ComplaintsforKaiser Foundation Health Plan Inc

• Initial Complaint

  06/20/2024

  Complaint Type:

  Customer Service Issues

  Status:

  Answered

  More info

  In the past year, Kaiser's website has been having terrible problems with: not allowing me to sign in, reporting I have outstanding unread messages incorrectly, and is always down after 5pm, on weekends, and constantly asking for input which they do nothing to resolve.This is totally unacceptable. I cannot make appointments online, or access my medical records, or access any of the medical information that is available to members.

  Business response

  07/01/2024

  Thank you for your email.  I've forwarded this information to the Member Relations department.  A team member will review and follow up with the patient directly for further assistance.   Thank you for reaching out. 

  Customer response

  07/01/2024

   
  Complaint: 21880302
  
  I am rejecting this response because: I have contacted member services in the past and they were not effective.  They supposedly forwarded a letter to me which I could not access because once again, I could not sign in to the KP.org website.  I just tried signing in a few minutes ago, and was not successful. ****** services should send me a written letter stating what has been done or will be done so that I can sign in...It would be pointless if they again send me an email that I must sign in to KP's website in order to read it.  
  
  Sincerely,
  
  *********************

  Business response

  07/03/2024

  Thank you for your email. I've forwarded this information to the case manager handling this concern.   Thank you for reaching out.  

  Customer response

  07/03/2024

   
  Complaint: 21880302
  
  I am rejecting this response because: Nothing has been resolved.  Kaiser continues to forward my complaint to various people whom they say have been assigned to resolve my case, but I have yet to communicate directly with anyone.  I tried again last evening to sign in to the KP.org website, and on the screen to enter my user i.d. and password, error message appeared that what I had entered did not match.  I made no changes to this information at anytime.  But, in an effort to expedite my sign in, I agreed to change my password which was accepted by the website.  Whe I tried to sign in using my new password, it was accepted.  But I was once again presented with the same previous screen where I clicked on the sign on box, only to be shown the same screen again.  I do not believe that anyone assigned to resolve my issue is competent at all.  I also question the capabilities of the employees that remain in the IT department.  I am tired of this issue...

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

• Initial Complaint

  06/15/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I had medical insurance up through the end of this year. I had an appointment which was moved to January 4th. Upon checking in, I verified that my appointment would be covered (wellness). My insurance fully covered physical for a job.I received a bill for over $750 for this wellness visit.I submitted a complaint with Kaiser and asked for a review. They have instead submitted the bill to collections.

  Business response

  06/18/2024

  Thank you for your email.  I've forwarded this information to the Member Relations department.  A representative will review and address the concern through the Health Plan grievance process and follow up with the patient directly.   Thank you for reaching out. 

  Customer response

  06/19/2024

   
  Complaint: 21856246
  
  I am rejecting this response because:

   

  there chosen communication was a letter finally denying any liability for the communication received.  Theyve accepted no responsibility for the communication of their staff and deflect.  
  This is intentionally misleading and is healthcare extortion.  
  Sincerely,
  
  *********************

  Business response

  07/03/2024

  Thank you for your email.   I've forwarded this information to the Member Relations department.  A representative will follow up with the patient directly to address this concern.   Thank you for reaching out.  

  Customer response

  07/03/2024

   
  Complaint: 21856246
  
  I am rejecting this response because:

   

  they have failed to respond to multiple phone calls on my behalf
  
  Sincerely,
  
  *********************

• Initial Complaint

  06/06/2024

  Complaint Type:

  Sales and Advertising Issues

  Status:

