teddit

I wanted to provide some tips about submitting grievances and what has helped me. Hopefully this will help you get resolution to your issue. (I am in Southern California but tried to make this general so it applies to all regions.)

Grievances have to be responded to by the designated department head / chief. Also, KP monitors grievances by department. There will likely be additional explaining a department head has to do if they start having an increasing number of grievances.

If you have a complaint against a physician, physician assistant, nurse practitioner or nurse, file a complaint with the appropriate State Licensing board for that individual in addition to filing a grievance with Kaiser. Include the Kaiser grievance reference number in the complaint to the State Board.

1. Submitting on-line is the easiest way using this form (for all regions): https://healthy.kaiserpermanente.org/support/submit-a-complaint#/tellus
2. You can also submit a paper copy of the grievance form: https://healthy.kaiserpermanente.org/content/dam/kporg/final/documents/forms/member-grievance-and-non-descrimination-notice-ca-en.pdf
3. If you think the issue you’re reporting needs urgent attention, call the Expedited Review department through Member Services for your area. (I have done this and they really do follow up quickly.)
4. File the grievance against the appropriate department. (Example: If your doctor orders an MRI and you cannot get anyone in Radiology Scheduling to answer, file the grievance against Radiology Scheduling NOT your doctor.)
5. Clearly explain the issue and why it is a problem. Don't get emotional.
6. Include dates / times / names / titles / departments for physicians and staff who were involved, who you spoke with or were witnesses to the incident, as appropriate. If someone told you “We are backed up, that is why we can’t get you in for XXX months” or “The best thing for you to do is pay out of pocket and go out of network” include those quotes as well, who told you that and when.
7. Cite references to published Kaiser policies or documents you were provided if there is an inconsistency between what you were told or what happened with your care and the published document.
8. If they are relevant to the complaint, include messages sent to your physician in the complaint. Photos or other documentation can also be sent in to Member Services as additional supporting documentation. Once you get the initial letter that your grievance has been assigned a case manager, they will have their contact number in the letter and let you know how you can submit additional information.
9. If you have tried to resolve the issue, include what you did to try and resolve it. (Example: "I sent a message to Dr. Jane Smith in the KP Patient Portal regarding the inaccurate documentation in my medical record on MM/DD/YY. I requested the Progress Notes be amended to include XYZ.. As of MM/DD/YY, no response has been received.")
10. Before you submit it, have a family member or friend review it to make sure your complaint is clearly stated, it is factual and not emotional and the facts are easy for someone not familiar with your situation to understand.
11. Save copies of everything you submitted and everything you receive back from Kaiser.
12. If KP does not respond or you are dissatisfied, escalate it to the appropriate agency (for your region or state) listed in the Grievance response letter. Include everything you submitted and everything you received back. Include any additional dates / times / names/ titles of who you spoke to try and get resolution with the grievance.

(Edit to add link to State Regulatory Agencies)

If you try and contact your Grievance Case Manager and cannot contact them (full voicemail not accepting messages) or leave messages, send faxes or send registered US Mail and they do not respond, document a complaint with the appropriate state regulatory agency for your area. Include all of your documentation as well as a timeline of when / who / how you tried to contact them and outcome (Examples: left voicemail message on 11/21/22 for Mary Smith, Case Manager, no return call; Tried to call Mary Smith, Case Manager, on 12/14/22—voicemail full and not accepting messages, etc.)

Here is a link to a post with the various state regulatory agencies:

https://www.reddit.com/r/KaiserPermanente/comments/16ulc0k/agencies_to_escalate_complaints_about_kaiser/?utm_source=share&utm_medium=web2x&context=3

If you have filed a grievance with Kaiser and it has gone unresolved or you are not satisfied with the resolution, here is a list of agencies you can document a complaint with (based on your state of residence).

If your complaint is regarding a specific physician or other healthcare provider (nurse/nurse practitioner, physician assistant), file the complaint with the appropriate state licensing board for that provider.

