How to fight Kaiser Permanente
Put your mental boxing gloves on because dealing with Kaiser for anything serious is a battle.
First you have to understand the principles under which Kaiser operates.
1. Incompetence and stupidity is institutionalized
When I accompanied my father to his pre-cataracts surgery information session, I was shocked that the instruction sheet was illegible to some of the visually impaired patients. One woman couldn’t read it at all and kept asking me to read the instructions to her. The font was too small for the elderly patients. DUH! How could the ophthalmology staff not bother to think that elderly patients who need eye surgery might have trouble reading small sized font AND have memory and hearing problems that would prevent them from both hearing the surgeon give his instructions and remember what he had said?
When I pointed out to the doctor that his patients couldn’t read the small print, he didn’t care and said he wasn’t the one who prepared the materials. The administrative structure at Kaiser is such that the doctors don’t work together with the support staff to make their offices work efficiently. If the doctor were in private practice, he/she would be dependent on having a smoothly running office to get good ratings from patients. Not at Kaiser.
A few weeks later, while I was waiting for my father to get out of eye surgery, one of the administrative staff was using the office phone to call potential employers to look for jobs. He did this right in front of me and anyone in the office could hear! It doesn’t take a brain or eye surgeon to know that calling potential employers on your current employer’s office phone in front of your clients is a terrible idea!
One time I was in the Kaiser bathroom and I overheard Kaiser employees talking about how many more minutes they had to work, and how they couldn’t wait to get out of there. Did they not think that the people paying their salaries, the actual members who pay insurance premiums, were in their earshot?
There are hard working doctors, nurses and support staff at Kaiser, but you have to work hard to find them or be lucky. The culture of incompetence runs deep throughout the entire organization.
2. Kaiser doesn’t care about health, it only cares about money
Forget Kaiser’s ads about “building better tomorrows” and those featuring the antioxidant properties of blueberries bringing you to better health. My gastroenterologist friend calls Kaiser the “matasanos” (an old Spanish word for the doctors who are the killers of the healthy).
Walk into a Kaiser facility and count how many overweight staff you see. You will soon get tired of counting. I have seen Kaiser staff eating junk food at their desks. The blueberries are nowhere to be seen!
This isn’t about fat shaming or being politically correct. The United States is experiencing a terrible diabetes and obesity epidemic and it’s only getting worse. Kaiser, and other medical institutions, have to be on the front lines of this epidemic and teach its staff and patients about diet and exercise. If I come into a Kaiser facility where almost every employee who is not a doctor is overweight, I can’t trust the institution to lead me to healthier tomorrows when I am in better health than the Kaiser staff.
If Kaiser’s own staff don’t follow its diet and exercise recommendations, then Kaiser is not serious about health care.
Kaiser is officially a not-for-profit health plan. However, in 2014, George Halvorson, Kaiser’s former Chairman and CEO in 2014 made over $10 million a year, according to Kaiser’s own website (http://khn.org/news/blue-shield-lifts-the-veil-on-executive-salaries/). That looks like a lot of profit to me!
Kaiser is like a financial pyramid scheme. You’re fine at Kaiser if you don’t get sick and just pay your monthly premiums and come in a couple times a year for checkups, cold medications and routine procedures. Kaiser makes its money from young and healthy people who barely use its services but pay premiums. Kaiser rations services to save money. They hire lots of administrative staff to reduce services and deny patient care. Kaiser physicians become shareholders after three years of service and have a profit-sharing scheme where they get a percentage of every dollar that is collected from patients and government and not spent. This way, the doctors are incentivized to minimize care so they make more profit. Kaiser currently has $21.7 billion in cash reserves, that’s 1600% more cash reserves than what is mandated by California law. Kaiser is hoarding money and cutting services. (Tracy Seipel for Mercury News. March 19, 2015 California drops hammer on Blue Shield tax-exempt status http://www.mercurynews.com/2015/03/19/california-drops-hammer-on-blue-shield-tax-exempt-status/.) This is profit making off of you, the Kaiser patient.
Kaiser’s pyramid scheme
- Micromanage or die
- These are your choices at Kaiser:
a) Be a pain in the ass and make sure the staff follow through.
b) Don’t stick up for yourself and end up six feet (two meters) underground.
It’s better to be a thorn in Kaiser’s side than dead due to Kaiser’s negligence.
Don’t assume that the staff will actually read instructions about patient drug allergies and dietary restrictions. Check each and every medicine to make sure it is not contraindicated for your condition or contain elements to which you are allergic.
