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Help for Kaiser Permanente Patients on this public service web site.
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HOW TO FILE A KAISER GRIEVANCE/COMPLAINT.  WHEN TO CONTACT DMHC OR CMS.

Before believing blindly that DMHC is going to help you please read a recent court ruling:


Claims, complaints, grievances, and appeals for Washington Kaiser plans in easy printable form


Claims, complaints, grievances, and appeals Processes for Oregon Kaiser medical plans
http://howto.kaiserpapers.org/oreapp.html

Printable Grievance Form found after Kaiser Grievance Literature
http://howto.kaiserpapers.org/oreapp.html
Authorization form for KP NW to release medical information




CALIFORNIA SPECIFIC INFORMATION ON FILING A GRIEVANCE WITH KAISER.

So you are having problems with your Kaiser program, doctor, pharmacist - anything related to Kaiser and want to complain to someone that may fix the problem.  Here on this page is the procedure that you must follow.  

KEEP IN MIND THAT THESE MANDATORY PROCEDURES DID NOTHING TO HELP THE KIDNEY PATIENTS IN THE KAISER PERMANENTE NORTHERN CALIFORNIA KIDNEY TRANSPLANT PROGRAM.  KEEP IN MIND THAT THE PEOPLE SUFFERING IN THAT PROGRAM DID COMPLAIN AND DID FOLLOW ALL THE PROCEDURES ON THIS WEBPAGE AND THAT THEY RECEIVED NO HELP AT ALL.  KEEP IN MIND THAT GOVERNMENT AGENCIES ACKNOWLEDGED THAT THEY KNEW PEOPLE WERE COMPLAINING BUT TOOK NO ACTION WHATSOEVER TO HELP THE PATIENTS.

You must create a paper trail.  It is a rule and you really cannot avoid it.   Maintain a positive attitude but do not be upset or surprised if you do not receive satisfaction or reach resolution with any part of the process. Many people discover that because they have Kaiser, and only because they have Kaiser that there is very little in the way of help anywhere.

 If you had any other company for insurance you probably would not have half the problems but what is done is done and you have a problem now so go on to the next step -

Order your medical records
http://www.harp.org/recordmethod.htm
and while you are waiting for them  go to Step 1.  Note:
If you have a true life threatening concern you may pass Step 1 and go to Step 2.

Step 1 -  

You must  file a grievance with Kaiser in your area.  A grievance is really just a letter stating your complaint or concerns that you can send off to Member Services.  The links for you to file online and relevant information for most situations are directly below:

FOR ALL REGIONS TO FILE A COMPLAINT OR GRIEVANCE WITH KAISER:

The quickest method and one that should be used with the return receipt feature on your e-mail program is to write directly to:
E-MAIL: mscc@kp.org

The online web form feature can be used but there could be a problem with obtaining a copy of your letter for your records and verifying that they have received it:
There is no way to reliably maintain a web link to the section of the Kaiser web site to the online form. You will have to obtain that by searching the kaiserpermanente.org or kp.org web site.

OREGON AND WASHINGTON KAISER GRIEVANCE FORMS AND PROCEDURES ADDITIONAL INFORMATION
http://howto.kaiserpapers.org/oreapp.html
 
KAISER FOUNDATION HEALTH PLAN, INC
KAISER FOUNDATION; PERMANENTE MEDICAL CARE PROGRAM
CONTACT - Member  Services Department
PHONE NUMBER - (800) 464-4000
E-MAIL: mscc@kp.org

Note - the above email link may become invalid as Kaiser does not appear to have a stable method of maintaining either web page links or e-mail addresses.  This is the e-mail address that they advertised most recently.
 
If you feel you cannot trust the Kaiser web form for Medicare matters, in particular pharmaceutical issues and do not want to use the above direct Kaiser e-mail address then proceed to Step 2 and use the Medicare?CMS/HHS links to file your complaint.  If these government agencies feel this is wrong they will either ask you to re-submit to the above address or they will forward your complaint directly to Kaiser.

If you are uncomfortable or not trusting with filling out a web form then send the grievance to Kaiser, certified mail, keeping the receipt for delivery, or if you are emailing them directly send your letter using the return receipt feature in your e-mail program.  This simply proves Kaiser received your letter.