  Answered

  More info

  I have been with Kaiser Permanente for about 3 years. Throughout these years, I would rate their service a 0 out of 10. More specifically I have 2 complaints. First, in 2022-2023 my wife had a mental breakdown as a result of pregnancy, hormones and changes in her mind/body as a result. ** refused to acknowledge PFL for a caregiver because she did not have a c section. We found thats a HARD requirement for KP. My wifes mental issues were well documented throughout her entire pregnancy yet KP refused to acknowledge this as a real and serious issue. Policies are so dated and need serious review before its too late for others. We struggled through this period and instead of focusing on celebrating with our child, I had to deal with this for the first 3 months of my childs life. Its absolutely unacceptable. More recently, I am in need of shoulder surgery. Since Nov of 2023 I have had to FIGHT to get an x ray to mri to appointment and now to schedule a surgery. KP is non responsive. Promises call backs but does not. The scheduling office does not answer their phones nor do they call back. I have been trying to reach them and schedule my surgery date since April of 2024. Its now June. Once they finally respond, I have a high suspicion that my date will no longer be available, which I asked for since before the schedule was out. No company should be in business with these behaviors let alone be anywhere related to my health. This negligence has caused me such stress and anxiety. It causes me to avoid treating health issues because I know everytime its a fight and struggle. If you want to know how I feel, I am so angry at the amount of money I pay and what I get in return. Its robbery and someone needs to be held accountable. I pay $1k for month for KP to not perform their obligated service to me and my family.

  Business response

  06/10/2024

  Thank you for your email.  I've forwarded this information to the Member Relations department.  A representative will review and follow up with the patient directly for further assistance.   Thank you for reaching out. 

  Customer response

  06/10/2024

   
  Complaint: 21810688
  

  The business said they are forwarding this to whatever department as their response, which is the same thing that happens with any complaint. It ends with no resolution and a "we care about our customers" lecture. I expect some refund for the years of terrible service and lack of service provided to my family. In the toughest of times, KP has done everything they can to provide as little support as possible. If it means more work or more resources expended, i.e. costing them money, you will not get support.
  
  Sincerely,
  
  ***********************

  Business response

  06/18/2024

  Thank you for your email.  This concern is being reviewed through the Health Plan grievance process.   A representative will follow up with the patient directly upon completion of the review.  Thank you for reaching out. 

  Customer response

  06/19/2024

   
  Complaint: 21810688
  
  I am rejecting this response because this is a joke. This is the same response from weeks ago, "Thank you for your email.  This concern is being reviewed through the Health Plan grievance process.   A representative will follow up with the patient directly upon completion of the review.  Thank you for reaching out." How is a company that collects over $1k a month from me able to operate on such grounds?
  
  Sincerely,
  
  ***********************

• Initial Complaint

  05/28/2024

  Complaint Type:

  Order Issues

  Status:

  Resolved

  More info

  I am a member ******** of Kaiser. On May 8, 2024, I was promised a mobility assessment that was approved by my primary care doctor. ************************ So far nothing has happened. Today, I made a follow-up call, and gave up after being on hold for 45 minutes. It is obvious that the staff is overworked. Also, it is obvious that patients are not important.

  Business response

  05/31/2024

  Thank you for your email.  I've forwarded this information to the Member Relations department.   A representative will review and follow up with the patient directly to address this concern.   Thank you for reaching out.

  Customer response

  06/01/2024

  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,
  
  *******************************

• Initial Complaint

  05/24/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  In October 16, 2023, I went to AFC *********** in **********, ** and confirmed they accept Kaiser ********************* I needed stitches and did a follow up, the physician mentioned that there was a bacterial growth (all cured now) and took a sample to be tested to provide me the proper antibiotic, the physician mentioned it was sent to a lab but I did not mention the company of the lab. In Mid December I received a bill from Quest Diagnostic explaining that they were the lab and Kaiser denied the coverage (although they covered the rest of the urgent care visit). Kaiser paid the bill using my HSA without by consent and Quest has on their record that I have paid it in a check on December, although throughout December I was on vacation and did not open in the letter with the bill till January. I filled a dispute with Kaiser and they found it in my favor to charge me only the deductible and the reason it was denied was because Quest sent the bill to Kaiser but the incorrect Kaiser address. Kaiser needs to send Quest the Explanation of Benefit (***) however they claim Quest received it, although Quest claims to never received it. At the soonest I noticed on March 2024 the *** page was down and still down now as of this writing. I cannot get refunded the total amount to my HSA because until Kaiser or myself are able to send the *** to Quest to issue the proper refund (claimed by Kaiser). Long story short I was overcharged $368.62 of the total and Kaiser's *** system is down and they take my HSA account money without noticing let me alone requesting it.

