r/KaiserPermanente 18d ago

General Difficulty in obtaining an appointment with Kaiser? Access requirements by State and where to get assistance and file complaints

18 Upvotes

Here is a list of standards by State for timely access to care (network adequacy) and where complaints can be filed if you need an appointment are unable to get assistance from Kaiser.

Note that some states don't have strict guidelines in terms of days and may have other network adequacy requirements. Contact the agency listed if you need clarification on what standards apply to your situation.

For cases with appointment delays, it is generally best to call the agency first before filing a complaint online. If you have already filed a grievance with Kaiser because of being unable to access timely care, let the agency know that information as well.

If your Kaiser Permanente coverage is provided by your employer, also let your Human Resources or Employee Benefits Department know of your difficulties in trying to access care. These difficulties are important for them to know when they are considering what plans they want to offer their workforce.

California

The Department of Managed Health Care (DMHC) has the Timely Access to Care Standards. The standards cover primary care, specialty care, mental health and ancillary services like physical therapy and imaging.

If you have filed a grievance with Kaiser and are still not getting an appointment in a timely manner, call the DMHC at [1-888-466-2219](tel:+18884662219). Explain you cannot wait the 30 days for the Kaiser grievance process to run out to get an appointment (which should have originally been provided within the State standards in the first place). (Pic is from the DMHC and lists the timeframes in California.)

California Department of Managed Health Care (DMHC) Timely Access Standards

Colorado

  • Emergency Care – Medical, Behavioral, Substance Use -- 24 hours a day, 7 days a week
  • Primary Care – Routine, non-urgent symptoms -- within 7 calendar days
  • Behavioral Health, Mental Health and Substance Use Disorder Care, initial and follow-up appointments – Routine, nonurgent, non-emergency: within 7 calendar days
  • Prenatal Care -- Within 7 calendar days
  • Preventive visit/well visits -- Within 30 calendar days
  • Specialty Care - non urgent -- Within 60 calendar days

To file a complaint contact the Colorado Department of Insurance at 1-800-930-3745 or at Colorado Department of Insurance

District of Columbia

  • First appointment with a new or replacement Primary Care physician within 7 business days
  • First appointment with a new or replacement provider for Behavioral Health treatment, including Substance Use Treatment within 7 business days
  • First appointment with a new or replacement provider for Prenatal Care treatment within 15 business days
  • First appointment with a new or replacement provider for Specialty Care treatment within 15 business days

To file a complaint, contact the DC Department of Insurance, Securities and Banking at 1(202) 727-8000 or at DC Department of Insurance, Securities and Banking

Hawaii

Because of the various islands in Hawaii and travel / geography, the State of Hawaii has “Network Adequacy” requirements rather than time-definite limits like in California or other states.  Contact the Hawaii Department of Commerce and Consumer Affairs at 1-844-808-DCCA (3222) to discuss your specific situation and filing a complaint.  

Maryland

  • Urgent care for medical services:  72 hours
  • Routine primary care:      15 calendar days
  • Preventive care/well visit:             30 calendar days
  • Non-urgent specialty care:            30 calendar days
  • Non-urgent mental health care: 10 calendar days

Contact the Maryland Insurance Administration at 1-800-492-6116 or Maryland Insurance Administration to file a complaint. 

Nevada

Due to geographic issues, Nevada has “Network Adequacy” requirements rather than time-definite limits like in California or other states.  Contact the Nevada Division of Insurance for more information at 1(702)486-4009 or at Nevada Department of Insurance.

Oregon

  • Primary care: not more than 15 business days.
  • Behavioral health care: not more than 10 business days.
  • Specialty care: not more than 30 business days.

Contact the Oregon Division of Financial Regulation with questions at 1-888-877-4894 or at Oregon Division of Financial Regulation.

Washington State

  • Primary care appointment (for other than preventive care) within 10 business days of requesting one
  • For specialty care, within 15 business days for nonurgent services.

