ComplaintsforKaiser Foundation Health Plan Inc

• Initial Complaint

  08/14/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  My deductible amount on my physical benefit card and in my kp.org online account both said it was $2,500. I went to get some services (all in network) that added up to around $2,900 and was told that my deductible was $5,000 because I had someone else on my plan. All the while, the card I received in the mail and the card that I have on my kp.org account said that it was $5,000. This was misleading information to hear AFTER I had received services and now was financially responsible. I could have made other considerations on the services I was going to receive if I was told that my information was incorrect ahead of time.Not only was my deductible information incorrect, I reached out in May 2024 to member services to hopefully resolve this issue and have my deductible match the $2,500 number I was told it was. They "created a case" and I never heard ANY follow up. I called again (now August) and the person told me that my case had been escalated and a note was put on it that they would not change my deductible but NO ONE EVER REACHED OUT TO ME.Overall misleading deductible inforamation, I feel like my deductible was doubled under my nose without being told before hand and when I reached out for support there was no follow up on a resolution in my case.

  Business response

  08/16/2024

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

  Customer response

  08/16/2024

   
  Complaint: 22142426
  
  I am rejecting this response because: their response was just that it was forwarding it to the right team. Will happily accept a response if my deductible is set to the $2,500 amount I have on my Kaiser card and in my Kaiser online portal.
  
  Sincerely,
  
  *******************

  Business response

  08/20/2024

  Dear Better Business Bureau (BBB),

  Thank you for your notice about a concern brought to your office by the individual named in your letter dated August 15, 2024.

  Due to privacy reasons, we are unable to address any individuals complaint in detail through correspondence with the BBB. Therefore, this response is acknowledgement that we are in receipt of this concern. If this individual received services at a Kaiser Permanente facility, we will forward this complaint to Member Relations to investigate and provide resolution. Upon the completion of the investigation, we will contact the individual directly by letter with the outcome within 30 days.

  Our mission is to offer care and service of the highest quality, and we appreciate your dedication to helping individuals who may have received care at our facilities or through our plans. Thank you for your partnership.

  If the individual named in the complaint wants assistance in the meantime, they can alternatively reach *************** by phone at **************, Monday through Friday from 8 a.m. to 5 p.m.

  
  Sincerely,

  ****************
  Member Relations Coordinator

  Coverage provided by Kaiser Foundation Health Plan of Washington or Kaiser Foundation Health Plan of Washington Options, Inc.

  Customer response

  08/20/2024

   
  Complaint: 22142426
  
  I am rejecting this response because: this is false. I attached a document with my Kaiser ID number clearly shown on it and included my Kaiser ID number in my initial complaint. This is completely false that you are unable to identify me. *** also submitted similar tickets with your team and have gone to member relations already and this BBB complaint mentions that I have already done this.

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

• Initial Complaint

  08/10/2024

  Complaint Type:

  Product Issues

  Status:

  Resolved

  More info

  On June 19, 2024, I typed up an official arbitration request to Kaiser Foundation Health Plan. The letter officially went out in the mail on June 20, 2024. As of today, I have not received any acknowledgment back. After speaking with member services in late July, I was informed that my arbitration request was not on file as received. My arbitration request followed the guidelines listed on the Office of the Independent Administrator website, and was mailed to ***************************************************, Attn. Legal Department. My Kaiser medical record number is ********, ******************* region. I simply just need confirmation that my arbitration request was received.

  Business response

  08/15/2024

  Thank you for your email.  ******************** advised they will ask the counsel  assigned to your case to follow up with you directly.   Thank you for reaching out.

  Customer response

  08/15/2024

  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

  08/09/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  I am writing to formally complain about the inadequate care and refusal of necessary medical services I have experienced with Kaiser Permanente.**Background:**I am currently pregnant and have been seeking necessary OB/GYN care from Kaiser Permanente. However, due to my decision to seek fertility treatments outside of their network, Kaiser Permanente is refusing to provide me with essential OB/GYN care. This includes the refusal to prescribe a medication that is critical for both my health and the health of my fetus.1. **Denial of Care**: Kaiser Permanente has refused to provide basic OB/GYN services, despite the fact that these services are vital for ensuring a safe and healthy pregnancy.2. **Medication Refusal**: They are unwilling to prescribe medication that has been deemed necessary by healthcare professionals for the wellbeing of both myself and my unborn child.3. **Past Issues**: I have experienced significant issues with Kaiser in the past, including inadequate care during a previous ectopic pregnancy. This history of poor treatment further exacerbates my concerns.4. **Poor Communication**: The doctors at Kaiser have been consistently rude and unresponsive, making it extremely difficult to communicate with them and receive timely care.The denial of these essential services and the lack of professional, compassionate care from Kaiser Permanente have caused considerable stress and concern for my health and the health of my unborn child. Their refusal to provide the necessary medication is particularly alarming, as it poses a direct risk to my pregnancy.I am seeking intervention to ensure that Kaiser Permanente fulfills its obligations to provide comprehensive OB/GYN care, regardless of where I obtained fertility treatments. I request that they prescribe the necessary medications and improve their overall standard of care and communication.

