms. ****** is also lying about this - saying the complaint was passed to the Executive Director when it was not - simply to make ****** look better to the BBB. In summary, I have NOT been provided the information they claim they provided me, ****** currently has NO method of verifying health insurance coverage to their members when they call them, and they willing to boldly lie - both to their members about their coverage and to the BBB. The most disturbing thing about this response is the willingness of Ms. ****** and ****** ********** to boldly and consciously lie to the Better Business Bureau. I strongly advise the BBB to do a more thorough investigation, and I am willing to provide the BBB with any and all documentation of my interactions with ****** ********** and Ms. ****** so as to prove that I have never received the information she claims I have been given. Final Business Response /* (4000, 15, 2014/05/27) */ May 27, 2014 Ms, ******* ****** Trade Practices Specialist ******/******* BBB ************** ******,********* ***** Complaint Case # ******** Consumer: ****rey ****** Case Opened: May 13, 2014 (rebuttal) Dear Ms. ******, This is in response to your email received on May 13, 2014, forwarding concerns on behalf of our member, ****rey ******. The member noted above expressed their continued concerns regarding information provided to him by ****** **********. It is the member's belief that his initial concerns shared with ****** ********** were not documented and shared with the appropriate department to include the Executive Director of our Member Services Contact Center (MSCC). In addition, our member shared that he was not provided a complete list of providers outlining where he could seek radiology services in********* Springs. Therefore, our member has requested a second review of his initial grievance with a request for follow-up to his initial complaint. I regret our member's continued dissatisfaction, but I value the opportunity you have given me to review and respond to their continued concerns. Reviews of our member's grievance and the management of out member's initial concerns expressed to our Case Resolution Specialist team have been completed. As follow-up to our member's concerns, I have confirmed that ****** ******, Case Resolution Specialist did formally document and share our member's complaint with the appropriate department to include the Executive Director for Member Services Contact Center (MSCC). I wish to extend our apologies to our member, for his continued dissatisfaction with ****** ********** processes and procedures. Please note, a complete copy of our provider listing for the********* Springs area has been mailed to our member for further review. Should our member need further assistance he may contact CareCore National at (888) 835-1712 to receive further assistance. Again, I thank the BBB 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 BBB or our member has any questions, please contact Member Services: ******/******* members may call ************, toll free at **************, between 8 a.m. to 5 p.m., Monday through Friday. Deaf, hard of hearing, or speech impaired members who use a TTY may call ************. ******** Springs members please call ************** or deaf, hard of hearing or speech-impaired members who use TTY may call **************. You may also contact our department through our Web site at ********************. We thank the BBB and the member for given ****** ********** another opportunity to research this matter. Sincerely, ******* ****** Senior Case Resolution Specialist Member Experience Team Final Consumer Response /* (4200, 17, 2014/06/01) */ (The consumer indicated he/she DID NOT accept the response from the business.) I do NOT accept this response from ****** **********. I received the list of providers in the mail this weekend as Ms. ****** claims was sent, however this does not give any detailed information about *what* is covered. Furthermore, I was originally told Memorial Hospital was NOT a provider, now the documentation they have sent me shows they ARE a provider. What started all of this is the refusal of ****** to tell me where I could get an X-Ray of my Spine. Note that, now ALMOST FORTY DAYS LATER, there is still no such method of receiving this information from ******! More importantly - no one can tell me if this information will still be accurate TOMORROW. So how can I know if this list of providers is still accurate tomorrow? Next month? Next year? How does one verify? They have made NO changes to their call center, NO changes to how they operate, NO changes to how they respond to the BBB, and NO changes to how they interact with their members. I challenge the BBB, or anyone reading this complaint - call ******. Ask any one of their member service representatives where you can get a specific order filled (an X-Ray, MRI, etc). Ask them if you can go somewhere besides Penrad; ask them BASIC QUESTIONS about your health care plan. They won't be able to answer. That's a problem. And for all of their double-speak responses, they have not taken ONE identifiable ACTION to change their policies. All they have done is sent a couple emails to some people within their organization, and promised, "this will be looked into, but we cannot tell you when or how or what has happened with it." Why should I take ****** at their word? They have clearly LIED to me numerous times - even directly to the Better Business Bureau! This type of willingness to boldly LIE and refuse to give their members information about their health care plan is NOT a resolution to my complaint. This goes to the issue which is not addressed by Ms. ****** - ****** ********** has, and continues to, outright LIE to the Better Business Bureau as well as their clients. They say they cannot provide a list of providers, then they say they can. They say they *did*, then they acknowledge they did *not* and send a list to me. They say Memorial is not a provider, then they say they are. They say you have to call Penrad to get a list of providers, but Penrad obviously does not keep that list, and ****** REFUSES to give out that list to their clients. They say Care Core National keeps the list not ******, then ****** sends me a list with their logo on it. ****** has outright LIED - as is documented in this complaint history. They have are willing to LIE to their members, LIE to the BBB, LIE to anyone and everyone whom they speak to. They have made absolutely NO changes within their organization to prevent other members from experiencing this frustration in the future. As such, I do NOT accept this response from ****** **********, and request the Better Business Bureau complete a more thorough investigation into ******'s outright lies, misinformation, willingness to withhold and distort information (even when interacting with the BBB), stubborn refusal to change any processes within their organization, and refusal to provide their members with details about their health plan in a reasonable time frame. It has taken me forty days to finally receive a list of providers from ******, but in the process I am left with an unfulfilled BBB complaint, a stack of lies and misinformation, and now confusion on what is and is not covered!

