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I am wondering if anyone else is having a problem with Kaiser refusing to pay for the PT that Hilo Kaiser referred to Life Care Center.
From what I can gather since I received a "denial of Service" note earlier this month, it seems that they have not paid for November on, leaving us (the poor schmuck patients) in the middle of a pissing match! (Kaiser had to refer out their internal PT in late August when their Hilo on-staff PT had to leave with no notice)
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Kaiser Hilo has had issues with PT staff off and on for several years. My experience with their billing for outside services (even those they initiated) has shown it to be a train wreck. At one point a supervisor even admitted that it could take months to sort things out. My advice is to politely complain by pointing out that going to this therapist was their idea . . . and insist on speaking to a supervisor when they inevitably drop the ball on your initial contact. The referral to Life Care should be in your medical record, and you should save a copy of it outside your Kaiser web page if you haven't already. I managed to get my family's situation corrected by persistence. Good luck.
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This is a much larger issue, as they did not even HAVE a therapist on staff (Katie left without advanced notice on Aug 23 & all of the PT patients were referred out)
Katie will be back next month, but for now....
It is odd, it seems that there is a coding issue where the Kaiser automated claims system will not approve the properly filled out claims & no one at Kaiser Permanente Hawaii (at least since I first called on 1/6 & many follow calls since) can seem to figure out how to reprogram the stupid automated system.
My guess this may be a part of the fact that they do not have the money for maintaining their systems on a much larger level!
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Yes, there is indeed a larger overall issue, Carey. I did not know that you had already started a correction process, and your experience up to this point is no surprise to me at all. FWIW, they did tell me to ignore the bills that they couldn't seem to stop sending, and they did keep a promise not to send things to collection. Don't be surprised when somebody hijacks this thread shortly to describe the decline in services available at Kaiser Hilo and the decline in quality of what remains.
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the decline in services available at Kaiser Hilo and the decline in quality of what remains
It's not Kaiser-specific, not even a little.
If you need medical care here, you and/or your employer have to pay HMSA at least $700/mo; specialists are just a short flight away on Oahu. Anything else is a waste of time and money, assuming you can even find a doctor who is taking new patients. (My doctor has trouble keeping my prescription refills current -- and that's an improvement over the last doctor.)
I assume the status quo is acceptable simply because neither the lawmakers nor the public have managed to do anything about it. Maybe we could build a protest camp on the space between Kaiser and HMC, see how far that gets us.
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Luckily for Life Care (not me, nor anyone else involved in this) every patient referred does sign paperwork that makes us responsible for bills not paid for by Kaiser & they also have the right to cancel appointments, which they have done for Monday 1/20, and they have the right to do further cancellations if the meeting with Kaiser Reps on Tuesday at Life Care on 1/21 does not "pay off".
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Carey,so sorry to hear you are having billing problems with Kaiser. I too have had the experience. One dept. (customer service) would tell me one thing while yet another ( billing on the mainland) was not helpful & continued to bill me. Months down the road and no resolution. I jumped thru their hoops & followed their dispute resolution guidelines.......to no avail.
I finally filed a complaint, in writing, w/ copies of substantiating documents with the State of Hawaii Insurance Division, Department of Commerce & Consumer Affairs . They were absolutely marvelous in assisting me. Kaiser now had to answer to them....instead of just little ol me. The matters were resolved and my account was corrected.
I do hope that you can resolve in house with Kaiser, but if not, This State Office actually did it's job for me and what a relief it was to have help in ending the injustice.
It would be marvelous to report that all has been peachy since then. I did of course leave Kaiser, signed up for HMSA, found a Doctor that I liked....that is until she closed her office....then went to Aloha Nui, Loved them, until they changed their patient format......then signed up at Bay Clinic , Keaau. Staff there is friendly, location is clean
BUT, they do have a tendency to cancel long standing appointments and they too suffer from "coding issues".
Document in writing all that you can, good luck w/ Kaiser and if their system fails you, I hope that you have the good fortune W/ the Health Branch Investigators that I experienced.
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Mahalo Reni, yes, what you describe is exactly what I am going through, but it seems this time Kaiser Hawai`i really screwed up & is playing this game with everyone they referred out to Life Care for the month of November & Life Care is not playing the game with Kaiser, as they made special arrangements to handle an increased client load from Kaiser when Kaiser Hilo lost the services of Katie, their only in-system PT, on Aug. 23 with no notice.
& this will also effect those referred PT patients at Life Cares` sister facility, Hale Anuenue if things are not resolved by Kaiser at their meeting Tues am
I will definitely be filling a claim as you have described on Tuesday!