  Business response

  08/15/2024

  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 the concern through the Health Plan grievance process.   Thank you for reaching out. 

  Customer response

  08/15/2024

   
  Complaint: 22116107
  
  I am rejecting this response because:
  
  I have sent multiple messages over time about my issues over long periods of time and have yet to get a response from anyone. I have had high stress and had my health directly impacted by the lack of response and brushing off by the company. 
  
  Sincerely,
  
  *************************

  Business response

  08/16/2024

  Thank you for your email.   I've confirmed this matter is under review through the Health Plan grievance process.   A representative will follow up with the patient directly.   Thank you for reaching out. 

• Initial Complaint

  08/03/2024

  Complaint Type:

  Product Issues

  Status:

  Answered

  More info

  Kaiser Permanente creates an undue burden on their customers regarding reimbursement requests from external providers for COVID-19 tests. Firstly, they provide no ability for customers to track their reimbursement requests with external providers for COVID-19 tests. You don't even receive a confirmation email. Their online claims system does not track reimbursement requests for COVID-19 tests - not sure if they track requests for any other external providers. They acknowledge there is no ability for customers to track this. I had to ********************** customer service four separate times because Kaiser "erroneously" processed my claims. Each time I contacted customer service, the agent acknowledge the claim was processed incorrectly. FOUR SEPARATE TIMES. The claim was for a mere $44.38. I submitted it and first received $14. Then I contacted customer service, they acknowledged it was processed incorrectly, and "sent it back for processing". Then I received $8.39. I contacted customer service, they acknowledged it was processed incorrectly, and "sent it back for processing". Then I received $16.99. They REALLY do not want to reimburse their customers properly. They're going OUT OF THEIR WAY to make sure customers are not properly reimbursed. I will now have to spend at least another 30 minutes of my time to reach out to their customer service AGAIN to get the $5. I am owed.

  Business response

  08/09/2024

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

• Initial Complaint

  08/02/2024

  Complaint Type:

  Billing Issues

  Status:

  Resolved

  More info

  I ma on Ozempic medication for my Diabetes and i am on ********* I was paying unteal last month $***** and last month they start to charge me $****** and today i went to get the medication and they charge me $******. I did complaind when i so ****** from ***** wich is a big diffrence. I was told that is a percentage i have to pay but not to go up every month. before was $***** every month and to go up again is rediculouse. I need to be looked into because with ******** should be only $***** not to $****** . something is not ******. I want to be dropt down to what i payed before $***** and get reiburst the difrence or ****** and ****** .00. the pharmacy i get my medication is ****************************On ******** with fixed income i should pay $***** even 0 for the diabetes medications not to be charge an arm and a leg. Something is wrong.

  Business response

  08/09/2024

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

  Customer response

  08/11/2024

  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

  07/31/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  Kaiser Permanente is billing me after they discontinued my coverage. They never had permission to re-start my coverage and they are billing me over $6,000.00 for non-coverage since Sept or Oct of 2023. I have talked to member services several times with promises they would forgive the amount owed as I never even thought I still had coverage and never used Kaiser from last payment date. Also Covered Calif. helped me with a tax obligation concerning this coverage. Covered Calif. resolved the dispute over my coverage issue with Kaiser, but Kaiser is still billing me.

  Business response

  08/06/2024

  Thank you for your email.  I've forwarded this concern to the 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. 