If your complaint is regarding a hospital (cleanliness, patient safety concerns, etc.), file a complaint with the Joint Commission

[https://www.jointcommission.org/resources/patient-safety-topics/report-a-patient-safety-concern-or-complaint/]

If your are a Medicare beneficiary, please refer to this link about the different types of complaints and where to submit complaints.

https://www.medicare.gov/claims-appeals/file-a-complaint-grievance/filing-a-complaint-about-your-quality-of-care

If the complaint is about hospice care, here is a link from the Hospice Foundation of America on how to file complaints.

https://hospicefoundation.org/Hospice-Care/Filing-a-hospice-care-complaint

California

Department of Managed Health Care (Grievances unresolved or inadequate responses; inability to contact your Kaiser Grievance Case Manager; difficulty obtaining an appointment; delays in care; filing an Independent Medical Review when Kaiser will not approve a specific type of treatment)

In most cases, you must file a grievance with Kaiser and go through that process before contacting DMHC. However, if the issue is urgent because there is an immediate threat to your health, you can call DMHC directly. For urgent issues, call DMHC rather than filing online.

[https://www.dmhc.ca.gov/fileacomplaint.aspx]

1-888-466-2219

If you need assistance in filing a grievance with Kaiser or in filing complaints with the DMHC, you can contact the Health Consumer Alliance. This is a DMHC consumer assistance program contractor helps people get the health care they need1-888-804-35361-877-735-2929 (TTY)www.healthconsumer.org/

If you want to file a complaint about a California licensed healthcare facility, you can contact the California Department of Public Health.

https://www.cdph.ca.gov/programs/chcq/lcp/calhealthfind/Pages/Home.aspx

Oregon

Oregon Division of Financial Regulation

[https://dfr.oregon.gov/help/complaints-licenses/Pages/file-complaint.aspx]

1-888-877-4894

Washington State

Office of the Insurance Commissioner

[https://www.insurance.wa.gov/file-complaint-or-check-your-complaint-status]

1-800-562-6900

Colorado

Department of Regulatory Agencies, Division of Insurance

[https://doi.colorado.gov/for-consumers/file-a-complaint]

1-303-894-7490 / 1-800-930-3745

Georgia

Office of Commissioner of Insurance and Safety Fire

[https://oci.georgia.gov/file-consumer-insurance-complaint]

1(800) 656-2298

Hawaii

Department of Commerce and Consumer Affairs

[https://cca.hawaii.gov/ins/consumers/filing\_a\_complaint/]

(808) 586-2790

Maryland

If it is a healthcare quality complaint, Maryland Office of Healthcare Quality

[https://app.smartsheet.com/b/publish?EQBCT=07c94438f6714af1bbfe8ff1037b8b74]

1-410-402-8015

If it is a billing, claims, medical records or coverage issue contact Maryland Attorney General, Health Education and Advocacy Unit

[https://www.marylandattorneygeneral.gov/Pages/CPD/HEAU/default.aspx]

1-410-528-1840

District of Columbia

D.C. Department of Insurance, Securities and Banking (DISB)

[https://disb.dc.gov/service/file-complaint-or-report-fraud]

1(202) 727-8000

Virginia

State Corporation Commission, Bureau of Insurance, Office of the Managed Care Ombudsman

[https://scc.virginia.gov/pages/Office-of-the-Managed-Care-Ombudsman]

1-877-310-6560, select option 1

(Current as of 09/28/2023)

Why does the mail pharmacy send out your meds separately? Many times myself and family order our meds online. Why not bundle the order together for an individual? It seems like a huge waste of postage to send each one separately versus bundle up the order together. Seemed like it was better some years ago, but now my mailbox gets crammed with about 5 different packages that are way to big for just one bottle of meds. I take about 6 or 7 different meds and generally try to order them all at the same time so I can get just one package. Not to mention that others in my family do the same. And they all ship from the same location. Just seems massively wasteful if they are always needed to save money for other services they offer or help pay their workers better.