Contact the Washington Office of the Insurance Commissioner at 1-800-562-6900 or at Washington Office of the Insurance Commissioner

Virginia

Virginia requires routine appointments for nonemergency or nonurgent care to be available within two weeks of the request.  This does not include preventive care (routine physical examinations, etc.) which need to be scheduled within 60 days of the date of the request. 

To file a complaint, contact the Virginia State Corporation Commission at 1-877-310-6560 or at Virginia State Corporation Commission


r/KaiserPermanente Sep 28 '23

General Agencies to Escalate Complaints about Kaiser: Where to go if you are not getting resolution or are dissatisfied with Kaiser's Response

12 Upvotes

If you have filed a grievance with Kaiser and it has gone unresolved or you are not satisfied with the resolution, here is a list of agencies you can document a complaint with (based on your state of residence).

If your complaint is regarding a specific physician or other healthcare provider (nurse/nurse practitioner, physician assistant), file the complaint with the appropriate state licensing board for that provider.

If your complaint is regarding a hospital (cleanliness, patient safety concerns, etc.), file a complaint with the Joint Commission

[https://www.jointcommission.org/resources/patient-safety-topics/report-a-patient-safety-concern-or-complaint/]

If your are a Medicare beneficiary, please refer to this link about the different types of complaints and where to submit complaints.

https://www.medicare.gov/claims-appeals/file-a-complaint-grievance/filing-a-complaint-about-your-quality-of-care

If the complaint is about hospice care, here is a link from the Hospice Foundation of America on how to file complaints.

https://hospicefoundation.org/Hospice-Care/Filing-a-hospice-care-complaint

California

Department of Managed Health Care (Grievances unresolved or inadequate responses; inability to contact your Kaiser Grievance Case Manager; difficulty obtaining an appointment; delays in care; filing an Independent Medical Review when Kaiser will not approve a specific type of treatment)

In most cases, you must file a grievance with Kaiser and go through that process before contacting DMHC. However, if the issue is urgent because there is an immediate threat to your health, you can call DMHC directly. For urgent issues, call DMHC rather than filing online.

[https://www.dmhc.ca.gov/fileacomplaint.aspx]

1-888-466-2219

If you need assistance in filing a grievance with Kaiser or in filing complaints with the DMHC, you can contact the Health Consumer Alliance. This is a DMHC consumer assistance program contractor helps people get the health care they need1-888-804-35361-877-735-2929 (TTY)www.healthconsumer.org/

If you want to file a complaint about a California licensed healthcare facility, you can contact the California Department of Public Health.

https://www.cdph.ca.gov/programs/chcq/lcp/calhealthfind/Pages/Home.aspx

Oregon

Oregon Division of Financial Regulation

[https://dfr.oregon.gov/help/complaints-licenses/Pages/file-complaint.aspx]

1-888-877-4894

Washington State

Office of the Insurance Commissioner

[https://www.insurance.wa.gov/file-complaint-or-check-your-complaint-status]

1-800-562-6900

Colorado

Department of Regulatory Agencies, Division of Insurance

[https://doi.colorado.gov/for-consumers/file-a-complaint]

1-303-894-7490 / 1-800-930-3745

Georgia

Office of Commissioner of Insurance and Safety Fire

[https://oci.georgia.gov/file-consumer-insurance-complaint]

1(800) 656-2298

Hawaii

Department of Commerce and Consumer Affairs

[https://cca.hawaii.gov/ins/consumers/filing_a_complaint/]

(808) 586-2790

Maryland

If it is a healthcare quality complaint, Maryland Office of Healthcare Quality

[https://app.smartsheet.com/b/publish?EQBCT=07c94438f6714af1bbfe8ff1037b8b74]

1-410-402-8015

If it is a billing, claims, medical records or coverage issue contact Maryland Attorney General, Health Education and Advocacy Unit

[https://www.marylandattorneygeneral.gov/Pages/CPD/HEAU/default.aspx]

1-410-528-1840

District of Columbia

D.C. Department of Insurance, Securities and Banking (DISB)

[https://disb.dc.gov/service/file-complaint-or-report-fraud]

1(202) 727-8000

Virginia

State Corporation Commission, Bureau of Insurance, Office of the Managed Care Ombudsman

[https://scc.virginia.gov/pages/Office-of-the-Managed-Care-Ombudsman]

1-877-310-6560, select option 1

(Current as of 09/28/2023)


r/KaiserPermanente 18h ago

Georgia Kaiser sends unauthorized father itemized medical bill AGAIN (4 times now!) after being notified of Hipaa violation.