As added protection if you still feel an element of distrust with Kaiser acknowledgeing receipt of your complaint the following has been suggested by a physician:

"If one really wants protection one should be utilizing snail mail and return receipt requested so that a human being must sign for it and that office can be held accountable. For proof of what was in the
envelope one can send an exact copy to a third party (or oneself) by mail to be left unopened. It will therefore be dated by the post office. Every once in a while as one moves up the ladder it might
behove them to include copies of all prior correspondences in the same envelope noting what is enclosed in the cover letter. It might also be helpful to send the same letter to a different office based on circumstances such as the office of the President of the company or the registered agent (generally attorneys or someone that is able to receive service of a lawsuit). This sets one apart from everyone else and keeps a paper trail that is difficult to dispute."

You will be advised that you now must wait 30 days before going on to Step 2.  However, if this problem is a true emergency then you may bypass the 30 day wait and immediately proceed to Step 2.

Step 2:

Unless you have a true life threatening emergency you must FIRST have completed the above process listed in Step 1.  Next:

If in California you are now allowed to file a complaint with the Department of Managed Health Care.
http://www.dmhc.ca.gov/

Be positive when filing all complaints but don't get your hopes up that your needs will be addressed.  If they are be pleasantly surprised.  Be aware that the employees at these agencies are just as upset as you are with the restrictions in helping the public that they have had imposed on their jobs. 

If you are in other states and have completed Step 1 with the Kaiser Grievance Process contact your Department of Insurance to file a formal complaint.

If you are a Medicare/Medicaid patient you may proceed to GO and file a complaint with HSAG - Health Services Advisory Group at: http://www.hsag.com/home.aspx
or the QIO (Quality Improvement Organization) assigned to your area.  Check with CMS on this if you reside outside of California.

HSAG or any QIO are not government agencies.  They are private organizations that have obtained a Federal Government Contract.  Their membership consists of medical entities (hospitals, HMO's etc., including Kaiser)  It is unlikely that they will be able to help you after something bad has happened but you have to follow the rules.

HSAG could take several months to complete their investigation for non-emergency matters.  If the matter is truly an emergency they may be able to help and may be able to address the issue in a very short period of time, sometimes within hours.

One of the simplest ways to complain about a Medicare matter is to use the resources on the following page::
http://www.hhs.gov/omha/needtoknow.html

Much information on CMS can be found at:
http://www.cms.gov/

If you are a straight Medicaid  or MediCal Patient your best bet is to start with DMHC or the respective Department of Insurance in your state.  At least they can advise you who oversees those divisions.

You can also contact the various agencies overseeing the hospitals, home health problems, emergency care, etc. that are available in your area.  Generally they are part of your local and state Health Departments. Ask for the applicable division of your area or state Health Department that will address your concerns.

It doesn't hurt to also write to your Federal Elected Officials.  They can at least make inquiries that may help with your situation.

After you have exhausted the above processes your only other recourse is to try to find an attorney willing to take on a Kaiser case.  This is a last resort as you do not want to become involved in any Kaiser arbitration matter unless you absolutely have to.  See:
http://legalstuff.kaiserpapers.org/arbitrationsection.html

These attorneys are far and few between and have the luxury of picking the cases they want because of the great number of  Kaiser malpractice/negligence cases that are available to them.  NOTE:  Kaiser sets aside in their annual budget $40,000,000.00  ($40 Million) just for malpractice/negligence problems per year.  One physician reported the figure to be $400,000,000.00 but we believe that the 40 figure is more accurate.  There are many, many of these cases and Kaiser expects them to happen.

If you are a senior citizen or your case involves a senior murder or unnecessarily hastened death then don't hold your breath that any attorney will want to take the case.  Under California law there generally isn't enough money for an attorney to cover their expenses with these cases, so they rarely will take them on.  It has nothing to do with your case being good or bad.  It has a lot to do with the fact that attorneys are running businesses and cannot take on unprofitable cases without causing themselves financial harm.

If the matter involves criminal conduct write a letter to your local police agency and/or try to have a police report written up.  You will probably have to be politely persistant to gain the assistance of law enforcement.

That is about all there is that you can do.  As one Permanente physician told me :
"If you have Kaiser and something goes wrong - You Are Screwed!"  "The system is intentionally set up against the patient!"

By now if you are not laughing at the actual mandatory process that our government is making us all go through read it all again.  The intent, unless you are the rare very lucky exception is to make you give up and let Kaiser win. 

We also have prepared for your use a sample letter to resubmit your complaints to the various government agencies at:
 http://howto.kaiserpapers.org/sampleconsumerletter.html


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