{"id":"kaiser-permanente","page":"https://escalate.alexgaoth.com/#/c/kaiser-permanente","html":"https://escalate.alexgaoth.com/c/kaiser-permanente/","generated":"2026-10-15","company":{"id":"kaiser-permanente","name":"Kaiser Permanente","aliases":["kaiser","kp","kaiser foundation health plan","kaiser foundation health plan inc","kaiser health plan"],"sector":"insurance_health","website":"https://healthy.kaiserpermanente.org","regulators":["dol-ebsa","cms-no-surprises"],"channels":[{"id":"member-services-phone","type":"phone","label":"Member Services, California (Northern and Southern), English","value":"+1-800-464-4000","hours":"24 hours, 7 days; closed holidays","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill","poor_service"],"notes":"Listed as the English line on Northern and Southern California medical center member services pages. TTY 711.","source":"https://healthy.kaiserpermanente.org/northern-california/facilities/san-mateo-medical-offices-300395/departments/member-and-administrative-services-dlp-108917","last_verified":"2026-10-12"},{"id":"ca-senior-advantage-phone","type":"phone","label":"Member Services, Medicare Senior Advantage (Southern California)","value":"+1-800-443-0815","purposes":["claim_denial","claim_delay","billing_error"],"source":"https://healthy.kaiserpermanente.org/southern-california/support/member-services-locations","last_verified":"2026-10-12"},{"id":"ca-medi-cal-phone","type":"phone","label":"Member Services, Medi-Cal members (California)","value":"+1-855-839-7613","hours":"24 hours a day, 7 days a week","purposes":["claim_denial","billing_error"],"notes":"TTY 711.","source":"https://healthy.kaiserpermanente.org/southern-california/shop-plans/medicaid/new-members","last_verified":"2026-10-12"},{"id":"wa-member-services-phone","type":"phone","label":"Member Services, Washington","value":"+1-888-901-4636","purposes":["claim_denial","claim_delay","billing_error"],"notes":"Washington Medicare members call 1-888-901-4600.","source":"https://healthy.kaiserpermanente.org/washington/support/member-services","last_verified":"2026-10-12"},{"id":"nw-member-services-phone","type":"phone","label":"Membership Services, Northwest (Oregon and Southwest Washington), outside Portland","value":"+1-800-813-2000","purposes":["claim_denial","claim_delay","billing_error"],"notes":"Portland area 503-813-2000. TTY 711.","source":"https://healthy.kaiserpermanente.org/oregon-washington/facilities/Interstate-Medical-Office-Central-100269/departments/member-and-administrative-services-dlp-106149","last_verified":"2026-10-12"},{"id":"co-complaint-form","type":"web_form","label":"Member grievance/complaint form, Colorado (PDF)","value":"https://healthy.kaiserpermanente.org/content/dam/kporg/final/documents/forms/member-complaint-form-co-en.pdf","purposes":["claim_denial","poor_service"],"notes":"The form lists 303-338-3800 or toll-free 1-800-632-9700 for the Denver/Boulder and Mountain areas.","source":"https://healthy.kaiserpermanente.org/content/dam/kporg/final/documents/forms/member-complaint-form-co-en.pdf","last_verified":"2026-10-12"},{"id":"complaint-form","type":"web_form","label":"Submit a complaint (file a grievance report)","value":"https://healthy.kaiserpermanente.org/support/submit-a-complaint","purposes":["claim_denial","poor_service","billing_error"],"notes":"Linked from the support center as \"File a grievance report\".","source":"https://healthy.kaiserpermanente.org/support","last_verified":"2026-10-12"},{"id":"grievance-status","type":"portal","label":"Grievance and appeal case status","value":"https://healthy.kaiserpermanente.org/secure/support/complaints-grievances-appeals","purposes":["claim_denial","poor_service"],"access":"login","source":"https://healthy.kaiserpermanente.org/support","last_verified":"2026-10-12"},{"id":"member-services-message","type":"portal","label":"Email member services (secure message)","value":"https://healthy.kaiserpermanente.org/secure/messages?compose=member-services","purposes":["claim_denial","claim_delay","billing_error","poor_service"],"access":"login","notes":"For non-urgent questions. Kaiser Permanente says it responds within 3 days.","source":"https://healthy.kaiserpermanente.org/support","last_verified":"2026-10-12"},{"id":"claim-summary","type":"portal","label":"Review visit-cost and claims