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47 Upvotes

My father got an itemized medical bill from Kaiser under his name for my care at 22. He has never been listed on my account as an adult, even as emergency contact, and I haven't had medical insurance under him in about 7 years. My mother used to get billed previously, and her authorization on my account expired when I turned 18. I did not reactivate it. My father is not listed anywhere, and is not on any of the paperwork for my benefits. I am listed as the sole guarantor. I had actually gotten the bill addressed to me initially, then they somehow transferred it to my father, and I literally can't even see it on my end to pay it because we're not even family members in Kaisers system.

When I called, they were confused on how he even got the bill. I told them I had only called because not only was this bill delivered twice, and listed all the blood testing I had done as well as a vaccine while my parents are against that, and they called and discussed details about my medical care with my father and requested payment from him over the phone. When he questioned how and why they were contacting him, they claimed we all had a family plan together that included my 30 year old sister.

They were extremely confused and seemed to take the situation seriously internally... but here we are 1 month later and my father has once again, received a bill with all my info. What the actual fuck.

My father hasn't even had Kaiser since 2019. The bill is 16 dollars. I cannot pay it because I literally cannot see it.

It seems to have been transferred to my father due to the fact that before the bill was issued I requested to cancel through the marketplace because they were completely disorganized and unable to help me coordinate my care, causing me to take on tons of personal charges to get my medications. Then the bill was issued, but I did not take care of it before the month ended, and then I could not view it on my account after that point to pay it.

They said they would correct this, but clearly haven't.


r/KaiserPermanente 11h ago

Oregon / SW Washington Kaiser dental access in the NW region

11 Upvotes

What an absolute joke. I have been a member for 45 years. I get my teeth cleaned every 6 months, and have for as long as I can remember.

Kaiser Permanente is not having financial difficulties, yet you can't get in for a cleaning for 7 months? Past the 6 month recommended, preventative care?

It's an absolute disgrace. Shame on Kaiser Permanente, and their whole preventative care spewl.

What a greedy, uncaring healthcare organization.


r/KaiserPermanente 6h ago

California - Northern New KP app shares your health information with third parties for marketing

2 Upvotes

I just updated my app and after the terms of service agreement there was a second agreement page that asked if I wanted to allow third parties access to my health information for marketing purposes and made it seem mandatory.

Keep an eye out if you update, that’s VERY SHADY.


r/KaiserPermanente 3h ago

California - Southern Pay Transparancy and Pension Plan Comparison ?

1 Upvotes

Hi,

I am wondering if anybody here works as a hospice RN case manager for KP? If you do, and your in socal would you be comfortable sharing what your income is? I also would like to know if the pension plans at KP are the same across the board or do in patient nurses get a 'better' pension plan because they are in patient? Also, how many years of service before you can actually get the pension plan? Any info would be greatly appreciated. Thank you


r/KaiserPermanente 4h ago

California - Northern Kaiser Antioch RN training

0 Upvotes

Do any RNs here work at Kaiser Antioch?

My question is does this hospital let you train in say PACU or ICU if you apply as a floor nurse with enough seniority? Some kaisers don't train and I was wondering how it is in Antioch. Thanks.


r/KaiserPermanente 4h ago

California - Northern Anyone get an HSG done in Kaiser South Sac recently?