  Business response

  05/30/2024

  Thank you for your email.   This information is under review through the Health Plan grievance process.   A team member will follow up with the member directly.   Thank you for reaching out. 

  Customer response

  06/01/2024

   
  Complaint: 21757739
  
  I am rejecting this response because: Kaiser has failed to have the *** statements available online or in person Kaiser facility as was informed to me would be done in May. Quest Diagnostics has proceeded with the refund to People Soft (I am not familiar with this). Due to this experience, the resolution not being completed, and Kaiser not informing me about their action or any part of the process, I am not satisfied knowing this could still delay my refund per my plan and that this could occur to me again and other individuals in similar situations to me. They need to get this done properly with transparency.
  
  Sincerely,
  
  ******************

• Initial Complaint

  05/21/2024

  Complaint Type:

  Order Issues

  Status:

  Answered

  More info

  Hello,I am writing about medical fees claimed by my medical and health insurance provider, Kaiser Permanente (KP). On March 3rd 2024, I was treated for a mild paronychia: the treatment consisted in soaking my finger for perhaps 30 minutes in tepid water; in the next ***** minutes, the physician opened up the area around my fingernail with a pliers- or scissor-like metal utensil, put a bandage on it, all while holding a pleasant conversation, and sent me away. Maybe 10 days later, a bill arrived in my mailbox: $5019, of which I owed $928, due to my Kaiser Permanente HMO plan. Since then, I have been disoriented by the mismatch between the price tag and the service, and don't really know how to approach the problem. I feel as if I am subject to racketeering from an organization I previously saw as benevolent. From the website cms.gov and other internet sources, I think I figured out paronychia treatment should cost somewhere in the $100-$200 range, which I find about right, given the equipment and skills that were required. Not knowing what to do, I haven't paid the bill, or acted, until a friend recommended I reach out to BBB and other organisms. My complaint is:- Kaiser did not tell me the fee would be so exorbitant. A similar paronychia treatment, a dozen year ago by KP resulted only in a bill, paid upfront, of $100.- The excessive price is causing great distress in me. - Partly because of the price, but mainly - because, by having an HMO plan, I was thinking that I was helping lower health costs in our country. Instead, I see I am paying an institution, KP, that has extortionary prices. - I cannot reconcile the $5000+ bill with the relative triviality of the treatment.- Could Kaiser Permanente be inflating its bills in order to comply with regulations on health insurance companies or nonprofits? (I have to admit ignorance here, but I expect regulations to exist to bound the accounting practices of such entities) Best regards, *******

  Business response

  05/24/2024

  Thank you for your email.   I've forwarded this information to the Member Relations department.   A team member will review and address this issue through the Health Plan grievance process and follow up with the patient directly.   Thank you for reaching out. 

  Customer response

  05/27/2024

   
  Complaint: 21739097
  
  I am rejecting this response *today* because:

  1)  I have not heard back from Kaiser Permanente ("the business")
  2) I do not know when the five calendar day window provided by the Better Business Bureau ends, and I do not want the case to be closed.

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

  Business response

  05/31/2024

  Thank you for your email.   I've forwarded this information to our Member Relations department.  A team member will review and address this issue though the Health Plan grievance process and follow up with the patient directly.    Thank you for reaching out. 

  Customer response

  06/05/2024

   
  Complaint: 21739097
  
  I am rejecting this response because: I haven't received any further reply from Kaiser Permanente, as of EOD June 4th, near the end of the time-window in which I can reply to this questionnaire.
  

     Thank you for your help, ******. Could you outline for me some possible next steps?

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

  Business response

  06/13/2024

  Thank you for your email.   This concern is under review through the Health Plan grievance process.  We will let the member know the outcome and inform them about any other rights they have no later than 30 calendar days from when we received the case.   Thank you for reaching out. 

