When things go wrong in medical care, people often seek redress. Most states have public agencies to address complaints, problems, negligence and irregularities in different parts of the nation's health care system.
When it comes to health-care giant Kaiser Permanente, which is a health maintenance organization, or HMO, complaints can mean a lot of things. Complaints may have to do with insurance coverage, facilities or individual health-care providers. There are state-level complaint systems for all of these issues.
Gather as much documentation as you can, whatever your complaint is. State agencies require proof and evidence to resolve problems and apply penalties. Many agencies ask for documentation to be attached to the complaint forms.
Contact the agency in your state that handles hospital-related complaints, such as a department of public health, if you have an issue with a facility. In California, where Kaiser has its greatest number of facilities, the California Department of Public Health handles consumer complaints related to hospitals and nursing homes. You can download complaint forms online and complete them, or call or request them by mail.
File a complaint with your state insurance commission or board if your complaint is about Kaiser's insurance coverage or billing. In California, the Department of Managed Care handles these matters. It also has a Help Center that you can call in emergency situations, such as when financial coverage decisions are taking more than 30 days on needed treatments.
Submit a detailed complaint form to the state medical board if your issue is with the practice and decisions of an individual physician within the Kaiser health care system. You may have to call a central complaints line and explain your complaint to a board representative before the agency will send you forms. Additionally, in order to lodge the complaint, you must sign a privacy waiver to allow the board under federal law to review your medical files as part of its investigation.
Complain to your state's nursing board if your issue has to do with nursing staff at a Kaiser facility. Most state boards make complaint forms available for download on their websites. You must sign a waiver of confidentiality to give the board access to information that otherwise would be protected by federal privacy laws.
Follow up with the regulatory agency in your state. Such agencies provide timetables for their review and action, but often these are busy and understaffed government agencies. You may need to advocate for yourself to get their attention.
- Include as much documentation as you can with your complaint. If you lack documentation, be as clear and detailed as you can in your written statements.
- California Department of Public Health: Complaint Against a Healthcare Facility or Provider
- California Department of Public Health: Complaints Regarding Health Care
- California Department of Managed Health Care: Insurance Complaints
- California Medical Board: Consumer Complaints
- California Board of Registered Nursing: The Complaint Process
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