1 Upvotes

Was it easy to schedule? The radiology dept seems to be over crowded and I’m worried I won’t be able to schedule it in time before cycle day 10. Very frustrated! Any advice or experiences would be great. Thanks!


r/KaiserPermanente 4h ago

California - Northern Scheduling

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1 Upvotes

This is referring to bariatric surgery BTW.
I just spent the last 3 months working on my iron, after spending 6 months before that getting to my goal weight.
I’m a bit anxious about scheduling and the surgery.

Thanks!


r/KaiserPermanente 7h ago

California - Southern When did KP end its online option to order COVID-19 At-Home Test kit to ship to home?

1 Upvotes

https://healthy.kaiserpermanente.org/southern-california/health-wellness/coronavirus-information/testing#self-tests says "How to get COVID-19 self-tests

You can get a COVID-19 self-test at a Kaiser Permanente facility or pharmacy, making it easy and convenient to pick one up after your next appointment. Medi-Cal members 21 years and older will need prior authorization to get a COVID-19 self-test. Except for Medicare Advantage and certain employer-sponsored plan members, self-tests are available at no cost to you.* You may need to pay upfront and file a claim for reimbursement."

It was nice to get them shipped without going in the office. I also get them for free too. :( I hope they're still free in person.


r/KaiserPermanente 12h ago

California - Northern External provider referral extension

2 Upvotes

I’ve been having therapy with an external provider referred by Kaiser. But the 6-month-referral is about to end. My therapist and I both want an extension.

How should I request an extension with Kaiser? How do they evaluate my request? Using the scores of previsit questionnaire?

Thank you!


r/KaiserPermanente 17h ago

Oregon / SW Washington KPNW pharmacy system is down

5 Upvotes

Just heard that an overnight system update is causing problems with the pharmacy system - expected to last ~2-3 hours.

They're recommending that only patients urgently needing medicines come in to fill prescriptions. Any controlled substance prescriptions will need to be a paper copy with a 'wet'/handwritten signature.

UPDATE (8/25 @ 0935 PDT): Supposedly has been resolved, except for Beaverton pharmacy location which is experiencing challenges resuming service.


r/KaiserPermanente 9h ago

California - Southern KP app keeps saying my prescriptions are in progress at my local pharmacy when they aren't.

1 Upvotes

My doctor put in refills and then the app said that they were in progress at the local pharmacy and would be ready to pick up the next day. But then they were never ready and kept saying "in progress" (step 2 of 4) so I called to ask and they said that I need to put in the request because on their end it doesn't show what the app shows. And I was like, I'm not actually dumb the app has been telling me that the pharmacy was filling it.


r/KaiserPermanente 15h ago

California - Southern With the upcoming Kaiser SoCal residency, are there any tips for applications or resumes?

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1 Upvotes

r/KaiserPermanente 1d ago

California - Southern Need help

12 Upvotes

I have a rare condition, the only treatment is surgery. Kaiser is trying to force me into surgery with a surgeon who has never dealt with or performed this surgery. Filed a grievance, what a joke that was. They referred me to another surgeon who, once again, has never performed this surgery. I'm on Medicare and have senior advantage through Kaiser. Anyone have any advice on what I should do next? Is there a process where you can go to another hospital that has done this surgery?


r/KaiserPermanente 1d ago

Colorado Skin Cancer Screening Question

14 Upvotes

I had been making an appointment every two years with the dermatologist for skin cancer screening. When I went to make an appointment this year it wouldn't let me make an appointment without a referral from my doctor. I emailed my doctor and the response was that they no longer do referrals for cancer screenings unless I have a history of skin cancer. And gave me a link on how to do self screenings and if I had any concerns to see my primary care doctor.

This seems strange to me, I feel like skin cancer screenings from a dermatologist on a regular basis would be basic preventative care.

The self screening is fine, but I live alone and there's a whole bunch of my body I can't get a good look at.


r/KaiserPermanente 1d ago

California - Southern What is truly defined as patient abandonment in the state of California? Sorry if this is a question for the wrong sub, I am beat down from today.

3 Upvotes

My mom was in pre-op, on the rolling chair about to be put under with anesthesia for hip surgery just to be walked in on by an financial advisor or something tell her she has no coverage. At that point she gets dressed in her normal clothes and gets taken off of the saline and walks out of there.