6/24/2014 Billing/Collection Issues | Read Complaint Details
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Complaint: Saw a nurse practitioner. The nurse practitioner was rude and prescribed a drug I told her I had a bad reaction to. The drug again made me very sick. The only appointment that wasn't over 2 months away was with a nurse practitioner. I saw her on 4/07/2014. I had to wait about two hours from my appointment time. She was rude, dismissive, gave in accurate drug price information and prescribed the very drug I told her I had had a reaction to years ago. She nonchalantly said just to try the drug again. She also told me it would cost $15, not $61. I got the immitrex prescription filled took it when my next migraine began and I became violently ill and developed a needles and pins sensation and rash in my arms. I threw up for 6 hours and had diaherria as well.

Desired Settlement: In addition, the appointment was under 10 minutes long. I am not sure why I would be expected to pay for such poor, brief treatment. I would like this bill waived. Since I cannot even get through to be put on hold when calling Kaiser (several times), I have not been able to resolve this directly.

Business Response: Initial Business Response /* (1000, 5, 2014/06/11) */ June 11, 2014 Ms. ******* ****** Lead Trade Practices Consultant ******/******* BBB **** ******** ******,*************** Complaint Case # ******** Consumer: *** ***** Case Opened: June 10, 2014 Dear Ms. ******, This is in response to your email received on June 10, 2014, forwarding concerns on behalf of our member; *** Wozny. The member has sought the assistance of the Better Business Bureau for the resolution of their concerns with ****** **********. The member has stated that she was seen by a Nurse Practitioner who was rude and dismissive and late in seeing her. She also shared that the Nurse Practitioner prescribed medication that she ended up having a negative reaction to. The member is requesting for the office visit charge to be removed from her account. Additionally, member states that the Nurse Practitioner quoted an inaccurate price for the prescription of $15.00 and the member ended up paying $61.00. We value the opportunity to review and respond to their grievance and apologize for the member's dissatisfaction. We have formally documented and shared the grievance with the appropriate managers and physician leaders, to include the Pharmacy Department Supervisor. Also, the concerns presented regarding the quality of care, and reaction to the medication was reviewed by the Chief of Primary Care. A review of the prescription charge of $61.00 was completed. It was determined that this charge is correct. The member has a High Deducible plan which includes prescriptions. The prescription was processed accurately and applied toward the members deducible. The prescription was a generic brand and if the deducible had been met, the charge would have been $15.00. The $61.00 cost will remain the responsibility of the member. The Nurse Practitioner discussed several different migraine treatments such as preventive daily medications. Based on the clinical feedback I am unable to honor the members request to have the office visit charge removed from her account. The Nurse Practitioner was spoken to regarding the member's feelings that she did not listen to her or was rude. I am very sorry the member had a negative experience. 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: ****** ********** Member Services **** ***** ****** Street ******,********* ***** Written requests will be reviewed by Member Services Administration who will respond to you in writing within 14 calendar days of the receipt of the member's request. We may extend this timeframe up to an additional 14 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 BBB or the member has any questions, please contact me at (***) ***-****. Also, you may contact Member Services: ******/******* members may call ***-***-****, toll free at 1-***-***-****, between 8 a.m. to 5 p.m., Monday through Friday. Deaf, hard of hearing, or speech impaired members who use a TTY may call ***-***-3820. ******** Springs members please call 1-***-***-**** or deaf, hard of hearing or speech-impaired members who use TTY may call 1-***-***-****. You may also contact our department through our Web site at kaiserpermanente.org. Please thank our member for their understanding in this matter. We know that they have a choice for their healthcare, and we thank them for choosing ****** **********. Sincerely, ********* ***** Case Resolution Specialist Member Experience

4/2/2014 Problems with Product/Service | Read Complaint Details
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Additional Notes

Complaint: Issues with cancelling insurance due to signing up through Connect for Health Colorado I have contacted Kaiser and Connect for Health Colorado on several occasions to request cancellation of my insurance. Every time I've been directed to call 'The other company' to cancel. Connect for Health has stated that they cannot cancel my insurance policy as they are the gateway for sign-up, but not the ones in control of my policy/policy provider. Kaiser has stated that, although they provide the insurance, they have no control over billing or cancellation. Both companies have stated that they are 'submitting a request'. But I have heard nothing regarding said request. I have sent messages to Kaiser, to which they responded "Thank you for your inquiry and for using the Kaiser Permanente Web site. Unfortunately since you signed up with Connect for Colorado you would have to contact them for cancelation of your policy please call ***.***.**** for more information on how to Cancel and how to receive a refund. Thank you and have a nice day." I would simply like to cancel my insurance policy. I had initially requested a refund for my first months payment due to the fact that I didn't receive my bill or membership information/number until halfway through January, and had to call in to make payment to avoid losing my insurance. At this point in the venture, a full refund of all that I've paid them ($429.58) would be exceptional considering that I've experience nothing but frustration with this organization, however I will be happy with just getting my policy cancelled if it comes down to it.

Desired Settlement: Ideally I would like to receive a full refund due to the high level of frustration with simply trying to start and discontinues my insurance policy, however at the least I want my policy terminated.

