How do I get Kaiser to provide the care they are supposed to provide?

Is the 57 correct for your sister's age, then she is not getting Medicare at this point. I know nothing about Kaiser but I do think someone dropped the ball when your sister was discharged to her home and nothing was set up for continued care. It was an unsafe discharge on their part IMO. At discharge they would have gotten a doctor's order for continued care and hopefully checked with Kaiser what would be covered. That all then should be discussed with your sister or the person representing her.

I would contact her PCP. If that doesn't go anywhere then the ER. Office of Aging maybe able to help you get help thru Kaiser. I hope someone has POA. It will make things easier.

The quickest way to address these issues is to call transport by EMS to ER. Returns to ER from discharged patients who have undergone an unsafe discharge should be brought to the attention of the Social Worker immediately on admit with "unsafe discharge" used and the explanation that rehab is needed. Hospitals get dinged badly by JCAHO, their accreditation organization, for returns to hospital within _____________number of day of discharge.
Social worker, discharge planner and nurse manager for care all need to be informed by the medical POA for the patient. Do know that of all hospitals recently given evaluations for such things (included is infection, unsafe discharges etc) Kaiser did BETTER than almost anyone.

I'm assuming you're documenting all the contacts with Kaiser?  If not, you should start doing so, immediately.   Sometimes I use e-mail as opposed to phone calls b/c I can easily print out the contact info and save it online, so there's no question of the contact's response to issues.   E-mail is better than phone calls for documentation and creating a contact trail.

If you aren't documenting, try to recreate all the contacts and list them, as well as Kaiser's response.   

Go through the policy with a fine toothed comb and also document applicable provisions.    Then start again, in writing.   Cite the policy and member services provisions that apply. 

You might also consider getting an Ombudsperson involved, although I'm not sure what kind of and/or whether or not they would interact with Kaiser on this kind of issue.

Another choice is to hire an attorney, potentially medmal as the refusal to pay for treatment could be considered medical malpractice.

Good luck.

This might help, but not sure.
If you have an HMO, they are required by law to give you the same benefits that Medicare would give you if you qualify for Medicare.

Hope this makes sense, that's all I know.

NFD No further details.

MIL has s4 non Hodgkin lymphoma. Chemo and rads kept her alive with her cancer now called inactive. Not remission. And thanks to said chemo plus possible interaction with her ms, she barely can get on the commode or into the car.

Her docs identified the ms marker and initially disqualified her for car t. Asct was recommended instead. I was invited to view the patient booklet.

It was insane. You are basically stripping people of whatever immunity they have acquired since birth. You have to do all the child vaccinations again. Every single bug can get you.

The doctors eventually decided that a better idea was to refer her to the newest version of car t. But then with simple rads, the cancer in her brain became inactive. So no one pursued further treatment.

And then her mobility went from 50 percent to maybe 10 on a good day due to Cumulative nerve damage probably caused by the induction chemo or the complications that arose. Had she had car t or asct, let alone both, she might have ended up losing the ability to even attempt the commode. Both those treatments require a hella dose of chemo after all.

The latest and greatest is not always the best. i shudder to think how fragile her physicality is, as it is. I’m grateful she got neither when she was in contention, because things really change when you can’t even stand or maybe sit.

It sounds like she was discharged with "failure to progress". This means she needs a skilled nursing facility with 24 hour care. Whoever agreed to take her home needs to reconsider; perhaps her spouse?

My advice is to call everyone you have a personal number to. The pcp, her stroke doctor and whatever social worker she has, emphasizing that if she is readmitted the numbers won’t look good.

My sister works at Kaiser. There was a patient they wanted to discharge who just refused to leave, for eight months. This could and should be your loved one or the advocates speaking for her. Make them do it.

My sister is also an award winning department chief who is also on several committees overseeing the overall health policy. There’s generally a trend against allowing seniors with severe pre existing conditions access to million dollar operations followed by more operations and lifelong follow up in the near future. Too many of the paients have chronic complications that sap quality for quantity of life, and these surgeons in not just Kp but the whole American College of Surgeons fear being in that position down the road.

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Well, my DH & I have Kaiser & they sent us to Arizona, to the Mayo Clinic, for a liver transplant for DH, and paid for a studio apartment type hotel room for 2 months in advance, 100%. All we have to pay is our out-of-pocket max of $1,500 as usual, as we do every calendar year, Kaiser will cover the rest of the $1 million plus expense associated with this. In 2020, they paid for triple bypass surgery and a VATS lung surgery complication that was required about 10 days later. In 2019, they paid for a pacemaker for DH as well, which was implanted on the 4th of July.

Whoever tells you that Kaiser "HMO's offer only bare-bone services" is obviously misinformed.


Go to your sister's KP.org portal and find her Primary Care Provider's name and send him or her a detailed message with your concerns on behalf of your sister. You can also try calling the number on the back of her member services card; there are different numbers for different services.

You can take her back to the hospital/ER for evaluation, if she's in dire straits right now, as she may need more rehab/PT & OT in house (not at home). Open your mouth WIDE and use your voice and don't stop until you get the help you need for your sister.

If worse comes to worse, here are other avenues to try:

How do I contact the Kaiser ombudsman?
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.

https://healthy.kaiserpermanente.org/washington/support/submit-a-complaint#/tellus

Wishing you the best of luck getting your sister the care she needs.

Bad Discharge Planning on the hospitals part. You need to contact her doctor, a nd the director of the Rehab facility . From what your telling us she probably should have stayed in Rehab longer. Get on the phone and don't stop calling until they get you some results and If you can't get any results by calling, take her back into the ER.

Unfortunately, HMO'S offer only bare-bone services. They have very strict money-saving policies. I'm afraid that your complaints will go unattended. I don't know if you qualify for Medicare or Medicaid. Kaiser won't help you.