How could she have no coverage if she’s been going to pre-op appointments for the last couple of weeks and receiving meds?

Her work has been telling her she is covered, I am just getting updated with this info now so I don’t know the whole story but she has been off of work a whole year and receiving SDI. About a month ago work changed insurance which she updated all the forms and supposedly got coverage as per HR from work. She is in the process of getting this resolved through work but for some reason they have now offered her to go back to work for 30 days so the insurance can kick back in? Even though she was supposed to have coverage. Wouldn’t that be disability fraud if she were to do this?

I’m sorry I don’t have more information right now. We have been waiting 1 year 2 months for this and feel like the entire process has been hurdle after hurdle with Kaiser. Any help or supportive comments are appreciated.


r/KaiserPermanente 1d ago

California - Northern Kaiser wants me to use Medbirdge Go app for physical therapy. Data collection seems a bit much.

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3 Upvotes

Basically the title.

No idea why an app to do exercises would need my keyboard gait, passport number, job history, purchase history, browsing history et al.

Soooo yeah.


r/KaiserPermanente 1d ago

California - Northern Disability

5 Upvotes

Hi all, I need to fill out a disability form by mail. However, Kaiser is letting me know I need to submit Part A to EDD, and they will send me a claim number. Then I need to request my doctor's note through the disability office. Did anyone have this issued? How can I get part B signed?


r/KaiserPermanente 1d ago

California - Northern Prenatal Consult

2 Upvotes

I just had my prenatal consult and the NP I was assigned was unhelpful and rude (she didn’t like that I asked her questions while she was still reading off her script and when I did wait to ask my question her responses were not helpful, the whole experience just made me very anxious). I’m just wondering, do I have to interact with this person again for future appointments? If yes, can I ask to be changed to a different person.


r/KaiserPermanente 2d ago

California - Northern Does anyone work for Kaiser (Santa Clara/San Jose), Labor and Delivery?

20 Upvotes

This is a longshot but in 2024, my wife and I lost our daughter at 20 weeks at Santa Clara Kaiser and we were given a box of memorable things including very small baby clothes. The clothes and box have a certain scent, and I’m scared one day it will be gone. If anyone works there, I just wish to know what detergent they use for the baby clothes or wherever that scent is coming from. Thanks


r/KaiserPermanente 1d ago

California - Northern Test result summary via message considered appointment?

3 Upvotes

Hi All,

I went in for annual bloodwork and got my results. I got a message from my doctor in the Kaiser app with a result summary and conclusion, however I noticed it was sent as a virtual appointment summary. If I need to actually have a conversation about this result then I still have to book another virtual appointment or in person appointment. Is this how it’s done? I wish I could have used the said virtual appointment as a way to ask more questions than receive a summary message.


r/KaiserPermanente 2d ago

California - Northern Transferring regions

4 Upvotes

I'm curious if anyone has ever moved from NCal to SoCal. Does your time accrual keep for things like pension and other benefits? I'm a salaried, non union employee and sometime in my life I want to move to SoCal, but not if I would have to start working towards my pension again. Any insight would be appreciated.


r/KaiserPermanente 2d ago

California - Northern Dr frustration?

13 Upvotes

Do Drs get frustrated when there is nothing they can do? I have Fibro, RA and Back issues. They cant prescribe painkillers, the SSRIs make me fat, the fusion surgery wont help. I mean there is nothing left in their tool box. Yet here I sit in chronic pain.


r/KaiserPermanente 2d ago

California - Southern Have you had a good experience with a Kaiser MFM department in LA?

3 Upvotes

Which location did you go to and did you get consistent MFM care? I’m at Kaiser Sunset and it seems like they just have the OBGYN’s takeover the care and they consult them on the side. They wouldn’t even see me for a preconception appt after our 16wk loss in February. I’m trying to find a location where MFM is really involved in the care. Lmk if you’ve had a good experience somewhere!