• Initial Complaint

  05/18/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  On March 1, 2018, I enrolled in ******** Health Insurance (Hospital Part A and Medical Part B) 1 currently receive $139. in monthly Social Security Benefits that is used by ******** to partially pay for my ******** monthly premium. My current monthly ******** premium is $174.70 leaving a monthly shortage of approximately $35.70 The ****************************** and ******** advised me of the following: "Because your benefit doesn't cover the full amount of your premiums, you'll also get a bill each year from Social Security. If your benefit check is less than your ******** promium amount, you will be billed annually for the remaining balance that the benefit check doesn't cover. You will not be able to change your billing cycle and Social Security doesn't mail annual bills at a specific time of year. You may not get your annual bill at the same time each year and you should wait until you receive your annual bill before making your payment to the ******** Premium Collection Center."Over the past several years, I have attempted to contact Social Security and ******** by phone, online, mail and in person with minimum success; endeavor to make continuous and or automatic payment arrangements. Specifically between February through March 2024 also prior years 1 have waited on the phone on hold for several hours to speak to a representative only to have the call dropped with no call back. Recently after waiting on the phone at: ************** on hold for hours. I attempted to contact the ******************************, via email at ********************** and received the following response: "Please contact us at our toll-free number **************."On February 18, 2024, I was treated by my health care provider for a medical condition but was denied a doctor's recommended additional high level cancer screening because I could not afford to pay a $200. fee. I later contacted my health care provider membership services department and they advised policy was canceled.

  Business response

  05/31/2024

  Thank you for your email.  I've forwarded this information to our Member Relations department.   A representative will review and address this concern through the Health Plan grievance process and follow up with the member directly.   Thank you for reaching out. 

  Customer response

  05/31/2024

   
  Complaint: 21731098
  
  I am rejecting this response because: Kaiser continue to provide inefficient and insensitive  communication regarding my complaint. They refuse to provide a "direct line of communication" to resolve my health and billing concerns. In addition, they have not considered my age related disabilities: including cognitive and short term memory loss. I'm seeking a "full reinstatement of health care membership coverage" including the: "Kaiser Senior Advantage ************* Plan" and should not wait several additionals months for a resolution.
  
  Sincerely,
  
  ***********************

  Business response

  06/03/2024

  Thank you for your email.  I would like to confirm that this issue is under review through the Health Plan grievance process.  You will be notified of our response as quickly as your case requires based on your health status, but no later than 30 calendar days of receipt. You will receive a call or letter informing you of the outcome of your Grievance.  Thank you for reaching out. 

• Initial Complaint

  05/10/2024

  Complaint Type:

  Product Issues

  Status:

  Answered

  More info

  On October 24, I was contacted by Kaiser membership services by text that their was problem with my "entitlement". I called and was told that I did not pay my September ******** Part A payment. However, I was listed as "active" and was given care. I then called the ****************************** and was told that I had no lapses in payment. I relayed this to Kaiser the next day and was told that everything was fine.On November 24th, I again received a text message that my ******** had not been paid for September. I called Kaiser and was told that their website stated that I did not pay and *** needed to state that they would correct the problem. I was told that the only proof that they would accept was this "website."I went to *** in ************ and received a letter stating that I was current with my ******** Part A and B payments, but they could not correct the problem because I was current with my payments. I sent this to Kaiser Administration. in ************ late December, I received a letter from Kaiser stating the letter was "invalid." I again went to *** and received a more detailed letter again stating that the payments from March 2023 through October 2023 when I was able to use my wife's 40 credits when she turned 62. I did not receive a response.On January 30, I received a letter from Kaiser that I had not responded to their January letter (this was because I had just sent them the *** letter the day before I received theirs). So on February 1st, I went in person to ********** services with a copy of my proof to find that they were closed and only taking phone calls. We then faxed the statements and letters from *** to Kaiser Administration in ********* on February 5th. At this point, my Social Worker called and said that Kaiser had found the letter. I have now begun to receive bills from Kaiser and my Dialysis center (******************* in ******* Dunes) who was contracted by Kaiser to provide my dialysis back to March when I enrolled.

  Business response

  05/16/2024

  Thank you for your email.  I've forwarded this information to our Member Relations department.  A team member will review and address this concern through the Health Plan grievance process and folllow up with the member directly.   Thank you for reaching out. 

