A. If you bought your previous non-Medicare plan yourself, be sure to cancel it as soon as your enrollment in a Kaiser Permanente Medicare health plan is approved. If you don't, you'll need to pay the premiums for both plans until you cancel your previous plan.
What to do if Kaiser Permanente won’t treat you?
Immediately go to the nearest hospital or any facility that can give you the care you need. Kaiser Permanente won’t be able to help manage your care until your emergency or urgent care need is under control or is being managed by a doctor.
Can I choose a hospital outside of the Kaiser Permanente system?
As a member, you do not have a choice in selecting hospitals outside of the Kaiser system or doctors outside of the Permanente medical group. If you have an issue with the medical treatment and/or care you have received from a specific doctor, nurse, or other health care professional at Kaiser, you will find a complaint form on their website.
How do I file a complaint against Kaiser Permanente?
If you have an issue with the medical treatment and/or care you have received from a specific doctor, nurse, or other health care professional at Kaiser, you will find a complaint form on their website.
How do I get reimbursement from Kaiser Permanente for prescription drugs?
Before you submit a claim for reimbursement, be sure to review your coverage or contact Member Services for assistance at 1-888-901-4636(TTY 711), Monday through Friday, 8 a.m. to 5 p.m. Reimbursement requests must be received by Kaiser Permanente within 12 months from the date of service. I have Medicare Part D drug coverage.
How do I fight Kaiser Permanente?
If you prefer, you may file a grievance online at kaiserpermanente.org, in person at your local Member Service office, or by phone by calling 1-800-464-4000.
How do I advocate for myself at Kaiser?
Here are some ways to become more active and involved in your care.Ask questions. It may help to write down your questions before your doctor visit. ... Bring a support person. ... Help your doctor. ... Use your whole team. ... Be part of each decision. ... Make a plan.
Can Kaiser deny coverage for preexisting conditions?
Individual applicants can't be denied coverage based on pre-existing conditions (such as a physical or mental condition, disability, or illness diagnosed prior to enrollment), their medical expenses over the past year, or other factors that might predict their use of services.
What to do if your doctor is not helping you?
Here are steps you can take if your doctor isn't listening to youBe honest about how you are really feeling. When the doctor says “How are you?” how do you respond? ... Set clear goals and communicate them. Take some time to consider what you want to get out of this appointment. ... Ask the Right Questions. ... Find a new doctor.
What is Kaiser Believe me policy?
The program, called “Believe Me,” allowed patients who believed they were Kaiser Permanente members but were not yet officially entered in the system to get care without paying at the time of service. Kaiser holds the medical bills for 90 days to give the system time to catch up.
Does Kaiser Permanente cover therapy?
Does Kaiser Permanente PPO cover therapy? Yes. Kaiser PPO offers coverage for mental health services including therapy. Kaiser Permanente PPO has an extensive network of therapists to choose from, giving you the opportunity to find the therapist that's just right for you.
What pre-existing conditions are not covered?
Health insurers can no longer charge more or deny coverage to you or your child because of a pre-existing health condition like asthma, diabetes, or cancer, as well as pregnancy. They cannot limit benefits for that condition either.
What's considered a pre-existing condition?
As defined most simply, a pre-existing condition is any health condition that a person has prior to enrolling in health coverage. A pre-existing condition could be known to the person – for example, if she knows she is pregnant already.
Can insurance companies deny pre-existing conditions?
Yes. Under the Affordable Care Act, health insurance companies can't refuse to cover you or charge you more just because you have a “pre-existing condition” — that is, a health problem you had before the date that new health coverage starts.
What should you not say to a doctor?
The 10 Worst Things Patients Can Say to PhysiciansAnything that is not 100 percent truthful. ... Anything condescending, loud, hostile, or sarcastic. ... Anything related to your health care when we are off the clock. ... Complaining about other doctors. ... Anything that is a huge overreaction.More items...•
What is medical Gaslighting?