Medicines: Several years ago, my father was hospitalized. The Kaiser doctor prescribed my father an antibiotic, to which it was already noted that he was allergic. The doctor didn’t bother to look at the list of medicines to which my father was allergic. When I saw that antibiotic in my father’s list of medicines, I told the nurse to tell the doctor to take that off of my father’s list. My father could have been poisoned and killed by the doctor’s negligence.
- A few weeks later, I found out later on that the ingredients to that antibiotic were also in an eye drop that was prescribed to my father. My father had a bad reaction to the eye drops. I had to drive him to the ophthalmologist and show the Kaiser ophthalmologist that she had prescribed my father an eye drop that contained an antibiotic allergen. Then there was a big mess with the pharmacy to get my father a refund because of this mistake.
Food: Even though the card that came with my father’s hospital food said very clearly that he was diabetic and was not supposed to have white rice, white bread, desserts, and sugar, the Kaiser kitchen staff kept giving my Dad sugary foods like yogurt with high fructose corn syrup and Jell-O, white bread and white rice. I had to make a major fuss. When I told the nurse the food was unacceptable, she said the emergency room had no other food. This is not a hospital in Aleppo, Syria that has just been bombed with no food choices. When I criticized the dietician for giving my father food that was equivalent to poison for a diabetic, she looked at me like a deer in the headlights and told me the food, although sugary, still fell into the “daily allowed amounts of sugar”. My father was in the hospital because of an illness caused by diabetes and Kaiser was feeding him high fructose corn syrup — one of the main culprits in our nation’s diabetes and obesity epidemic!
Kaiser’s ad campaigns say that Kaiser helps its patients thrive. You can’t thrive when Kaiser gives you medicines and food that will poison you.
The matasanos will kill you by their stupidity!
Surgery: When my father had gastrointestinal surgery at Kaiser, my gastroenterologist friend told me what I had to make sure that Kaiser would or would not do to make sure that my father wouldn’t risk his life during the surgery. Most people don’t have a surgeon at their side who can double check on the procedures and medicines that are prescribed by Kaiser physicians. I was lucky.
If you don’t have a doctor friend to direct you, do as much research as you can on the Internet or in a medical library to know exactly what to ask. The doctors will know they can’t mess with you when you know what to ask and can respond intelligently to what they say.
You have to check everything the doctors, nurses and support staff do to make sure it is correct. These people do have managers but you have to become their unpaid manager.
2. You can get a second opinion
Kaiser saves money by preventing patients from seeing specialists and getting second opinions, especially outside of the Kaiser system. My aunt had an irregular heartbeat and her blood pressure would fluctuate between low and high blood pressure. Her primary care physician at Kaiser would not refer her to a cardiologist. When my aunt switched health insurance and went to a new non-Kaiser primary care physician, the new doctor immediately referred my aunt to a cardiologist who diagnosed her with arrhythmia, a potentially fatal condition if not treated correctly. If she had stayed at Kaiser, she could have died.
If your primary physician says you don’t need to see a specialist, insist on a second opinion. Find out who is the Chief of General Medicine at your Kaiser facility and speak to him or her. Document your concerns on paper, deliver your note by hand, by fax or by email to the office manager and communicate with the office manager to make sure your issue is handled. Don’t rely on just speaking to doctors and office managers. Put everything in writing.
If you have seen a specialist and want a second opinion and your specialist doesn’t want to help you talk to one of their colleagues, speak to the chief of the department. Ask the receptionist for the office manager for the department and tell them you want a second opinion. If they give you a load of BS about how you can’t get a second opinion, fight back. Insist.
If you need to see a sub-specialist, like a neuro-ophthalmologist, there may only be one for your entire state who works at Kaiser. Or there may be none at all. If the sub-specialist doesn’t have experience in your exact issue, Kaiser will pay for an outside consultation, at a nearby university hospital or elsewhere, if there is a sub-specialist there who will see you. But you may have to do the research to find an appropriate doctor. Kaiser will not willingly pay for an outside referral so be prepared to fight this one and prove that there is no one at Kaiser in your geographic area with the exact expertise you need. You may have to write a letter documenting the doctors you have contacted and who has what kind of expertise.
(Read the section below for more information: “Forget Member Services and go straight to the top.”)
3. Know the law
The next best thing to having a doctor friend at your side is knowing your legal rights. If you cite a legal statute that Kaiser is breaking to the face of the offending Kaiser party and use the words “medical malpractice,” you will scare the pants off of them. Kaiser staff are not used to patients fighting back. They prey on the vulnerable, especially those who don’t speak English well.
Be aware that when you signed up for Kaiser insurance, you signed away a lot of rights to sue Kaiser.