Business Response: Initial Business Response /* (1000, 5, 2014/03/19) */ March 19, 2014 Ms. ******* ****** Trade Practices Specialist Denver/Boulder BBB P.O. Box ***** Denver, Colorado 80204 Complaint Case # ******** Consumer: ****** ******-****** Case Opened: March 4, 2014 Dear Ms. ******, This is in response to your email received on March 5, 2014, regarding Kaiser Permanente (KP) member, ****** ******-******. The member has sought the assistance of the Better Business Bureau (BBB) for the resolution of his concerns with Kaiser Permanente (KP). Mr. ****** advised that he has tried to cancel his KP health plan through Connect for Health Colorado (C4HCO) and KP. He states each company sends him to the other company to request the cancellation. He also states that he did not receive his KP health plan enrollment information and health record number until mid-January. Mr. ****** has requested that this matter be resolved, and if possible, he would like his KP health plan cancel as though never active. We value the opportunity you have given us to review and respond to our member's concerns. We have also provided a direct response to our member regarding his concerns. Please note that C4HCO is the organization responsible for determining the cancellation date of the member's health plan, since he applied for health care coverage through C4HCO. Our records indicate that C4HCO received Mr. ******'s cancellation request on February 21, 2014. As such, C4HCO has cancelled the member's KP health plan effective February 28, 2014. KP did contact C4HCO regarding Mr. ******'s request to cancel his policy as though never active. However, C4HCO has indicated they could not honor his request, since they did not receive his cancellation request until February 21, 2014. KP sincerely apologizes for the confusion and frustration Mr. ****** experienced regarding this matter. 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, he has the right to request a second review. Please have him put the request in writing to: Kaiser Permanente Member Services **** South Havana Street Aurora, Colorado 80014 Written requests will be reviewed by Member Services Administration who will respond to you in writing within 14 calendar days of the receipt of the member's request. We may extend this timeframe up to an additional 14 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 BBB or the member has any questions, please contact me at (***) ***-****. Also, you may contact Member Services: Denver/Boulder members may call ***-***-3800, toll free at 1-800-632-9700, between 8 a.m. to 5 p.m., Monday through Friday. Deaf, hard of hearing, or speech impaired members who use a TTY may call ***-***-3820. Colorado Springs members please call 1-888-681-7878 or deaf, hard of hearing or speech-impaired members who use TTY may call 1-800-521-4874. You may also contact our department through our Web site at kaiserpermanente.org. Please thank Mr. ****** for his understanding in this matter. Sincerely, ****** W. ****** Case Resolution Specialist Kaiser Permanente Initial Consumer Rebuttal /* (3000, 7, 2014/03/24) */ (The consumer indicated he/she DID NOT accept the response from the business.) With all due respect, I have spent enough time contacting Kaiser, and will waste no further time. I am requesting they resolve the issue to terminate my policy internally, and refund all money that I have paid them.

3/13/2014 Advertising/Sales Issues | Read Complaint Details
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Additional Notes

Complaint: I asked for 'all associated costs'of a procedure. Was not given accurate information, then "required" to make f/u appt. then charged $200. I am very frustrated and disappointed by the way Kaiser handled my situation and billing complaints. I was very careful in all my actions, I prepared and got all the information i could and it turns out kaiser was not accurate with their information and I am the one that has to pay for it. Background is: I was given the option of having a sleep apnea test. One Dr highly recommended it and one didn't think it would give us any new information but it could not hurt. So I called twice to Kaiser was transferred numerous times with both calls. I was finally able to get an approximate cost of the test recommended. I was very specific in getting the cost of the test and all associated expenses with it. I was very careful to budget and plan accordingly to the information I was seeking and they said they gave me in full. I received the test. As with twenty previous tests I was told and expected to receive the results via the website or email from the ordering physician. I was called a few days/week after the test to come in for the results. I asked for them to be sent to the website and/or email. I asked to speak to the physician over the phone. I have 4 kids and three school schedules everyday to maneuver around. I did not want to bring my baby in and did not see why I needed to be face to face for results, since it had never happened before. They were very adamant I come in. So I did, and did so under the assumption that it was included in the cost and associated costs of the test. I was sent a bill, this bill in dispute weeks after for the amount of 192.65$. I never would have had the test knowing this added cost. this two hundred dollar added expense raises my expense by 40%. Had the kaiser employees given me accurate information that this appointment would be mandatory and associated with the test I would have opted to not get this test and do an alternate much less expensive test. By not including this appointment fee in their estimate i feel Kaiser has been fraudulently inducing to proceed with the test. This is poor customer service. Almost as frustrating was the actual appointment. I met with a Nurse practitioner not even the ordering or referring physician. I had to wrestle and juggle my baby the entire time. And I was given no new information other than the test found no information. How in the world is it mandatory to tell me face to face that nothing results can be gathered from the test. I was so frustrated by the waste of my time I kept asking the nurse for options and how do I figure out what my problem is then. She referred me to their Kaiser website, which I was already referred to by two other physicians and could almost recite to her. Yet I am forced to comply and come in at an inconvenient time only to be told we have no new information for you but check out the website for help. as is the fact that they required you to attend a mandatory but useless meeting to discuss the (non)results. So my results from this interaction are no new medical advice or information, wasted morning wrestling with my daughter and I get sent a bill for $200. Kaiser feels that because I was seen by the nurse and actually discussed my issue and she advised me ie:pointed me to the website of useless help for my situation that I assumed the cost. I however feel that they were fraudulent in not adding the appointment into the costs when I asked for all expenses associated with this test. I also feel that it is very poor medical care and customer service to waste peoples time when information can be easily and safely sent through their own website. To cap it all off. They sent me to collections, when I have been waiting to hear back from their dispute office. I am forced to leave messages, fill out forms and can never discuss my dispute with kaiser. I leave a message and the only response I get it a letter from a collection agency. Where's the law for me, where's customer service

Desired Settlement: not be charged for an appointment I was told was covered in costs of the procedure. Account be closed from collections. An apology for not having better customer service. Improving their dispute system so Patients can actually voice opinion and discuss the dispute and get FEED BACK and not just a letter of collections.