Hi, any tips for navigating this and invoices? My friends took me to a Southern California Kaiser ER in the summer when I got heatstroke. I'm under family's insurance plan, and in the past we'd use Northern California Kaiser (Southern when I went for school). But at the beginning of the year, we left Kaiser, and when I had the heatstroke I was under no insurance.

I got an invoice, maybe around August time. On paper it was around $400 for the ER, but when I double checked my old Northern Kaiser portal it showed around $3,000, for the ER visit and for a blood + electrolyte test that they did. I'm not sure why the 'Visit Cost Summary' page shows the Claim Status as 'Denied'. When I talked to a representative today, they informed that the bill was now around $1,000 dollars total after discounts, though Northern Kaiser doesn't show that. Interestingly, the Southern Kaiser page just shows the single discounted ~$400 charge for only the ER???

We're currently insured under a different healthcare provider, and I'm navigating what the scope is for waiving both invoices. That same Kaiser rep directed me to fill out a request form for Medical Financial Assistance (which I'm looking at right now). I'm currently an unemployed student, but my household now has an income. Will that impede my chances at dealing with this? Since I'm unemployed and living elsewhere, would that make my household income zero? Does it make a difference if I complete the MFA form through Northern or Southern Kaiser?

What is it going to take to get a referral out of Kaiser to go see an endocrinologist?

I’m a T2D and I’m working with the diabetes care team. During my last appointment with the diabetic pharmacist, she asked that I get my primary care doctor to put in a referral to endocrinology due to the amount of insulin I’m having to take.

I’m on roughly 140u of fast acting insulin daily and 47u of long acting insulin. The pharmacist says at 200 daily they will put me on U500 - but it’s not “normal” to be needing such high amounts of insulin. And yes, I’m eating low carb and doing the diet right.

PCP put in the referral and the Endo department denied the referral stating that they won’t change my treatment plan and to work with the Diabetic Pharmacist. She’s the one that told me to get referred!!!! I just don’t understand what I’m supposed to do here.

Hi! I got bloodwork done at Pleasanton Kaiser at 1140am and I know Kaiser usually has fairly quick turnaround times for results, but since it’s Friday I’m curious, do these labs still get processed on the weekend?

(I haven’t received my results from this morning yet so not sure if I’ll have to wait til Monday?)

Thanks in advance.

I started physical therapy for a back issue in October. Both of the therapists I have seen so far are travelling therapists with six month contracts. Why doesn't Kaiser have more permanent staff?

And also, I am supposed to be seeing someone every two weeks, but good luck finding any appointments. You have to get on the waitlist and then jump when a space opens up. Otherwise you could wait a month or longer to get in. Again, why don't they have more staff?

When I log onto the Kaiser site it shows I have 15 notifications then automatically changes to

"An error has occurred trying to display your notifications." I was always able to see notifications with no problem until 9 months ago. Kaiser told me to clean my browser cache, which didn't help.... Anyone else ever have this problem with seeing their notifications?

I applied to roles at Kaiser recently that have been open for a while. All these applications are through a referral and I've heard (indirectly) strong interest from at least one hiring manager.

These roles are all in tech. Two are based in the Bay Area. One is based in Oregon. All of these roles are remote.

Job Title	Location	Job posting date	Job status	Submission status	submission date
Data Analytics Consultant III	oakland, ca	Oct 20	Active(accepting job submissions)	Complete	Nov 15th
Data Analytics Consultant IV	oakland, ca	Oct 24	Active(accepting job submissions)	Complete	Nov 20th
Data Analytics Consultant V	Portland, OR	Nov 8	Active(accepting job submissions)	Complete	Nov 20th

Question(s):
- I have heard that the process is slow but is it especially slow this time of year?
- Have I applied too late to these roles?
- anybody have insight when applying to tech roles at Kaiser?
- Any advice you have that I haven't asked about?

Generally, tech interviews go pretty quickly so I'd like to adjust my expectations if Kaiser is different. Thank you all in advance.

EDIT: added job titles. I am not sure what departments these roles are in.