summary","value":"https://healthy.kaiserpermanente.org/secure/coverage-costs/claims-summary#/","purposes":["claim_delay","claim_denial","billing_error"],"access":"login","source":"https://healthy.kaiserpermanente.org/support","last_verified":"2026-10-12"},{"id":"claims-help","type":"web_form","label":"Claims help (submitting claims and appeal rights)","value":"https://healthy.kaiserpermanente.org/support/claims-summary-help","purposes":["claim_denial","claim_delay"],"access":"open","source":"https://healthy.kaiserpermanente.org/support","last_verified":"2026-10-12"},{"id":"billing","type":"portal","label":"Pay premium and medical bills","value":"https://healthy.kaiserpermanente.org/secure/billing","purposes":["billing_error"],"access":"login","source":"https://healthy.kaiserpermanente.org/support","last_verified":"2026-10-12"},{"id":"advice-phone","type":"phone","label":"Call for advice (getting care; not a claims or billing line)","value":"+1-800-218-1059","notes":"TTY 711.","source":"https://healthy.kaiserpermanente.org/support","last_verified":"2026-10-12"}],"escalation":[{"rung":"frontline","channel":"member-services-phone","note":"Use the member services number on the back of the member ID card for your region, or send a secure message."},{"rung":"written_complaint","channel":"complaint-form","note":"Grievance or appeal. Track it in the grievance case status page."},{"rung":"state_agency","agency_kind":"insurance_department","note":"External review for fully insured plans; complaint to the state. In California, HMO plans are regulated by the Department of Managed Health Care."},{"rung":"regulator","regulator":"dol-ebsa","note":"Employer self-funded (ERISA) plans."},{"rung":"regulator","regulator":"cms-no-surprises","note":"Surprise bills under the No Surprises Act."}],"playbooks":[{"issue":"claim_denial","summary":"Read the EOB for appeal steps, file a grievance or appeal, track it online, then go to the state regulator.","evidence":["EOB or Statement of Accumulation","denial letter","member ID card (medical record number)","medical records","receipts for out-of-plan care"],"steps":[{"do":"Open the claims summary and the EOB or Statement of Accumulation. It gives the steps to submit an appeal.","channel":"claim-summary"},{"do":"Ask member services by secure message or by the number on the ID card to explain the decision.","channel":"member-services-message"},{"do":"File the grievance or appeal. Then track the case status online.","channel":"complaint-form"},{"do":"After the final internal decision, ask for external or independent medical review through the state regulator (fully insured plans), or contact the Department of Labor for employer self-funded plans.","regulator":"dol-ebsa"}],"facts":[{"kind":"policy","claim":"Kaiser Permanente says you have the right to appeal the plan's payment decision on any claim you personally submit, and that the EOB or Statement of Accumulation gives the steps to submit an appeal.","issues":["claim_denial"],"source":"https://healthy.kaiserpermanente.org/support/claims-summary-help","last_verified":"2026-10-12"}]},{"issue":"billing_error","summary":"Compare the bill with the claims summary, message member services, then file a complaint.","evidence":["bill","claims or visit-cost summary","member ID card"],"steps":[{"do":"Compare the bill with the visit-cost and claims summary.","channel":"claim-summary"},{"do":"Send a secure message to member services that names the charge and the amount you expected.","channel":"member-services-message"},{"do":"If it is not fixed, submit a complaint.","channel":"complaint-form"}]},{"issue":"surprise_medical_bill","summary":"For out-of-network emergency care, submit the claim to Kaiser Permanente, compare the bill with the EOB, then contact the CMS help desk.","evidence":["the bill","EOB","member ID card","emergency visit records"],"steps":[{"do":"Submit the out-of-plan emergency claim to Kaiser Permanente for reimbursement (see claims help).","channel":"claims-help"},{"do":"Compare the provider bill with the EOB. Tell Kaiser Permanente and the provider that the bill may be a surprise bill.","channel":"member-services-message"},{"do":"Contact the CMS No Surprises Help Desk.","regulator":"cms-no-surprises"}]}],"known_blockers":["Member services messages, claims summaries and grievance status need a kp.org login.","Member services numbers