• Initial Complaint

  07/13/2024

  Complaint Type:

  Order Issues

  Status:

  Answered

  More info

  I have a single payer agreement with Kaiser for several clients. For the last year, Kaiser has been making Decimal point errors and paying me under $2 for every client hour on every other form submitted. I have been trying to recoup .you correct fees since March and have not been payed. There is no clear way or avenue provided to solve this issue and the main email I am sent to does not respond at all or takes 6 weeks. I'm owed around 10k at this point in time. My clients are high risk so I try to keep working with them as a therapist. But I may have to cease services as it appears there isn't an intent to pay me the contracted fee at this point.

  Business response

  07/24/2024

  Thank you for your email.  I've forwarded this information to the ************************** for review and follow up directly with the provider.   Thank you for reaching out. 

   

• Initial Complaint

  07/13/2024

  Complaint Type:

  Order Issues

  Status:

  Answered

  More info

  I am filing a formal complaint against Kaiser Permanente for misrepresentation, ethical violations, and failure of duty of care, which led to significant delays in my treatment and deterioration of my health.Background:Fall 2023: Kaiser staff (*********************, *************************, **********************) denied my referral request, falsely claiming ****************** was a qualified in-network motility specialist.Fall 2023: ****************** revealed he was not a motility specialist. Winter 2023: ****************** refuses to treat my emergency GI symptoms. Kaiser staff ignored my requests for an urgent GI appointment.December 2023: Filed complaint with Kaiser regarding ********************** refusal to see me. No response received.May 17, 2024: ******* from Escalated ************************** confirms my complaint was mishandled and re-opens it.June 14, 2024: Receive resolution letter with false claims, denying any wrongdoing, and failing to address core issues.Legal Violations:1. Misrepresentation: Kaiser misrepresented ********************** qualifications (C.R.S. 6-1-105) in order to deny my external referral request.2. Inadequate Care: Kaiser breached the Colorado Health Care Coverage Act (C.R.S. 10-16-113) by failing to provide timely care.3. Grievance Handling: Kaiser violated the ***************** of ********* Regulation 4-2-17 by not responding to my complaint.4. Duty of Care: Kaiser breached the Colorado Medical Practice Act (C.R.S. 12-240-101) by denying me referral requests on false grounds and refusing me urgent GI treatment.Health Impact:Motility Disorder: Diagnosed in 2024, could have been treated earlier.Reflux and GERD/SERD: Diagnosed in 2024, delayed treatment led to complications.Pancreatic Insufficiency: Diagnosed in 2024, delayed treatment caused severe issues.

  Business response

  07/15/2024

  
  We have received the member complaint. A case has been set up and assigned to a Case Manager for response. We will respond directly to the member. Thank you!
  
  

  Customer response

  07/17/2024

   
  Complaint: 21984600
  
  I am rejecting this response because:
  
  Kaiser merely acknowledged receipt of the complaint. Acknowledgement does not constitute a response.

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

  Business response

  07/19/2024

  Thank you for your email.   This concern is under review.   We will let the member know the outcome no later than 30 calendar days from when we received the concern.   Thank you for reaching out. 

  Customer response

  07/20/2024

   
  Complaint: 21984600
  
  I am rejecting this response because: the concerns have not been addressed.
  
  Sincerely,
  
  ***************

• Initial Complaint

  07/03/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  I had to get an itemized billing to sent to ***** so I could be reimbursed for my hospitalization plan policy. Only to find that ***** only accepts Faxes. I do not have a fax machine. I was trying to get an itemized billing and it was sent to me, but I was unable to open it. Kaiser was unhelpful.Kaiser billing was helpful by one person only and that person said I had to have this authorization to allow them to fax Aflac the information. I had an authorization on file, but it was not up-to-date. I went to fill it out and send it to NW.ROI @ kp.org. I followed up with a phone call talk to ***** and who answered the phone. She said she found my email, but it would be 30 days or more before they could even process it.Thats too long!! I have suffered from a heart attack and fell and have a wound on my arm. Thats hurting me. I need the money with my recovery. This is not reasonable. I asked to be expedited up, but ***** said theres nothing she can do until somehow this was process. Fax and then try to get Kaiser to re-release the itemized billing somehow, but that has not worked very smoothly at all. Nothing should be difficult. Not fair !

  Business response

  07/09/2024

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

  Customer response

  07/10/2024

   
  Complaint: 21938274
  
  I am rejecting this response because:

  because Aflac and Kaiser do not talk to each other, and I am unable even to this moment, receive my money from my Aflac insurance.

  Very difficult this should be fixed. Nothing should be this. This is an ongoing situation for lots of people and Kaiser is ignoring it and not moving this out when they can.