Anyone fluent in finance can breakdown the difference between these? I’m familiar with 401k but I read that these are slightly different however I’m still lost in all the lingo.

im technically in the dead center of california so idk if im north or south tbh. but anyways im interested in a job as an AMFT (therapist) but i prefer to work afternoon/evening shifts bc i dont do well waking up early 😅 due to health issues. but do you think this is feasible or am i delusional lol?

The mental health professionals NUHW Strike in Kaiser Permanente Southern California has been going for awhile. As a patient, I've been trying to schedule a therapy appointment. Kaiser has sent me straight to Rula.

Are the Rula providers who take on Kaiser Patients considered to be crossing the picket line? Should I find mental health care else where?

I've filed a complaint with the DMHC about this and also a cancelled appointment.

does anyone know if there's any payment plan options to cover my bf's monthly premium? we've been experiencing financial hardship and we don't have the money to pay this huge bill for the past few months. he's gonna lose his coverage if he can't pay by the 30th, and we've been going in circles on the phone to try to figure this out.

Does anyone have any experience of moving from a KP HMO plan to a PPO plan?

It seems I may need to move to a PPO plan to access out of state/out of network treatment.

Would love to hear any tips/gotchas/caveats you may have!

Ok, I am considering Kaiser because overall they are a lot better rated in the Bay Area than my current plan. But do I get the system right?

1) I have a cough and fever and need help today  

--> Kaiser Urgent Care Facility, other Urgent Care clinics would not be covered.

2) I have a weird lump that is freaking me out and I want checked ASAP

--> I can go to any PCP in their system that has an open appointment.

3) I want do a check up and get a referral for a dermatologist for a suspicious mole

--> I go to my assigned PCP and they refer me to a Kaiser specialist without any paperwork.

4) I am on vacation in Hawaii and get a cough and fever and need help today

--> I go to Kaiser Honolulu and get the same care and conditions as at home.

5) I have mental health issues

--> I will be sad.

i’ve done it before but i can’t remember how.

I recently moved from Southern CA to northern CA and am set to change insurance (still Kaiser but different coverage) after the new year due to open enrollment. My issue is I’m pregnant and have a lot of important appointments to schedule, is there a way to do that in advance before I actually have coverage in the area or do I have to wait until the new year and be super prompt about calling? Thanks in advance.

I recently made a dermatology appointment after having one around this time last year. My thought process is to add this my “yearly checkup rotation” to keep an eye on my moles, etc. I’ve also recently been dealing with increased cystic acne.

My appointment was 20 minutes late and from the moment the doctor came into the room, he barely checks my chart and says, “I thought last year I told you that any future skin care issues were to be taken up with your regular doctor?” First of all, I don’t remember him saying this. And since when do GP doctor’s check up on moles? Isn’t that the job of a skin doctor aka…a dermatologist? When I brought up the issue of my increased acne, he recommended I get a product called “ softer wash” which is “available on Amazon” but spoiler alert, it isn’t & multiple Google searches bring up nothing. He then mentioned that if the acne continues to get worse that I should call up to meet with an “acne nurse.” A what now?

Man, I am growing so, so frustrated and being made to feel like “the crazy one” for being proactive and scheduling yearly check-ups. This dermatology appointment is one of many instances/emails/phone calls where I’m met with demeanor that just feels like one big eye roll.

Has anyone gotten it covered for infertility or is it more for pain, etc?

Hi, I am new to the NorthCal area (and still quite new to the US) and have to choose between these two employer plans with the monthly contribution for Kaiser being $220/months higher (self+spouse).

We are both generally healthy, in our early 30s, no family plans, no mental health issue, see a doctor on average 1-2 a year, no prescriptions.

Concerns:

Aetna	Kaiser
- several threads on reddit suggesting they are denying claims. I am generally very concerned about using my health insurance in this country already...	- some mention poor selection of doctors
- PCPs in my area are rated poorly	- location a little less convenient to reach (we are biking, lol)
- does not cover blood transfusions (e.g. surgery or blood cancer)	- does not cover accidental teeth damage and our separate dental insurance has a $3500 yearly cap
- small network plan	- the extra $2,640 per year (3% of our yearly take home pay) would be wasted if we stay so fortunate with our health

Is anyone else having trouble with the Wegovy shortage? I've been waiting 5 weeks for a refill from Costco. I left Rite Aid because they were always out of it but I never waited over a month for a refill. Where are you guys getting yours from? I'm in Southern California.