differ by region and plan (Medicare, Medi-Cal, choice products); the number on the member ID card takes precedence. Numbers for Colorado, Georgia, Hawaii and Mid-Atlantic were not confirmed for HMO members.","The complaint page and EOB give the region-specific appeal procedure."],"notes":"Kaiser Permanente (Oakland, California) comprises Kaiser Foundation Health Plan, Inc., Kaiser Foundation Hospitals and The Permanente Medical Groups, serving 12.9 million members in nine regions (Northern and Southern California, Hawaii, Colorado, Georgia, Mid-Atlantic States, Northwest, Washington and Nevada). Each region has its own health plan company. Risant Health and its affiliates are outside these figures. Medicare and Medicaid members have their own appeal rules.","official_domains":["kaiserpermanente.org","kp.org"],"security":{"never_asks":[{"kind":"policy","claim":"Kaiser Permanente will never ask for your password over the phone or by email.","source":"https://healthy.kaiserpermanente.org/pages/online-security/protecting-personal-information","last_verified":"2026-10-12"}],"known_scams":[{"kind":"policy","claim":"Callers claim to be from Kaiser Permanente, say an account needs to be confirmed and ask for personal information. Kaiser Permanente advises contacting customer service directly to check.","source":"https://healthy.kaiserpermanente.org/pages/online-security/protecting-personal-information","last_verified":"2026-10-12"},{"kind":"policy","claim":"Offers of \"free\" medical treatment are usually scams, according to Kaiser Permanente Washington's fraud page.","source":"https://wa.kaiserpermanente.org/html/public/customer-service/fraud","last_verified":"2026-10-12"}],"report_phishing":[{"id":"fraud-hotline","type":"phone","label":"Kaiser Permanente confidential fraud hotline (listed on the Washington region fraud page)","value":"+1-888-774-9100","notes":"The page does not say which regions the hotline covers.","source":"https://wa.kaiserpermanente.org/html/public/customer-service/fraud","last_verified":"2026-10-12"}]}},"playbooks":{"claim_denial":{"company":{"id":"kaiser-permanente","name":"Kaiser Permanente","sector":"insurance_health","website":"https://healthy.kaiserpermanente.org","account_url":null},"issue":{"id":"claim_denial","name":"Insurance claim denied"},"playbook_source":"company","summary":"Read the EOB for appeal steps, file a grievance or appeal, track it online, then go to the state regulator.","evidence":["EOB or Statement of Accumulation","denial letter","member ID card (medical record number)","medical records","receipts for out-of-plan care"],"steps":[{"do":"Open the claims summary and the EOB or Statement of Accumulation. It gives the steps to submit an appeal.","channel":{"id":"claim-summary","type":"portal","label":"Review visit-cost and claims summary","value":"https://healthy.kaiserpermanente.org/secure/coverage-costs/claims-summary#/","purposes":["claim_delay","claim_denial","billing_error"],"access":"login","source":"https://healthy.kaiserpermanente.org/support","last_verified":"2026-10-12"}},{"do":"Ask member services by secure message or by the number on the ID card to explain the decision.","channel":{"id":"member-services-message","type":"portal","label":"Email member services (secure message)","value":"https://healthy.kaiserpermanente.org/secure/messages?compose=member-services","purposes":["claim_denial","claim_delay","billing_error","poor_service"],"access":"login","notes":"For non-urgent questions. Kaiser Permanente says it responds within 3 days.","source":"https://healthy.kaiserpermanente.org/support","last_verified":"2026-10-12"}},{"do":"File the grievance or appeal. Then track the case status online.","channel":{"id":"complaint-form","type":"web_form","label":"Submit a complaint (file a grievance report)","value":"https://healthy.kaiserpermanente.org/support/submit-a-complaint","purposes":["claim_denial","poor_service","billing_error"],"notes":"Linked from the support center as \"File a grievance report\".","source":"https://healthy.kaiserpermanente.org/support","last_verified":"2026-10-12"}},{"do":"After the final internal decision, ask for external or independent medical review through the state regulator (fully insured plans), or contact the Department of Labor for employer self-funded plans.","regulator":{"id":"dol-ebsa","name":"U.S. Department