Kaiser Permanente

In short

Kaiser is both the insurer and the care provider, and each region has its own health plan, so use the member services number on your ID card and the complaint steps for your region. In California, file a grievance with Kaiser; if it is not resolved in 30 calendar days, or Kaiser denies care as not medically necessary, go to the Department of Managed Health Care, which can send the case to an Independent Medical Review that Kaiser honors. Kaiser was fined $50 million in 2023 over delays in behavioral health care, so press for timely appointments. Kaiser will never ask for your password by phone or email.

How complaints actually go

• Kaiser says you can appeal its payment decision on any claim you submit yourself; the explanation of benefits gives the steps. Kaiser Permanente claims help
• Northern California commercial members lodge grievances with Member Services (1-800-464-4000; Spanish 1-800-788-0616; Chinese dialects 1-800-757-7585; TTY 711) or at kp.org. Kaiser aims to resolve them generally within 14-30 calendar days, and expedited reviews generally within 72 hours. Kaiser Permanente provider manual, 2023
• If the grievance is unresolved for more than 30 calendar days, or the member is not satisfied, the member may contact the DMHC, which decides whether the case qualifies for Independent Medical Review. Kaiser Permanente provider manual, 2023
• Outside California, the federal rules give 180 days for an internal appeal and 4 months after the final denial for external review, which the plan must follow. HealthCare.gov: internal appeals HealthCare.gov: external review

What tends to work

• Use Independent Medical Review for denials of care as not medically necessary, experimental treatments for serious conditions, or unpaid emergency or urgent care: reviewers are medical experts not affiliated with Kaiser, and Kaiser honors the DMHC decision. A case may qualify after 30 calendar days, or 3 days for expedited requests. Kaiser Permanente provider manual, 2023
• For mental health care delays, cite the wait-time rules. California's investigation found Kaiser's average follow-up behavioral health wait was longer than the 10 days the law sets (19 days in 2021), and when a plan cannot offer a timely appointment it must refer patients out of network and cover the care. CalMatters, October 2023
• Appeal Medicare Advantage prior authorization denials: in 2025 data, Kaiser Permanente overturned 40 percent of appealed denials in Medicare Advantage. KFF, August 2026

Traps and fine print

• The grievance and IMR steps above are written for California non-Medicare members; Medicare members and other regions follow different processes, so check the explanation of benefits or plan documents for your steps. Kaiser Permanente provider manual, 2023 Kaiser Permanente claims help
• IMR is for medical-necessity, experimental-treatment and emergency-payment denials; other complaints stay in the grievance process. Kaiser Permanente provider manual, 2023

By the numbers

• On October 12, 2023, Kaiser agreed to a $50 million fine and pledged $150 million over 5 years for behavioral health programs to settle California's investigation of its behavioral health care. Governor of California, October 2023
• Medicare Advantage, June 2024: Kaiser Foundation Health Plan denied 14.0 percent of skilled nursing facility admission requests (212 denials); of 39 appeals, 17 were overturned. HHS OIG OEI-09-24-00331, June 2026

Scams that target customers

• Kaiser Permanente will never ask for your password over the phone or by email. If someone says your account needs to be confirmed, contact customer service directly. Kaiser Permanente: protecting personal information
• Offers of "free" medical treatment are usually scams, according to Kaiser Permanente Washington; it lists a confidential fraud hotline at 1-888-774-9100. Kaiser Permanente Washington: fraud
• "Free" genetic tests and cheek swabs offered by phone, at events or door to door are used to steal Medicare information. HHS OIG genetic testing alert