Medical gaslighting is when a healthcare provider dismisses your complaints or concerns. They don't seem to take you seriously or blame your symptoms on a vague cause (such as stress). And they may send you home without a proper diagnosis or treatment plan.
What is classed as medical negligence?
Medical negligence is substandard care that's been provided by a medical professional to a patient, which has directly caused injury or caused an existing condition to get worse. There's a number of ways that medical negligence can happen such as misdiagnosis, incorrect treatment or surgical mistakes.
How do I advocate for a loved one in the hospital?
Learn to Advocate for Your Hospitalized Loved OneAsk Questions. The number one thing is to ask questions and find the people who can answer them. ... Have a Pad and Pen Handy at All Times. ... Be on the Lookout for Mistakes. ... Keep Your Family Member Grounded.
How do I contact Kaiser Advice Nurse Northern California?
To get advice or schedule an appointment, call 1-866-454-8855.
How do I get a Kaiser number in Southern California?
Call 24/7 at 1-833-574-2273 (TTY 711).
How to contact Kaiser Permanente for reimbursement?
Before you submit a claim for reimbursement, be sure to review your coverage or contact Member Services for assistance at 1-888-901-4636 (TTY 711 ), Monday through Friday, 8 a.m. to 5 p.m. Reimbursement requests must be received by Kaiser Permanente within 12 months from the date of service.
Can a claim be returned without reimbursement?
Claims sent to the wrong address or missing required information may be returned without reimbursement. Claims processed at pharmacies not in the plan network, including some federal facilities, will be reviewed for a reasonable need to obtain outside of the pharmacy network.
Can you appeal a Kaiser decision?
If Kaiser Permanente denies coverage for a medical service or payment of a claim, you have the right to appeal that decision. Disputes are reviewed through a first-level appeal process, with an optional second-level review available. You can use this appeal process, unless your contract states otherwise.
What is Kaiser's goal?
While Kaiser states that their goal is to provide the highest possible member satisfaction and that their priority is to resolve every concern or dissatisfaction wherever you receive care , they don’t seem to be able to acknowledge any wrongdoing on their part when faced with well-documented complaints. Testimonial.
What happened to Jupirena Stein?
Take the case of Kaiser victim, Jupirena Stein. Ms. Stein’s health has literally been ruined by a botched surgical procedure to remove one of her parotid glands. She collected extensive documentation to support her claims of medical negligence over a six year period following her surgery. Instead of acknowledging the fact that the surgeon in question made a devastating medical error, Kaiser claimed that they had no knowledge of any wrongdoing in her case.
Is Kaiser Permanente a victim of vascular injury?
The reality of her situation is that she has been a victim of a devastating vascular injury, a result of a surgical error. If you take some time to read complaints about Kaiser online, you’ll discover that filing a complaint against Kaiser Permanente has little chance of producing a positive result. Instead, you need to file a claim ...
Is Kaiser Permanente worth filing a complaint?
Why filing a complaint against Kaiser Permanente isn’t worth your time. Kaiser Permanente is one of the country’s largest not-for-profit health plans, serving 12.4 million members. Members are usually enrolled in the HMO by their employer. As a member, you do not have a choice in selecting hospitals outside of the Kaiser system or doctors outside ...
Can Kaiser respond to a complaint?
They might not respond to you, but they will respond to our lawyers. Filing a complaint against Kaiser Permanente is a very frustrating and stressful process that, in many cases, produces little if any positive results for victims of medical negligence. If you want to file a medical malpractice claim, you need to hire an attorney who is familiar ...
Can you choose a hospital outside of Kaiser?
As a member, you do not have a choice in selecting hospitals outside of the Kaiser system or doctors outside of the Permanente medical group. If you have an issue with the medical treatment and/or care you have received from a specific doctor, nurse, or other health care professional at Kaiser, you will find a complaint form on their website.
Can you sue Kaiser Permanente for medical malpractice?