Business Response: Initial Business Response /* (1000, 5, 2014/02/27) */ February 27, 2014 Ms. ************** Trade Practices Specialist ******/Boulder BBB ************** ******, ******** ***** Complaint Case # ******** Consumer: ********** Case Opened: February 12, 2014 Dear Ms. *******, This is in response to your email received on February 13, 2014, forwarding concerns on behalf of our member; **********. She has sought the assistance of the Better Business Bureau for the resolution of her concerns with Kaiser Permanente (KP). Ms. ****** has shared that she feels she was not properly informed of charges she would be responsible for, in association with required visits received following her sleep study. She feels that the customer service provided by KP surrounding her dispute has also not been adequate. She has asked that we waive the charges and document and share her concerns. I have confirmed that Ms. ****** was seen for a follow-up appointment to a sleep study on January 14, 2013. I have also confirmed that the appointment was not included in the cost of the sleep study and billed according to the benefits outlined in her Evidence of Coverage, applying to her deductible in the amount of $192.65. I apologize that Ms. ****** feels that KP did not handle her dispute in a matter she felt sufficient. I did note that KP reviewed her concerns in the Case Resolution Department on two separate occasions, first on May 17, 2013, and then on October 21, 2013. We documented and shared her concerns with the appropriate leaders. Additionally, we responded to her concerns in writing both times explaining how her plan works and why the charge is appropriate for the service received on January 14, 2013. However, as a one-time service gesture, I will be happy to waive the charges totaling $192.65 from her account. I will request that the amount be pulled back from collections and then the appropriate adjustments will take place. I ask that Ms. ****** allow a few weeks for the adjustments to be complete. 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 Case Resolution Team ************************ ******, ******** ***** If the BBB or the member has any questions, please contact me at (303) ********. Please thank our member's for their understanding in this matter. We know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente. Sincerely, **************** Lead Case Resolution Specialist Member Experience Kaiser Permanente Initial Consumer Rebuttal /* (2000, 7, 2014/03/07) */ (The consumer indicated he/she ACCEPTED the response from the business.)

3/13/2014 Advertising/Sales Issues | Read Complaint Details
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Additional Notes

Complaint: I direct a non-profit org, Centers for Christian Study International. We terminated our policy and have been wrongly billed beyond our termination. This complaint concerns a group policy with Kaiser Permanente involving Centers for Christian Study International. Group Number XXXXX-XXX, Plan Number 72ND. When I contacted Kaiser to notify them of the termination of our group policy in November, 2012, I was told that we were paid in full through December, 2012. I requested termination to be effective December 31, 2012. I was warned by the Kaiser agent ***** ** *******) that I would probably receive communication from the billing office saying that we still owed for a month, but that we did not, since Kaiser charges a month in advance. In fact I did receive such communication with such an allegation. I called Kaiser and disputed the bill, but received no proof, as requested. Kaiser sent the matter to a collection agency. I disputed the bill with them and asked for proof of the debt, with no response per my request. I again called Kaiser and left a message disputing and asking for proof of the debt. I have never received this. The bill has moved from collection agency to attorneys, each time with threats against our non-profit. This is harassment that must stop.

Desired Settlement: I want them to drop the alleged debt of $1,982.81 and communicate with any collection agency and/or attorney and/or consulting service that this matter has been resolved.