of Labor, Employee Benefits Security Administration","level":"federal","when_to_use":"Use for a problem with a private-sector employer health or retirement plan (ERISA plan), such as a denied or delayed claim, after you follow the plan's own claim and appeal steps. Government and church plans are generally not covered.","channels":[{"id":"health-plan-form","type":"web_form","label":"Request help from a Benefits Advisor (health plan)","value":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=3","purposes":["claim_denial","claim_delay"],"notes":"Asks for name, ZIP, state, phone, email, the last four digits of the Social Security number, and an attestation that you are the person the information applies to. The account holder must confirm this personally.","source":"https://beta.dol.gov/about/agencies/ebsa/ask-ebsa","last_verified":"2026-10-12"},{"id":"retirement-plan-form","type":"web_form","label":"Request help from a Benefits Advisor (retirement plan)","value":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=4","source":"https://beta.dol.gov/about/agencies/ebsa/ask-ebsa","last_verified":"2026-10-12"},{"id":"phone","type":"phone","label":"EBSA Benefits Advisors","value":"+1-866-444-3272","source":"https://beta.dol.gov/about/agencies/ebsa/ask-ebsa","last_verified":"2026-10-12"}],"facts":[{"kind":"process","claim":"ERISA sets minimum standards for most voluntarily established retirement and health plans in private industry. In general it does not cover group health plans of government entities or church plans.","source":"https://www.dol.gov/general/topic/health-plans/erisa","last_verified":"2026-10-12"},{"kind":"process","claim":"For a complaint under Title I of ERISA, expect a status report from the assigned benefits advisor every 30 days.","source":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=3","last_verified":"2026-10-12"},{"kind":"process","claim":"EBSA can help you understand your rights, but you should still review the plan documents and meet the plan's claim and appeal deadlines.","issues":["claim_denial"],"source":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=3","last_verified":"2026-10-12"}],"notes":"On 2026-10-12, www.askebsa.dol.gov and the old Ask EBSA page redirected to https://beta.dol.gov/about/agencies/ebsa/ask-ebsa, which links to the WebIntake forms above. EBSA regional offices: https://www.dol.gov/agencies/ebsa/about-ebsa/about-us/regional-offices"}}],"channels":[{"id":"member-services-phone","type":"phone","label":"Member Services, California (Northern and Southern), English","value":"+1-800-464-4000","hours":"24 hours, 7 days; closed holidays","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill","poor_service"],"notes":"Listed as the English line on Northern and Southern California medical center member services pages. TTY 711.","source":"https://healthy.kaiserpermanente.org/northern-california/facilities/san-mateo-medical-offices-300395/departments/member-and-administrative-services-dlp-108917","last_verified":"2026-10-12"},{"id":"ca-senior-advantage-phone","type":"phone","label":"Member Services, Medicare Senior Advantage (Southern California)","value":"+1-800-443-0815","purposes":["claim_denial","claim_delay","billing_error"],"source":"https://healthy.kaiserpermanente.org/southern-california/support/member-services-locations","last_verified":"2026-10-12"},{"id":"ca-medi-cal-phone","type":"phone","label":"Member Services, Medi-Cal members (California)","value":"+1-855-839-7613","hours":"24 hours a day, 7 days a week","purposes":["claim_denial","billing_error"],"notes":"TTY 711.","source":"https://healthy.kaiserpermanente.org/southern-california/shop-plans/medicaid/new-members","last_verified":"2026-10-12"},{"id":"wa-member-services-phone","type":"phone","label":"Member Services, Washington","value":"+1-888-901-4636","purposes":["claim_denial","claim_delay","billing_error"],"notes":"Washington Medicare members call 1-888-901-4600.","source":"https://healthy.kaiserpermanente.org/washington/support/member-services","last_verified":"2026-10-12"},{"id":"nw-member-services-phone","type":"phone","label":"Membership Services, Northwest (Oregon and Southwest Washington), outside Portland","value":"+1-800-813-2000","purposes":["claim_denial","claim_delay","billing_error"],"notes":"Portland area 503-813-2000. TTY 