You have to go to an arbitration procedure where Kaiser’s lawyers will outgun you. To prevent getting into a legal battle with Kaiser, show them your ammunition (your knowledge of the law) as soon as you smell that they are breaking the law.
a) Patient’s Bill of Rights under the Affordable Care Act:
b) Look up Medicare Law: https://www.law.cornell.edu/cfr/text/42/chapter-IV
4. Forget Member Services, complain straight to the top!
If you have any complaints for Kaiser, forego their Member Services Department unless you enjoy waiting for a response for 30 days and getting factually incorrect responses.
Kaiser Member Services is a black hole of incompetent people paid to respond to complaint letters. They have no medical background, don’t read your letters in detail, can’t spell, and may completely ignore half of the egregious medical mistakes explained in the complaint letters. Once I called to speak to the Senior Member Services representative who sent me a response with factual mistakes and omissions. I had to fight to get her attention because there was a screaming baby in the background. This Kaiser Member Services person was either taking care of her own baby during business hours or making extra money (while on the Kaiser clock) babysitting. In any case, she was distracted from doing her job and speaking to me, perhaps explaining why her response to my complaint was incomplete. It is unprofessional for Kaiser to hire people taking care of babies who have to make phone calls to do serious investigations into medical negligence, illegal behavior and irresponsible practices. I wonder, after getting so many incomplete responses to my complaints from Member Services, if the Member Services department ever did an investigation or just made up a response.
a. Find out who is the Chief for the department and communicate with them directly. They may apologize profusely and tell you that they can’t do anything unless you write to Member Services. In that case, since you need a paper trail of your complaint, submit a complaint to the Department of Public Health and to Member Services.
b. Physically go to the Kaiser facility and find out who the top administrator or area manager is. Speak to the secretary/receptionist in person and get that person’s email and phone number.
c. If you can’t go in physically, do a search on the Kaiser website (https://share.kaiserpermanente.org/bio/ ) to find out the names of the CEO, Executive Medical Directors and other top directors for your state. Their emails and phone numbers are not listed. However, you can figure out their email address by guessing. Most emails at Kaiser end in @kp.org, try a combination of the person’s first name and last name (i.e. Walt.Disney@kp.org). Do a search for that person’s name and @kp.org and you’re likely to find that person’s email on some forum for disgruntled Kaiser patients. Send your complaint to the top officers for your region.
d. If you can’t find the person’s email address, search for the corporate headquarters for your state and call during business hours to get the fax number for the executive you want to reach. Use www.faxzero.com to send free faxes online.
e. If the executive still says you have to go through Member Services, say that you know Member Services is a disaster and you want your issue dealt with immediately. If they push back, say that you will submit your complaint to Member Services but that you still want the executive’s office to oversee the investigation.
5. Let Kaiser bleed
Who will advocate for me?
Even though I’m willing to stick out my nose for myself and for my family members and be the thorn in Kaiser’s side, who is going to be there for me when I’m not able to do the research or stand up for myself? Who’s going to be there to make sure that Kaiser’s matasanos don’t kill me?
When I had the chance to switch medical insurance because of a change in my job, I was very happy to quit Kaiser. Kaiser claims that they offer affordable health care. It’s neither affordable nor do they provide health care if what you have to have is a medical advocate at your side at all times when you go in there to make sure that Kaiser doesn’t screw up.
I calculated that over the past eight years, I have paid over $30,000 in monthly premiums to Kaiser and have used my insurance very rarely. For less $13,000, I could have flown to South Africa for a two week medical holiday, received plastic surgery, gone on a safari, experienced a new culture, seen exotic animals and avoided feeding Kaiser’s financial pyramid scheme.
Money talks as does the lack of it!
I’m voting with my pocketbook by quitting Kaiser.
In order for Kaiser to change its ways and not rob its patients of their money and fail to deliver medical care, more of us need to publicly quit Kaiser and file claims with the Department of Public Health about Kaiser’s wrongdoing.
Kaiser needs to hemorrhage to wake up!
Write to the CEO and other executives and tell them why you are jumping ship. They’re going to listen when young healthy people quit Kaiser and go to other insurance companies. Kaiser needs young and healthy people to pay health insurance premiums because they use that money to pay for the care of the old sick people in their program, pad their cash reserves, pay their doctors’ profit sharing scheme and fund their CEO’s magnificent salary. If the only plan members Kaiser had were old and sick people, it wouldn’t be able to sustain itself.
Let the administrators and the financial people at Kaiser defecate in their pants when they realize how many young, healthy people are jumping ship.
Vote with your pocketbook and make a ruckus.