Business Response: Business Response /* (1000, 5, 2013/10/31) */ October 31, 2013 Ms. ******* ****** Trade Practices Specialist Denver/Boulder BBB P.O. Box XXXXX Denver, Colorado XXXXX Complaint Case # XXXXXXXX Consumer: ********* Case Opened: October 16, 2013 Dear Ms. ******* This is in response to your email received on October 17, 2013, forwarding concerns on behalf of our former member; ******* ****. He has sought the assistance of the Better Business Bureau for the resolution of his concerns with Kaiser Permanente (KP). Mr. **** feels that his non-profit group, Centers for Christian Study International, is being wrongly billed and sent to collections. We value the opportunity to review and respond to this grievance. I have researched this issue and confirmed that the Centers for Christian Study International was enrolled with KP under group number XXXXX-XXX through December 31, 2012. I have asked that an audit be completed on the premium payments made by the group for 2012. The audit shows that for 2012 there was a total billed amount of $23,632.75. We received payments through November 7, 2013 totaling $21,649.94, leaving the balance for December 2012 of $1,982.81. Additionally, I have documented and shared the concerns presented by Mr. **** with the KP Membership Accounting Department to include the Manager, as well as, with the Consolidated Services Center Manager. I am happy to further review this issue for Mr. **** if he can provide proof of payments made for 2012. At this time our records do indicate that the balance of $1,982.81 is accurate. Mr. **** can contact me directly at XXX-XXX-XXXX for further assistance. This feedback is essential to our commitment of continuous improvement in delivering the highest quality, most appropriate and compassionate ***** Our goal is to deliver excellent service. Grievances expressed do not affect 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 Case Resolution Team 2500 South Havana Street Aurora, Colorado XXXXX If the BBB or the member has any questions, please contact me at (XXX) XXX-XXXX. Please thank our member's for their understanding in this matter. We know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente. Sincerely, ****** ********* Lead Case Resolution Specialist Member Experience Kaiser Permanente Consumer Response /* (3000, 12, 2014/01/09) */ I have been waiting to receive documentation of the alleged underpayment of our premium, but have not received any. I do not consider this matter resolved. Please reopen. Business Response /* (4000, 14, 2014/01/22) */ January 22, 2014 Ms. ******* ****** Trade Practices Specialist Denver/Boulder BBB P.O. Box XXXXX Denver, Colorado XXXXX Complaint Case # XXXXXXXX Consumer: Center for Christian Study International Case Re-Opened: January 9, 2014 Dear Ms. ******* This is in response to your email received on January 13, 2014, forwarding the additional concerns on behalf of our former member; ******* **** of the Center for Christian Study International. He has sought the assistance of the Better Business Bureau for the resolution of his concerns with Kaiser Permanente (KP), that he considers still non-resolved. Mr. **** feels that his non-profit group, Centers for Christian Study International, is being wrongly billed and sent to collections. We value the opportunity to review and respond to this grievance. Mr. **** shared that he was waiting for additional information from KP. I apologize that Mr. **** still has continued dissatisfaction with our organization. We have mailed out the audit of his account to the address we have on file. The audit shows a detailed review of billing and payments for the group account. We hope this will assist him in reviewing his payment records. If Mr. **** does find payment submitted for December 2012, I ask that Mr. **** contact me directly to further discuss this matter. I can be reached directly at (XXX)-XXX-XXXX. This 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. Grievances expressed do not affect coverage in any way If the BBB or the member has any questions, please contact me at (XXX) XXX-XXXX. Please thank our member's for their understanding in this matter. We know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente. Sincerely, ****** ********* Lead Case Resolution Specialist Member Experience Kaiser Permanente CC: ******* **** XXXX XXth Street Boulder, CO XXXXX Consumer Response /* (4200, 16, 2014/01/24) */ (The consumer indicated he/she DID NOT accept the response from the business.) When we closed out our Kaiser Permanente account, I spoke at length with **** ** *******, a Kaiser staff member. We set the end of the policy for December 31, 2012. She explained to me that Kaiser bills a month in advance for services, so that our November payment would cover the policy through December 31, 2012. She also warned me that I would probably receive communication from Kaiser that we still owed for December, but that I should ignore this, since we had made sufficient payment. Our QuickBooks record for November 2012 shows that $1,982.81 was paid by check card to Kaiser Permanente on November 8, 2012. Our Wells Fargo bank statement confirms that there was a payment made to Kaiser Permanente by check card on November 8, 2012 in the amount of $1,982.81. Ms. ********* says that Kaiser has sent an audit of our account to us, but to date we have not received this. Consumer Response /* (-5, 18, 2014/01/30) */ Please note that I am sending an attached email from ***** L *******, account executive with Kaiser Permanente regarding the termination of our policy. It is being sent to ******* ******** Please note that Ms. ******* indicates the effective termination date of December 31, 2012. Please also note her comment: "Please note it takes 4 - 6 weeks for the entire cancelation process. In the interim, if you should receive billing/dunning notices, disregard." This confirms my earlier phone conversation with her, which I have referenced in the complaint. Consumer Response /* (-5, 19, 2014/01/30) */ See pdf attachment Business Response /* (4000, 20, 2014/02/08) */ February 8, 2014 Ms. ******* ****** Trade Practices Specialist Denver/Boulder BBB P.O. Box XXXXX Denver, Colorado XXXXX Complaint Case # XXXXXXXX Consumer: Center for Christian Study International Case Re-Opened: January 29, 2014 Dear Ms. ******* This is in response to your email received on January 29, 2014, forwarding the additional concerns on behalf of our former member; ******* **** of the Center for Christian Study International. He has sought the assistance of the Better Business Bureau (BBB) for the resolution of his concerns with Kaiser Permanente (KP), that he considers still non-resolved. Mr. **** feels that his non-profit group, Centers for Christian Study International, is being wrongly billed and sent to collections. We value the opportunity to review and respond to this grievance. Mr. **** shared additional information regarding communication that he has had with Account Executive, **** *******. I can see from this email how Mr. **** would think he would not have additional financial responsibility. Therefore, I will recommend waiver of the charges totaling $1,982.81. This can take additional time and may require further communication to Mr. ****. He is free to contact me directly or continue communication through the BBB. I can be reached at (XXX)-XXX-XXXX. Sincerely, ****** ********* Lead Case Resolution Specialist Member Experience Kaiser Permanente Consumer Response /* (4200, 22, 2014/02/13) */ (The consumer indicated he/she DID NOT accept the response from the business.) When the removal of the charges is no longer a "recommendation" but is verified to me by official communication from Kaiser Permanente I will drop my complaint, but not until then. Complaint Response Date bumped because: Holiday Business Response /* (4000, 24, 2014/02/27) */ February 27, 2014 Ms. ******* ****** Trade Practices Specialist Denver/Boulder BBB P.O. Box XXXXX Denver, Colorado XXXXX Complaint Case # XXXXXXXX Consumer: Center for Christian Study International Case Re-Opened: February 21, 2014 Dear Ms. Vicars, This is in response to your email received on February 24, 2014, forwarding the additional concerns on behalf of our former member; ******* **** of the Center for Christian Study International. He has sought the assistance of the Better Business Bureau (BBB) for the resolution of his concerns with Kaiser Permanente (KP), that he considers still non-resolved. Mr. **** feels that his non-profit group, Centers for Christian Study International, is being wrongly billed and sent to collections. We value the opportunity to review and respond to this grievance. Following my last correspondence provided to the BBB on February 8, 2014, I did recommend that the charges totaling $1,982.81 be waived from the group account for Center for Christian Study International for their December 2012 premiums. I have confirmed that on February 11, 2014, the account was recalled from collections and the balance of $1,982.81 was removed from the account. Mr. **** will not be responsible for the charges. If there are any questions I can be reached at (XXX)-XXX-XXXX. Sincerely, ****** ********* Lead Case Resolution Specialist Member Experience Kaiser Permanente Consumer Response /* (2000, 26, 2014/03/07) */ (The consumer indicated he/she ACCEPTED the response from the business.)

2/3/2014 Billing/Collection Issues
9/16/2013 Advertising/Sales Issues
9/10/2013 Advertising/Sales Issues | Read Complaint Details
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Additional Notes