711.","source":"https://healthy.kaiserpermanente.org/oregon-washington/facilities/Interstate-Medical-Office-Central-100269/departments/member-and-administrative-services-dlp-106149","last_verified":"2026-10-12"},{"id":"co-complaint-form","type":"web_form","label":"Member grievance/complaint form, Colorado (PDF)","value":"https://healthy.kaiserpermanente.org/content/dam/kporg/final/documents/forms/member-complaint-form-co-en.pdf","purposes":["claim_denial","poor_service"],"notes":"The form lists 303-338-3800 or toll-free 1-800-632-9700 for the Denver/Boulder and Mountain areas.","source":"https://healthy.kaiserpermanente.org/content/dam/kporg/final/documents/forms/member-complaint-form-co-en.pdf","last_verified":"2026-10-12"},{"id":"complaint-form","type":"web_form","label":"Submit a complaint (file a grievance report)","value":"https://healthy.kaiserpermanente.org/support/submit-a-complaint","purposes":["claim_denial","poor_service","billing_error"],"notes":"Linked from the support center as \"File a grievance report\".","source":"https://healthy.kaiserpermanente.org/support","last_verified":"2026-10-12"},{"id":"grievance-status","type":"portal","label":"Grievance and appeal case status","value":"https://healthy.kaiserpermanente.org/secure/support/complaints-grievances-appeals","purposes":["claim_denial","poor_service"],"access":"login","source":"https://healthy.kaiserpermanente.org/support","last_verified":"2026-10-12"},{"id":"member-services-message","type":"portal","label":"Email member services (secure message)","value":"https://healthy.kaiserpermanente.org/secure/messages?compose=member-services","purposes":["claim_denial","claim_delay","billing_error","poor_service"],"access":"login","notes":"For non-urgent questions. Kaiser Permanente says it responds within 3 days.","source":"https://healthy.kaiserpermanente.org/support","last_verified":"2026-10-12"},{"id":"claim-summary","type":"portal","label":"Review visit-cost and claims summary","value":"https://healthy.kaiserpermanente.org/secure/coverage-costs/claims-summary#/","purposes":["claim_delay","claim_denial","billing_error"],"access":"login","source":"https://healthy.kaiserpermanente.org/support","last_verified":"2026-10-12"},{"id":"claims-help","type":"web_form","label":"Claims help (submitting claims and appeal rights)","value":"https://healthy.kaiserpermanente.org/support/claims-summary-help","purposes":["claim_denial","claim_delay"],"access":"open","source":"https://healthy.kaiserpermanente.org/support","last_verified":"2026-10-12"},{"id":"advice-phone","type":"phone","label":"Call for advice (getting care; not a claims or billing line)","value":"+1-800-218-1059","notes":"TTY 711.","source":"https://healthy.kaiserpermanente.org/support","last_verified":"2026-10-12"}],"facts":[{"kind":"policy","claim":"Kaiser Permanente says you have the right to appeal the plan's payment decision on any claim you personally submit, and that the EOB or Statement of Accumulation gives the steps to submit an appeal.","issues":["claim_denial"],"source":"https://healthy.kaiserpermanente.org/support/claims-summary-help","last_verified":"2026-10-12"}],"rules":{"in_force":[{"id":"aca-appeals-external-review","title":"ACA internal appeals and external review for health coverage","citation":"45 CFR 147.136 (with 29 CFR 2560.503-1 for group health plans)","jurisdiction":"us-federal","status":"in_effect","summary":"After a health plan denies a claim, the patient has 180 days to file an internal appeal. The plan must decide within 30 days (care not yet received), 60 days (care already received) or 72 hours (urgent care). After a final denial, the patient can ask for an independent external review within 4 months; the plan must accept the reviewer's decision.","source":"https://www.law.cornell.edu/cfr/text/45/147.136","last_verified":"2026-10-12","points":[{"kind":"deadline","claim":"\"You must file your internal appeal within 180 days (6 months) of receiving notice that your claim was denied.