Kaiser - medical help

kserg · #1 03-08-2013, 07:44 PM

Hey guys, i been kinda searching for this and thought maybe someone can give me pointers... I know some people here are in medical professional so maybe they can tell me if i am wasting time...

In short question is this, can Kaiser be forced to pay as insurance for a non Kaiser Dr (specialist) considering they screwed up?

Longer note: They screwed up for a friend who was diagnosed with cancer 2 years ago and now its terminal according to them. It sounds like they are kinda going "meh" you got 6 months to live. I am going with they can screw themselves. I figure maybe i can find some more options for her family.

I know my grandma was given 6 months and we took her to a different Dr who helped her and she lived for quiet a bit more. My grandma was 80+ ...friend is 27 so i think she has a decent chance with decent Dr. Hoping anyway...

Thanks!

sandmangeck · #2 03-08-2013, 09:01 PM

How did they screw up? What is the diagnosis? Kaiser is not in our network but sometimes they authorize a patient to be seen in our clinic.
There are also a lot of studies in oncology practices. Patients can receive their infusions and other treatments at no cost.

kserg · #3 03-08-2013, 11:08 PM

Well they found a cancer 2-3 years ago, removed it... then 6 months later she went back with problems (don't have all details)... Not much was done until about a month ago when they finally looked at it and found terminal cancer.

Like said I don't know details about what was happening. However result went from "you have cancer" to "we remove it" to her going back to them for next 2 years and being told "it's normal" to "you have 6 months"

kserg · #4 03-08-2013, 11:11 PM

From what i hear, if you complain enough to Kaiser they will let you, but also it's a huge pain and they waste a lot of time..

darius8 · #5 03-09-2013, 12:53 AM

You have to file a grievance (complaint) first through the Member's Services dept. Every Kaiser hospital has one. They have to respond back to you within 30 days. If they deny your request for medical service or deem it not being medically necessary, you can then file a conplaint to the California Department of Managed Health Care (DMHC).

What ever the DMHC says, Kaiser must/will do. DMHC is a state agency that is very powerful. Here is a link to a "How to" file a complaint with Kaiser:

http://howto.kaiserpapers.org/kaiserproblems.html