• Initial Complaint

  05/06/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  Kaiser is deliberately withholding a life changing surgery from me. I am trying to get bariatric surgery because of severe pain stemming from an accident in 2020. I have seen several Kaiser drs that state that this surgery would significantly decrease my pain and quality of life. I have 2 fractured hips that are not being treated by Kaiser, even after telling the doctor about the pain. I have a bar in my left leg and a completely reconstructed ankle. Obviously will all of that, I should be moved up in line. Yet my nutritionist is not even going to schedule my final visit with her until JULY! That is completely egregious. Im just supposed to keep living in pain and taking medication for months? I started this process in January. Its May and Im barely halfway through. Most days I can barely walk and this needs to be taken more seriously. I pay almost $300 a month for this insurance. There is no reason I should be held back from getting this surgery that I desperately need.

  Business response

  05/06/2024

  This case was received by Kaiser Permanente on May 6, 2024. The case will be assigned to a representative for investigation and follow-up with the member. A written response will be provided directly to the member within 30 days from the date of receipt. 

  Customer response

  05/06/2024

   
  Complaint: 21671285
  
  I am rejecting this response because:
  
  Sincerely,
  
  *******************************

  Customer response

  05/07/2024

  No one ahas reached out or fixed the issue.

  Business response

  05/07/2024

  Good afternoon -

  Thank you for sharing the members' concerns. We will reach out and follow up with the member directly to address the concerns.

   

   

   

• Initial Complaint

  05/05/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  This is complaint is to Kaiser SF ***************I need use hearing aid on my 2 ears--both left one $1500 paid $300 after purchase was not working recently went to audiologist was not working she fixed it but she broke the top- then she temp fix it-did not work took again they said we send it out --waited waited no respond and were very rude like always thinking not hearing well i am stupid always threat me like animal the workers there like say go seat ask how long no answer--this is not the point after 2 months they said we keep your hearing aid -I NEED IT CAN NOT HEAR OR WORK TEMPORAY THAT I NEED TO DO--I HAVE MY RIGHT ONE PAID $1500 PLUS OVER $1200 FIXING IT EACH TME OVER YEARS LEFT ONE NEW AND THEY DO NOT ANSWER MY 12+ VOICE MESSAGES BOTTOMLINE I NEED MY HEARING AID--CALLED COMPANY THAT THEY SAID WE SENT IT NO RECORED THEY SAID KAISER KEEP ALL RECORD THEY NEVER GAVE ME DETAIL OF ALL SEND OUT AND EXPLANATION--ONLY ASKME SIGN SIGN SIGN--I ALWAY SIGN NOT KNOWING WHAT I SIGN I ONLY WANTED THEM FIX WHAT AUDIOLOSITBROKE PLEASE HELPthey say was reported and paid $300.00 now I have none on left ear and they are not giving to me even never asked them to replace it just wanted them to fix it---even some one loose and paid $300 they should be able to keep it never seen anything mention that never explained what I sign they are so rude always say go sit there like I am a kid or a dog or petI am neither of them but human need my hearing aid I paid for left one $1800 and right one I$1500 coast plus. $1200.00 REPAIR 4* $300 EACH TIME.My resolution is get back what they got from me to fix THE AUDILOGIST BROKE IT BOT KNOWING HOW TO CLEAN IT THE PERSON MESS IT UP LEFT MEWITH NO HEARING AID FOR 2 MONTHS RUDE AT ALL TIMES DO ALL MIXING UP RIGHT EAR AND LEFT EAR AND NEVER EVER EXPLAIN A THINGCAUSED ALLTHIS TROUBLE FOR ME CAN NOT EVEN WORK TEMP

  Business response

  05/16/2024

  Thank you for your email.  I've forwarded this information to the Member Relations department.  A representative will review this issue through the Health Plan grievance process and folllow up with the member directly.   Thank you for reaching out. 

*Some consumers may elect to not publish the details of their complaints, some complaints may not meet BBB's standards for publication, or BBB may display a portion of complaints when a high volume is received for a particular business. ↩