ComplaintsforKaiser Foundation Health Plan Inc

• Initial Complaint

  01/19/2022

  Complaint Type:

  Customer Service Issues

  Status:

  Answered

  More info

  Kaiser has apparently instructed their referral agency American Specialty Health ********** for ************ care to only pay invoices with Billing codes that match what the physician has written on the referral. In 2020 I asked my Doctor for a referral for LOWER BACK PAIN. He was not even aware of this referral program. However, he investigated and I received one good from 9/22/20-9/22/21. The Billing Code used by the Doctor was for lower back pain.I went to a Chiropractor that a fellow Kaiser patient referred me to in *****************. I noticed almost immediately from my monthly Summary ******** that the Dr. was not being paid. I called Am. Specialty and was told the wrong billing codes were being used. I called the Chiropractor; told them this and thought my actions had helped the Doctor get paid.I just received a new Summary of Care and see that the Dr. rebilled and again is not paid. In calling Am. Specialty, they said the invoices were rejected for being received outside the referral period and for for Bad Billing Codes. As an example, I was told an invoice was for "Subjugation". I asked what that meant. "Adjustment of the Spine." That's when I found out my Doctor had only used a Billing Code for Lower Back pain. No one can tell me that Adjusting the spine has nothing to do with Lower Back Pain Kaiser's Billing code and payment system is broken; hurting Dr.'s like Chiropractors. My friend tells me she has "Summary of Care" statements showing the same rejections.I believe there are thousands of unpaid invoices because the provider has used a Billing Code not included by the Kaiser Dr. **** is not fair to Chiropractors or other 3rd party providers. My back is great thanks to the services given to me and the Chiropractor should be paid in full. If invoices are rejected there needs to be a review system to resolve these issues in a timely manner.(Please note some of the attachments are 2 pages long)

  Business response

  01/19/2022

  Thank you for your email.  I've forwarded this information to our Member Relations department.  A representative will review and follow up with the patient directly to address the concern.  Please let us know if we can assist further.   Thank you.

  Customer response

  01/20/2022

   
  Complaint: 16481956
  
  I am rejecting this response because: 

  Come on.............all this message says is that my complaint has been referred to someone for review. This doesn't even say that they will pay the Chiropractor. They are scamming ALL CHIROPRACTORS or other 3rd party providers if a different billing code is used by the provider. Remember: in my case, my doctor did not even know about this program.

  Kaiser needs to change their payment practices and how their Doctors fill out referrals with proper billing codes. If the BBB were to be able to audit American Specialty, I am certain they would find hundreds if not thousands of unpaid invoices because the billing codes do not match
  
  Sincerely,
  
  ***************************

  Business response

  01/26/2022

  Thank you for your email. A representative from our Member ******************** called and spoke with the patient on January 21, 2022, to acknowledge receipt of his concern and to explain next steps in the review process. A letter was also mailed to the patient on January 22, 2022, confirming the same. The concern is currently under review and a response will be provided directly to the patient within 30 days from the date we received his concern.  

  Customer response

  01/28/2022

   
  Complaint: 16481956
  
  I am rejecting this response because: This is not a response. All it says, and I can confirm that Kaiser contacted me, that they will take up to 30 days to get back to me. I am puzzled that the BBB thinks this is a resolution. Please keep the complaint open until their is a completed response.
  
  Sincerely,
  
  ***************************

  Business response

  01/28/2022

  Thank you for your email. A representative from our Member ******************** called and spoke with the patient on January 21, 2022, to acknowledge receipt of his concern and to explain next steps in the review process. A letter was also mailed to the patient on January 22, 2022, confirming the same. The concern is currently under review and a response will be provided directly to the patient within 30 days from the date we received his concern.  

  Customer response

  01/30/2022

   
  Complaint: 16481956
  
  I am rejecting this response because: this response does not resolve the issue. All it says is that Kaiser will get back to me in 30 days. The BBB should not "wash their hands" of this problem from this response. Small business providers (like chiropractors) are not being paid for their services. The BBB should ask Kaiser to change their procedures to pay these providers.
  
  Sincerely,
  
  ***************************

  Business response

  02/02/2022

  Thank you for your email. A representative from our Member ******************** called and spoke with the patient on January 21, 2022, to acknowledge receipt of his concern and to explain next steps in the review process. A letter was also mailed to the patient on January 22, 2022, confirming the same. The member has been informed that his concern is currently under review and a written response will be mailed to him within 30 days from the date we received his concern. Thank you. 

• Initial Complaint

  12/20/2021

  Complaint Type:

  Service or Repair Issues

  Status:

  Resolved

  More info

  I am a veteran with sleep apnea, and I am a CPAP user. The only way to reach the Sleep Lab is through an antiquated phone system that does not have a call back function, or tell you how long the hold time will be. It becomes a battle of attrition to see how long you can stay on hold. I have filed a complaint with Kaiser, but there was no resolution. The Resolution Specialist said she would ping the Lab Manager. I dont even know what this means. It was evident she just wanted the complaint out of her files regardless of resolution status. This is simply bad medicine. I have discussed this with my Kaiser primary care physician and he informed me that their Sleep Lab is understaffed. I currently have an intermittent working CPAP machine with no way to get it replaced. I have also tried Apria to facilitate a replacement, again with no luck.

  Business response

  01/03/2022

  Thank you for your email.  I've forwarded this information to our Member Relations department.  A representative will review and follow up with the patient directly to address this issue.  Please let us know if we can assist further.   Thank you.

  Customer response

  01/06/2022

  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, I did received a replacement CPAP.  I still stand by my original complaint that the Sleep Lab is dysfunctional.  This issue could have been resolved much differently if they had an effective way to administer quality medical care.
  