Complaint: Due to Kaiser Permanente's misleading family plan deductible we are being forced to pay excessive medical bills relating to our daughter's leg cast. Due to a misleading deductible we are being forced to pay over $4,000 in medical bills to put a leg cast on our daughter. Note that there was no surgery or setting of the bone required in the procedure. Kaiser's role in this situation was to mislead us regarding the deductible. Upon signing up for this plan we were led to believe our deductible was $1,500 per individual, and $3,000 maximum for the family. Not only were the plan details worded and listed to appear to operate in this fashion, but every other family-plan insurer we have dealt with over the years operated in this way. After receiving this large bill for the leg cast, we were informed that the $3,000 family deductible applies to every member of the family, and the $1,500 individual deductible that is printed on our documentation and our insurance cards means nothing. Nowhere in our documentation is this specified, and it's in contradiction to basic common sense as well as nearly every other health insurance plan on the market. WE ATTEMPTED OVER AND OVER TO DISCUSS THIS WITH A CUSTOMER SERVICE SUPERVISOR OVER THE PHONE, AND WE WERE DISCONNECTED EVERY TIME. We have documentation of every phone call and every customer service rep we spoke to. WE ATTEMPTED A LETTER OF APPEAL IN EARLY JULY, AND OUR LETTER OF APPEAL WAS COMPLETELY IGNORED BY KAISER PERMANENTE. Additionally, we have already paid over $1,000 in medical bills related to this issue. More than 5 months after the fact, and long after all other bills were paid, we received an additional $3,000 bill. It was explained to us that Kaiser held up payment to Children's Hospital Colorado and caused this bill to be sent months after it was supposed to. 5 months is an unreasonable time to wait for a bill. We thought after paying over $1,000 in bills that we were finished. We had no idea that we were going to be charged an additional $3,000, months after the fact. We have a right to be billed in a reasonable time-frame and this is completely unreasonable.

Desired Settlement: We expect Kaiser to pay their share of this insane medical bill based on a $1,500 deductible as represented, and not a $3,000 deductible. We could have had the cast put on at an urgent care facility for a fraction of this cost, which makes our Kaiser insurance effectively worthless. We expect Kaiser to pay their share and/or negotiate a reasonable price with the hospital, but so far they have been unresponsive. We expect Kaiser to take under consideration that we have been fighting this for months and have been ignored and disconnected numerous times while trying to advocate for our basic rights.

Business Response: Business' Initial Response /* (1000, 5, 2013/08/28) */ August 28, 2013 Ms. ******* ****** ************************** Denver/Boulder BBB P.O. Box 48179 Denver, Colorado 80204 Complaint Case # ******** Consumer: **************** Case Opened: August 14, 2013 Dear Ms. ******, This is in response to your email received on August 15, 2013, forwarding concerns on behalf of our member; **************** He has sought the assistance of the Better Business Bureau for the resolution of his concerns with Kaiser Permanente (KP). Mr.*********** has concerns regarding the current deductible plan his family is on. He feels that KP provided misleading information on how the family vs. individual deductible works. Due to this the family now has excessive medical bills. Mr.*********** would like KP to pay anything over the amount of $1,500. We value the opportunity to review and respond to this grievance. I have confirmed that the*********** family is currently on a High Deductible Health Plan through KP. The plan is listed to have an individual deductible of $1,500 and a family deductible of $3,000 per family. The individual deductible only applies if one person is signed up on the plan. If there are two or more individuals on the plan then the family deductible applies. This is stated in the Evidence of Coverage which I will be happy to provide to the family at their request. I have also confirmed that the family has received services that are applying to the family deductible of $3,000 since there is more than one person on the plan. I have also noted in my review, that the member has also sought the assistance of the Colorado Division of Insurance (DOI) regarding this same complaint. At this time, KP cannot make a decision on waiver of deductible charges since the case is being reviewed for the DOI. The member should be receiving a response regarding this request after the DOI complaint investigation is complete, on or around September 4, 2013. I do apologize that the member feels that misleading deductible information was provided. I have shared this concern with the KP Large Group Sales Account Executive. 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 Case Resolution Team ************************ *********************** If the BBB or the member has any questions, please contact me at (***) ********. Please thank our member's for their understanding in this matter. We know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente. Sincerely, ******* ********* Lead Case Resolution Specialist Member Experience Kaiser Permanente

9/9/2013 Advertising/Sales Issues | Read Complaint Details
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Additional Notes

Complaint: We paid for an office copay but are now being charged for outpatient services. My son was referred by our Kaiser pediatrician to a Children's Hospital neurologist. We had our first visit 2/7/13 and we were advised that we were to pay a $60 office visit copay. Under our plan benefits, we would only owe additional money if testing was performed. No tests were done that day. We later receive a $424 bill. This bill is for professional services. We received this bill because the visit was billed as a hospital outpatient visit. I sent the bill back for review with Kaiser twice. Both times we were denied adjustment. From a conversation with ******** in the claims department, I understand that the "system" has been erroneously charging these types of visits as an office visit for years and has recently been corrected. I asked if the office visit money I paid could be applied toward the professional services bill. She said, "No. That was the Facility fee." So basically I have come to understand that because Children's Hospital handled the billing of this office visit, it is being billed as a deductible/coinsurance. Had we visited a neurologist at a site outside of Children's it would have been an office visit copay. It looks like we got to pay both ways. When I inquired about whether or not I would be able to speak to one of the insurance adjusters who repeatedly deny paying the balance owed, I am told that they do not speak to the public and there is no way I can contact them. And they do not place outgoing calls.

Desired Settlement: I want Kaiser to pay University Physicians the $454 balance for services at children's hospital neurology department on 2/7/13 and 3/28/13.