  Kaiser should be able to set up a link or a communication IT tool directly to Aflac with the itemized bill for hospitalization policies should not take this long or be this complicated

  Still not paid. Talk to a manager at Kaiser still unable to move this out Encrypted emails were sent, but I was unable to open them up from Kaiser. Kaiser IT tried to help me and still was unable to open them. If I cant read the email sent by Kaiser what good is it?

  This needs to be fixed
  
  Sincerely,
  
  *******************

  Business response

  07/16/2024

  Thank you for your email.   This issue is under review through our Member Relations team in *******     A representative will follow up with the member directly upon completion of the investigation.   Thank you for reaching out. 

  Customer response

  07/16/2024

   
  Complaint: 21938274
  
  I am rejecting this response because:
  As of today, Kaiser was trying to get an itemized list to Aflac so they so that Aflac could reimburse me according to the agreement that I have with Aflac insurance
  

  I still wanna make it clear for the public to know that Kaiser has been totally the problem and their systems to try to make it smooth operating has failed.

  In fact, it failed because there is no system in place. 

  Everything is extremely difficult on the Kaiser side is done everything possible to receive the information but Kaiser has tied things up in knots. Encrypted email is a mess. I was on the phone with IT with Kaiser for three hours and they couldnt get it to open. 

  We are on 30 days and its just basic information that just needs to be sent to *****. I am not the only Kaiser customer that has Aflac.

  please, ********************** fix the broken parts to the system. Nothing should be this hard.

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

• Initial Complaint

  07/01/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  My account has been broken for about 3 weeks already, and it shows errors instead of the monthly bill and my health coverage info. I reached out to Kaiser more than 20 times already (using their internal messaging system, chatting with representatives online, over email there are two incidents created for their IT team INC19894488, INC19848592). The tech support simply ignores me, the issue is not fixed, and it doesn't look like anyone actually started looking into the bug.I would really appreciate if you could help escalate this, so someone would take a look and fix the problem.

  Business response

  07/03/2024

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

  Customer response

  07/03/2024

  Complaint: 21926739
  
  I am rejecting this response because:

   

  I have talked to Kaiser representatives more than 20 times already over the course of the last 3 weeks. There are 2 incidents created with their IT Support team  INC19894488 and INC19848592, with zero outcome. I was told that there was a complaint filed at Kaiser on my behalf, and the issues were escalated to some supervisor, however, in reality, no one replies, and every time I reach out to Kaiser again, it's super clear that no one even tried to look into the issues and fix them (and I need to start it all over again with exactly the same results in the end none). They basically just keep ignoring me for 3 weeks already, while their system is broken and I cannot see my monthly bills in my online account (which I am supposed to pay by due dates somehow, without having access to the actual numbers), and I cannot see my health coverage information either.

  I need someone to actually look into the issues in their system which are affecting my account, and fix them. They keep telling me the same "someone will reach out to you" for 3 weeks, and it never happens (and every time I contact them, it's clear that no one has been doing anything at all). While I provided them all the details and screenshots multiple times.

   

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

  Business response

  07/12/2024

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

  Customer response

  07/13/2024

   
  Complaint: 21926739
  
  I am rejecting this response because:

   

  I think they have no idea what is going on with the case, and don't even coordinate things internally.

  The representative they referred to already responded on July 9 with simply showing that they didn't even try to look into the case or check what has been happening with my communication with Kaiser.

  I am attaching their response as well. They asked me in that response to reach out to an IT Analyst and provide the details with the screenshots something that I already did multiple times. I have been chatting with their IT support team for a few weeks already, and provided all the information about the issues, including screenshots and even details about errors in HTTP requests to their backend system. It's all recorded in my email communication with Kaiser and two incidents created in their internal support system. Based on the response I received, Kaiser's "Grievance & Appeals Operations" didn't even try to look into the issue and its current state.

  The same about the person you (BBB) are communicating with. Based on their response, they don't seem to have even tried to check the current state of the issue with the "Grievance & Appeals Operations" team.

  To be clear, I totally understand that BBB has its limitation in this communication, but I would really appreciate if you kept pushing for an actual resolution of the issue. I still can't see my bills in Kaiser's online system and the links to my health coverage info don't work. It's been already almost one month as I reported the issue to them, and my account is still broken, and I can't pay my bills because I simply can't see them.
  

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

*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. ↩