  Sincerely,
  
  *****************************

• Initial Complaint

  12/06/2021

  Complaint Type:

  Customer Service Issues

  Status:

  Answered

  More info

  Incorrect phone numbers, runarounds-call one number, they tell me to call another number, that number is incorrect and tells me to call the 1st number. In determinable wait times on the phone. Attempted to file a grievance on their site but the link is null. Reps are clueless and give out incorrect information. Currently waiting 40 on hold for the 2nd time today.

  Business response

  12/09/2021

  Thank you for your email. I've forwarded this information to our Member Relations department.  A representative will follow up with the patient directly to assist them.   Please let us know if we can assist further.  Thank you.

• Initial Complaint

  10/22/2021

  Complaint Type:

  Service or Repair Issues

  Status:

  Resolved

  More info

  Please see details in attached document

  Business response

  11/03/2021

  Thank you for your email.  I've forwarded this information to our Member Relations department.   A representative will review and follow up with the member to address this matter. Please let us know if we can assist further.  Thank you. 

  Customer response

  11/04/2021

  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

  10/08/2021

  Complaint Type:

  Order Issues

  Status:

  Answered

  More info

  My sister, *****************************, a Kaiser member, passed away September 4, 2021. I wish to bury her with my parents in ********, **. The ******************************* Services requested a letter from me and Kaiser detailing her mental disabilities to qualify her for burial. A letter was written September 10, 2021 by ********************* *********************************, but it was missing required information. I didn't receive the letter via mail as per Dr. *********** who stated "the letter was mailed and I should have received it" around this same time. After hospitalization (me) and against doctor's ******* September 30th, I went to Kaiser **********, MD medical records to get the letter and take it to the funeral home. October 4th, the director of **************** Funeral Home contacted me to tell me Kaiser left out pertinent information. Kaiser has continued to give me the run around ever since. No one is taking calls and correspondence went to ********** twice. I need someone from administration to solve this!

  Business response

  10/18/2021

  Thank you for your email.  This issue has been forwarded to our Member ******************** in ********.    A member of our staff will follow up with you directly to assist with this matter.  Please let us know if we can assist further.  Thank you. 

• Initial Complaint

  10/04/2021

  Complaint Type:

  Product Issues

  Status:

  Answered

  More info

  I was admitted to Kaiser Hospital on Sept.30 to Oct.6 2021. on oct 2 during a room change my wallet went missing out of my purse when i arrived at my new room i notified my nurse that my wallet was no longer present.i absolutely know without a doubt in my mind that my wallet with $400 dollars cash along with medical cards identification proofs for myself and my children.my wallet is retail $136.00 which was a gift from a family friend. i had my state id which is $36.00, corona virus proof of vaccination. my sons social security card along with my own social security card , $426.00 which 4 100 dollar bills were located in a white bank envelope, a $50 ********* gift card , my AAA card.i had tried to notify the higher up of the hospital floor i was on and i was told to be patient while the staff would try to find my wallet that i had just put in my purse right before my room change. i waited still no wallet ive called numerous times only bein given the runaround.

  Business response

  10/07/2021

  Thank you for your email.  I've forwarded this information to our Member Relations department.  A representative will review and contact the patient directly to address this issue.  Please let us know if we can assist further.   Thank you.

• Initial Complaint

  09/26/2021

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  I get below error every time I log in to my Kaiser Permanente web account to make any transaction, like scheduling for appointment, checking for results or opening the letters:We're sorry, but this feature is temporarily unavailable. For more information, call ************** (toll free), Monday through Friday, 6 a.m. to 7 p.m. Pacific Time or Saturday and Sunday, 7 a.m. to 3 p.m. Pacific Time, excluding major holidays.I reported this issue back in April 2021 and even escalated to the *** of the company. I sent thanks to the *** when he responded but after that no one else has resolved my issue. I am now escalating this to BBB because I don't get any proper response. I went for a COVID test today Sept. 26, 2021 for my international flight on Tues., Sept. 28, 2021 and I received a text message this night that the results are available but I can't view it anywhere. I have to now wait for morning to get in touch with their phone or chat services. No one is there available to help.

  Business response

  10/08/2021

  Thank you for your email. I've forwarded this information to our Member Relations team.  A representative will review and follow up with the patient directly to address this concern.  Please let us know if we can assist further.  Thank you.

  Customer response

  10/09/2021

   
  Complaint: 15908100
  
  I am rejecting this response because: the issue still persists. I keep getting multiple instructions asking me to perform specific steps but still no one is able to fix the issue since April 2021 (more than 6 months now)
  
  Sincerely,
  
  Marcos *******************************

  Business response

  10/15/2021

  Thank you for your email.  I've forwarded this information to our Member Relations team in ********.   A representative will follow up with the patient directly to address the issue.  Please let us know if we can assist further.   Thank you.

• Initial Complaint

  09/09/2021

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I've recently been diagnosed with MS so I've had to use my medical insurance more than ever previously. I had to go to the ** on 7/26/21 and was charged twice for some of the items- once on a hospital **** and once on a professional services ****. I was also charged twice for an MRI on 7/28/21 - once for the actual MRI (billed at $1745) and once just to have someone interpret it (billed at $683!!). I was never contacted by Kaiser to have my MRI results explained, instead I had to call member services and find my own neurologist and have them explain it to me. I've in fact had to contact member services multiple times since there has been a lack of transparency regarding my results multiple times.

  Business response

  09/10/2021

  Thank you for your email.  I've forwarded this information to our Member Relations department.  A representative will review and follow up with the patient directly to address the concern.  Please let us know if we can assist further.   Thank you. 

*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. ↩