My sister had a massive stroke. I can't get Kaiser to give her the care she needs. She was discharged after 2 weeks of rehab. She can't walk, talk, communicate or transfer herself. She lives alone and they have not provided the home heath aid or speech therapist that the rehab center and doctor recommended. Her policy and member services indicated she is entitled to 35 hours of care with such an Acute stroke. It has been almost a month since her release. see
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.
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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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.
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.
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.
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 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.