If you are considering filing a lawsuit against Kaiser Permanente for medical malpractice, you must go through Kaiser’s arbitration process vs suing a doctor, nurse, or hospital in a court of law.
What does the patient propose in Kaiser's refusal to grant a member's request for medically necessary treatment?
The patient proposes that Kaiser’s refusal to grant a member’s request for medically necessary treatment, and that they are not willing to identify themselves by name, it is the patient’s opinion, that the oral review is without merit, and a member can dispute their decision for the reason in this letter.
When did Dina Padilla work at Kaiser?
Dina Padilla November 3, 2007. After working in both Kaiser hospital and clinic in Sacramento, Ca., starting in the mid 1980’s to 1993 it has certainly been never ending nightmare, listening to patients and employees who are patients, that kaiser now entering into decades of operation, gets worse by the day.
What did the man say when I asked him about the missing muscles on my neck and shoulder?
When I asked him about the missing muscles on my neck and shoulder, just a few inches away from his eyes, he said to me, “I do not see whatever you see.”
Do caregivers feel pain?
He is half right. WE — the caregivers — do feel that pain. WE are the ones who have to deal with inadequate staffing and antiquated resources. WE are the ones who have to deal with doctors who really don’t care about their job anymore because they are so determined to make as much PROFIT as possible — not health care. WE are the ones who have to learn a new computer system every time the new (NON nurse) CEO decides they know what’s best for nurses.
Does Kaiser screw up?
Any healthcare is sometimes better than none, and Kaiser doesn’t screw up every single thing . Being forced to go back after harm has been done is actually one of the most horrifying aspects of the Kaiser Victim experience, so it wouldn’t hurt you to have a little compassion. NA February 26, 2017.
How to contact Kaiser Permanente for reimbursement?
For help with filing a claim for reimbursement, call the Away from Home Travel Line at . 951-268-3900. 1. If a member receives emergency services in a country where the U.S. government has imposed sanctions, the member may have to pay for services and then submit a claim to Kaiser Permanente for reimbursement.
What is the phone number for Kaiser Permanente?
If you travel by plane, keep your medications with you in your carry-on baggage. Away from Home 24/7 Travel Line: 951-268-3900 (TTY711kp.org/travel ) or *These features are available when you register on kp.org and seek care from Kaiser Permanente providers.
What to do if you believe you have an emergency?
If you believe you have an emergency medical condition, call 911 or go to the nearest hospital. For the complete definition of an emergency medical condition, please refer to your
What is routine care?
Routine care is for an expected care need, like a scheduled visit to your doctor or a recommended preventive screening or immunizations. Examples include:
Where is the Civil Rights Coordinator at Kaiser?
You may also contact the Kaiser Permanente Civil Rights Coordinator directly at One Kaiser Plaza, 12th Floor, Suite 1223, Oakland, CA 94612.
Where to file a grievance with KPIC?
If you believe that KPIC has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance by mail or phone at: KPIC Civil Rights Coordinator, 3701 Boardman-Canfield Rd, Canfield OH 44406, telephone number 1-866-213-3062.
Does Kaiser cover transportation?
Kaiser Permanente Georgia health plan does not cover transportation services for nonurgent, nonemergency care from outside the service area; and any request for transportation is subject to review. 3 . Kaiser Permanente providers, go to the . kp.org/travel .
David J. McCormick
I agree with Mr. Jaurez. I would suggest that you contact your doctor and ask why he or she is refusing to prescribe the medications. I hope you found my answer helpful. More
Scott J. Corwin
Change doctors. Ask the doctor who gives you the slip for medical marijuana for a script for the other pain meds, then fill them at Kaiser.
Tai Christopher Bogan
Will they give you the pain pills if you stop the Marijuana (MJ) It seems like you are in a catch 22. There might be a reason why the doctors refuse to give you the medicines, maybe it has to do with an unfavorable side effect when you combine your medicines with the MJ. See if you can quit MJ and then ask the docs to give you your pain medicine.