Business Response: Business' Initial Response /* (1000, 5, 2013/08/23) */ August 23, 2013 Ms. ******* ****** Trade Practices Specialist Denver/Boulder BBB P.O. Box 48179 Denver, Colorado 80204 Complaint Case # ******** Consumer: ****** ******** Case Opened: August 14, 2013 Dear Ms. ******, This is in response to your email received on August 14, 2013, forwarding concerns on behalf of our member; ****** ********. She has sought the assistance of the Better Business Bureau for the resolution of her concerns with Kaiser Permanente (KP). Ms. ******** has attempted to get clarification on why she has received additional billing for services received at the Children's Hospital on February 7, 2013 and March 28, 2013, for her son. Ms. ******** shared that she paid the office visit copayment and does not feel the additional charges are justified. She asked that we waive the amount of $454. We value the opportunity to review and respond to this grievance. I have confirmed that services were received on February 7, 2013 and March 28, 2013, at the Children's Hospital Neurology Department. According to the claims that were processed the Children's Hospital submitted a bill for each date of service for use of the facility, the member was applied a copayment of $60.00 for each visit for facility services. Additionally, the provider that serviced the member also submitted a bill that applied toward the member deductible and coinsurance. The amount applied on February 7, 2013 totaled $504.91 which included deductible and coinsurance charges while the March 28, 2013, only a coinsurance amount applied totaling $87.91. After additional review of the claims and claim processing I have confirmed that the charges are appropriate for the service received. The claims applied according to the member benefits set forth by the Evidence of Coverage in effect at the time service was received. The member should be informed that as a onetime service gesture KP has agreed to pay the current pending balance on file a University Physicians Inc. for services noted above. I have contacted University Physicians Inc. and as of August 23, 2013, the pending balance is $460.89. Additional payment is being forwarded to University Physicians, Inc., this can take a few weeks for processing. The member should also know that when services are provided outside of a KP facility that the claims process based on services billed from those providers. I would be happy to speak with the member regarding her benefit directly, and can be reached at the number listed below. We hope Ms. ******** will give us the opportunity to regain their confidence and trust as their health care provider as we work together in the future. 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 Case Resolution Team 2500 South Havana Street Aurora, Colorado 80014 If the BBB or the member has any questions, please contact me at **************. Please thank our member's for their understanding in this matter. We know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente. Sincerely, ****** ********* Lead Case Resolution Specialist Member Experience Kaiser Permanente

9/9/2013 Advertising/Sales Issues | Read Complaint Details
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Additional Notes

Complaint: We were referred to an out of net work provider for service and now owe a balance for their mistake. We are new to Kaiser as of April 2013 and joined the Fort Collins offices under the Kaiser Denver Boulder HMO Plan. We obtained a Doctor at that office and both my husband and I saw this Doctor once for a first visit. I had my first visit on April 29,2013, at that time Dr.********* had me get an xray of my left knee and I received an e-mail that gave me a refer to Orthopedic & Spine Center of the Rockies to look at my left knee. Below is the referral# (Referral # Creation Date Referral Status Status Update ********* 05/13/2013 Authorized 05/13/2013:Status History.) I visited the Orthopedic and Spine center of the Rockies. During that appointment with the specialist at that clinic it was determined that I needed a total knee replacement and we set up a Aug 20th appointment to do the procedure. It was later in July that I found out that the Kaiser Doctor had sent the referral to an out of network provider, the Ortho clinic took Kaiser Northern Colorado Ins not Kaiser Denver Boulder which again is the plan we have. I got a denial of service for my knee and filed a formal complaint with Kaiser. Kaiser called me and told me that they were sorry and this should have never have happen and it should have not gone this far. They waive the total cost of the balance of that visit to the Ortho clinic and I had to pay the 40.00 copay for the specialist, which would have been the same as if I had been referred to the right plan. They also said I could go to their Franklin Offices in Denver and see the right plan specialist with out another referral. All was well until today I opened a bill from The Center for Gastroenterology in Fort Collins, Co for 429.79, a balance left over from ****** *******'s colonoscopy on Aug 8, 2013. This test was ordered for ****** from Dr. ****** ********* during ******'s first office visit. Dr. *********'s office sent over a direct access referral form to the Gastro center to schedule this procedure for ******. He was called by the Gastro center and was told what he needed to do to get ready for the test. After the test we we received a bill for the 429.79 and were told by The Center for Gastroenterology that they do not take Kaiser Denver Boulder and that they are a out of network provider. If we had known this we would have used the Kaiser Denver Boulder facility and saved our self's a cool 429.79. Kaiser and Dr. *********'s office set up the appointment for the Surgery center and the Ortho Center and did this with a direct referral access form, this was something we did not see or have access to. I have had this happen two times now with this Doctor and Insurance in the referral process and I have filed a formal complaint with Kaiser about my knee and the Ortho bill. Frankly I have lost trust in this Insurance company.

Desired Settlement: We expect Kaiser to pay the full balance of 429.79 to Center For Gastroenterology in Fort Collins, Co. The total bill was 768.00, they (Kaiser) paid 338.21 and now the balance is 429.79 due to the negligence of the direct access form referral process sending us to a out of network provider instead of the plan we are enrolled in. We would have made different choices and used a Kaiser Denver Boulder HMO facility to have this test done given the choice. We were not in the decision making process. Also this has happened twice to us in less then 6 months. Trust has been broken.

Business Response: Business' Initial Response /* (1000, 5, 2013/08/23) */ August 23, 2013 Ms. ******* ****** Trade Practices Specialist Denver/Boulder BBB P.O. Box 48179 Denver, Colorado 80204 Complaint Case # ******** Consumer: ****** and ****** ******* Case Opened: January 2, 2013 Dear Ms. ******, This is in response to your email received on August 12, 2013, forwarding concerns on behalf of our members; ****** and ****** *******. The family has sought the assistance of the Better Business Bureau for the resolution of their concerns with Kaiser Permanente (KP). The family has stated that they have had more than one occurrence with KP referring them to providers that are not in their KP Denver/Boulder plan. Most recently they have received a bill totaling $429.79 and asked that KP pay this amount. We value the opportunity to review and respond to this grievance. I have confirmed that the *******'s have filed formal complaints directly with KP regarding their concerns. KP has documented and shared these concerns with the appropriate managers and plan leaders within the organization. I have also confirmed that the family was provided referrals for care in the Northern Colorado service area in error, and for this KP deeply apologizes for the frustration and lack of trust this has caused. We are currently reviewing our processes so that issues like this do not occur in the future. Additionally, I did note that KP processed a claim on July 23, 2013, for services Mr. ******* received. The claim processed as paid; however, because the provider is non-contracted with the members KP Denver/Boulder plan the family was being balanced billed the amount not covered by KP of $429.79. On August 20, 2013, KP sent additional payment to the provider in the amount of $430.14 which included interest. The *******'s should not be billed further for this service. We hope Mr. and Mrs. ******* will give us the opportunity to regain their confidence and trust as their health care provider as we work together in the future. 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 Case Resolution Team 2500 South Havana Street Aurora, Colorado 80014 If the BBB or the member has any questions, please contact me at **************. Please thank our member's for their understanding in this matter. We know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente. Sincerely, ****** ********* Lead Case Resolution Specialist Member Experience Kaiser Permanente