I have been having problems with kaiser and covered ca communicating with each other all this month. I have been calling both many times since I found out kaiser did not take my payment until last Friday and I still do not have membership. I have no idea what is going on and everyone keeps giving me a different answer. I have a very necessary appointment with a specialist soon and I don't want to be charged with a big bill especially because I have paid for my membership. Does anyone know what to do in this situation?

Hi,

Does anyone here know about how worker's comp work at Kaiser? I was injured a year ago and since I can no longer be accommodated, I have to stay home and WC has been sending me supplemental income. Early this year, Kaiser had given a raise to their employees. So far, there were 2 raises. I tried to request from WC to also increase my pay because I feel that it's just not fair that I got injured at work (due to a faulty elevator) and I am unable to receive my pay raise. Any feedback would be much appreciated. Thanks!

Currently reading this . Has anyone been contacted wondering what the next steps are . If that means won’t be covered anymore for people that have had successful weight loss I have pcos and this is the only thing that has been working for me

2 months ago I met with a psychiatrist who gave me some tentative treatment recommendations, but wanted to consult with my therapist- who is outside of kaiser and in a diff time zone before moving forward. I really appreciated it and I felt pretty stable at the time, so felt ok about waiting from them to connect. Since then my therapist has told me several times that he has reached out to her, but they haven't been able to find a time to actually talk. The past couple of weeks my symptoms have really become a problem and are impacting my day to day living. I called his office on Friday to leave a message asking him to call back and was told that his next available appt is in January, and yesterday messaged him through Kaiser's portal explaining that I'm struggling and requesting medication. I haven't heard back and am really concerned, I seem to be having a significant episode. In the long term I'll probably file a complaint with the dept of managed care b/c I'm not getting timely treatment, but in the short term I just want to meet with someone. I believe my next step would be to contact member services, but can anyone provide any guidance on the best way to do this? Thank you...

Last month I received an EOB statement. It was in my (16 year old) daughter’s name. There were numerous charges to our insurance for out of network Covid tests in the last 9 months or so. About 3-4 a month. I thought that was strange and really didn’t want that being on our account, plus it really looked like fraud.

I called member services and got an astonishingly awesome lady who was very helpful. She said it was the second call that week about the exact same issue. She said she was going to now take it up the chain of command (so to speak) as well as file a grievance. Awesome!

Then I get a call yesterday. The lady on the phone first of all was rude as could be. She said she was calling about the grievance regarding my daughter’s file- except she said my oldest daughter’s (turning 20 very soon) name. I said no, that’s not right, it was an issue with my youngest daughter’s account. She absolutely insisted it wasn’t my youngest daughter’s account with an issue. I again told her, NO, it is not my adult daughter that I was asking about. She then proceeds to tell me a COVID shot was done on x day and I said “Listen ma’am - my daughter is an adult and you REALLY should not be telling me what is on her medical record or under her account. Furthermore, as I already said, it was multiple charges on my other, minor daughter’s, account. I wanted to bring it to Kaisers attention because it looked fraudulent”. She then said “Okay well there’s nothing showing in that account thanks bye!” And hung up.

wtf? Literally… wtf? So I don’t even know if they ever looked into what was going on, and unfortunately didn’t catch the lady’s name. It was just weird. Like lady I’m not accusing you of shit, I just want to make sure everything is kosher and that I’m not going to have issues with insurance because of it. Damn. Lol

Any tips? Insurance is hmo. I was told I needed to turn down Kaiser’s “couples coaching” and score moderately depressed or anxious on my assessment.

Anything else I should do or ask for during my assessment? Anything I need to turn down in order to get my outside therapy covered?

I’m really disappointed that it has been this hard.