8/20/2013 Advertising/Sales Issues | Read Complaint Details
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Additional Notes

Complaint: Coverage has been canceled for non-payment, even though we have timely remitted, and Kaiser has deposited, all of our monthly premium payments. Our small-group coverage has inexplicably been canceled for non-payment, even though we have remitted, and Kaiser has deposited, all of our monthly premium payments...including the payment for July. We, and our agent, have corresponded with Kaiser multiple times since May 20, 2013, via email, mail and telephone...all without success. Kaiser's failure to timely correct their internal accounting records has now left our employees without health insurance.

Desired Settlement: Immediate and retroactive reinstatement of our small-group coverage, a letter of apology and reimbursement for all employee out-of-pocket expenses.

Business Response: Business' Initial Response /* (1000, 6, 2013/07/27) */ July 27, 2013 Ms. ******* ****** Trade Practices Specialist Denver/Boulder BBB P.O. Box 48179 Denver, Colorado 80204 Complaint Case # ******** Consumer: ****** ***** Case Opened: July 16, 2013 Dear Ms. ******, This is in response to your email received on July 16, 2013, forwarding concerns on behalf of our member; ****** *****. The member has sought the assistance of the Better Business Bureau for the resolution of his concerns with Kaiser Permanente (KP). The member stated that his small-group coverage has been cancelled by KP even though the premium payments were remitted timely. Mr. ***** asked that we retroactively reinstate the group, provide a letter of apology, and cover any out-of-pocket costs incurred by the enrollees. We value the opportunity to review and respond to his grievance and apologize for his dissatisfaction. We have formally documented and shared the grievance with the appropriate managers and leaders of our organization to include the Director of the KP Membership Accounting Department. Research has confirmed that the group did make timely premium payments and that the account was terminated in error. The premium payments were posted to the wrong account, causing the account to become delinquent. I have confirmed that this was a manual processing error. The account has been reinstated to show no gap in coverage. Due to this error, KP has implemented additional quality assurance steps to assure that this same mistake does not happen in the future. If the group has incurred any out-of-pocket costs for health care services received while the policy was in-active, I ask that they contact me directly so that I can reimburse these costs to affected members. I can be reached at **************. Additionally, a personal apology letter has been mailed to Mr. ***** containing the information noted above. 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. If the BBB or the member has any questions, please contact me at **************. Please thank our member for their understanding in this matter. We know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente. Sincerely, ***************** Lead Case Resolution Specialist Member Experience Kaiser Permanente

7/24/2013 Problems with Product/Service | Read Complaint Details
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Additional Notes

Complaint: Unable to make contact through phone or email I needed to make an appointment for my wife and they would not answer the phones, I also tried making an appointment on line vie the web as I was told I could do and I could not make the appointment until the fallowing week I could not make it for the current week.

Desired Settlement: I want proper service, I want to be able to call in an appointment or be allowed to make appointments on the internet as they advertise and not have to wait a whole week for an appointment.

Business Response: Business' Initial Response /* (1000, 5, 2013/07/20) */ July 20, 2013 Ms. Heather Vicars Trade Practices Specialist Denver/Boulder BBB P.O. Box XXXXX ******* ******** XXXXX Complaint Case # XXXXXXXX Consumer: ******* ******** Case Opened: July 16, 2013 Dear Ms. Lucero, This is in response to your email received on July 17, 2013, forwarding concerns on behalf of our member; ******* ********. The member has sought the assistance of the Better Business Bureau for the resolution of her concerns with Kaiser Permanente (KP). The member has stated he made several attempts both over the phone and on the internet to make an appointment with his wife's provider with not luck. The member wants proper service and to be able to call in and make an appointment. We have formally documented and shared the grievance with the appropriate managers and physician leaders with the in KP organization. I have confirmed that Ms. ******** was seen on July 16, 2013. I am sorry that the attempts that were made by our member to contact us were not successful. The member can contact our Clinical Contact Center at XXX-XXX-XXXX for appointments, Monday through Friday 7am to 6pm. Also if the member encounters trouble they may always contact our Member Service Contact Center at XXX-XXX-XXXX or myself, directly at XXX-XXX-XXXX Monday through Friday 8am to 5pm. Again, I am sorry for the occurrence that took place on July 16, 2013, and that we were not able to be reached by telephone. This is not the type of experience we want our member's to have. Feedback like this is essential to our commitment of continuous improvement in delivering the highest quality, most appropriate and compassionate ***** 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: ****** ********** Member Services **** ***** ****** ****** ******* ******** XXXXX Written requests will be reviewed by Member Services Administration who will respond to you in writing within 14 calendar days of the receipt of the member's request. We may extend this timeframe up to an additional 14 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 BBB or the member has any questions, please contact me at (XXX) XXX-XXXX. Please thank our member for their understanding in this matter. We know that they have a choice for their healthcare, and we thank them for choosing Kaiser Permanente. Sincerely, ****** ********* Lead Case Resolution Specialist Member Experience Consumer's Final Response /* (3000, 7, 2013/07/23) */ (The consumer indicated he/she DID NOT accept the response from the business.) No changes were made to improve the quality of service the same system remains. I challenge anyone to call on Monday and try to get an appointment without getting a recording informing you that you will be put on hold because of the large amount of activity and you will be put on a queue forever. What is required is more personnel attending to the needs of the customers and the website fixed so that a person can make appointments for the current week. If this requirements aren't meet then there is no fixing the system in place.


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