\"","issues":["claim_denial"],"source":"https://www.healthcare.gov/appeal-insurance-company-decision/internal-appeals/","last_verified":"2026-10-12"},{"kind":"deadline","claim":"The internal appeal must be completed within 30 days for a service not yet received and within 60 days for a service already received.","issues":["claim_denial","claim_delay"],"source":"https://www.healthcare.gov/appeal-insurance-company-decision/internal-appeals/","last_verified":"2026-10-12"},{"kind":"deadline","claim":"For urgent care claims, a group health plan must decide an appeal \"not later than 72 hours after receipt of the claimant's request for review\".","issues":["claim_denial","claim_delay"],"source":"https://www.law.cornell.edu/cfr/text/29/2560.503-1","last_verified":"2026-10-12"},{"kind":"process","claim":"In urgent situations, \"You may file an internal appeal and an external review request at the same time.\"","issues":["claim_denial"],"source":"https://www.healthcare.gov/appeal-insurance-company-decision/internal-appeals/","last_verified":"2026-10-12"},{"kind":"policy","claim":"Plans must continue coverage pending the outcome of an appeal, and may not reduce or end benefits for an ongoing course of treatment without advance notice and an opportunity for advance review.","issues":["claim_denial"],"source":"https://www.law.cornell.edu/cfr/text/45/147.136","last_verified":"2026-10-12"},{"kind":"deadline","claim":"An external review must be requested within \"4 months after the date you receive a notice or final determination\" from the insurer. A standard decision is due no later than 45 days after the request is received; an expedited decision no later than 72 hours.","issues":["claim_denial"],"source":"https://www.healthcare.gov/appeal-insurance-company-decision/external-review/","last_verified":"2026-10-12"},{"kind":"policy","claim":"The insurer is required by law to accept the external reviewer's decision. The HHS-administered process is free; a state or insurer-contracted process may charge, but not more than $25 per review.","issues":["claim_denial"],"source":"https://www.healthcare.gov/appeal-insurance-company-decision/external-review/","last_verified":"2026-10-12"},{"kind":"policy","claim":"If the plan fails to strictly follow the internal claims and appeals requirements, the claimant \"is deemed to have exhausted the internal claims and appeals process\", subject to a de minimis exception.","issues":["claim_denial","claim_delay"],"source":"https://www.law.cornell.edu/cfr/text/45/147.136","last_verified":"2026-10-12"},{"kind":"limit","claim":"These internal appeal and external review requirements generally do not apply to grandfathered plans.","issues":["claim_denial"],"source":"https://www.law.cornell.edu/cfr/text/45/147.136","last_verified":"2026-10-12"},{"kind":"contact","claim":"For plans that use the HHS-administered external review process, requests can be filed online with MAXIMUS Federal Services, by calling 1-888-866-6205 for a form, or by email to ferp@maximus.com. For a state process, the contact is in the final denial notice or Explanation of Benefits.","issues":["claim_denial"],"source":"https://www.healthcare.gov/appeal-insurance-company-decision/external-review/","last_verified":"2026-10-12"}]},{"id":"erisa-claims-procedures","title":"ERISA claims procedure timelines for employer benefit plans","citation":"29 CFR 2560.503-1","jurisdiction":"us-federal","status":"in_effect","summary":"Employer-sponsored benefit plans covered by ERISA must decide claims and appeals within set deadlines. Group health plans: 72 hours for urgent care, 15 days for pre-service and 30 days for post-service claims; disability plans: 45 days; other plans: 90 days. Group health and disability claimants get at least 180 days to appeal. If the plan does not follow the procedures, the claimant may sue.","source":"https://www.law.cornell.edu/cfr/text/29/2560.503-1","last_verified":"2026-10-12","points":[{"kind":"deadline","claim":"Group health plan initial decisions: urgent care claims \"not later than 72 hours after receipt of the claim by the plan\"; pre-service claims within 15 days, with one extension of up to 15 days; post-service claims \"not later than 30 days after receipt of the claim\", with one extension of up to 15 days.","issues":["claim_delay","claim_denial"],"source":"https://www.law.cornell.edu/cfr/text/29/2560.503-1","last_verified":"2026-10-12"},{"kind":"deadline","claim":"Disability claims: notice of decision \"not later than 45 days after receipt of the claim by the plan\", with an extension of up to 30 days and a second extension of up to 30 days. Other plans (not group health or disability): not later than 90 days, with one extension of up to 90 days.","issues":["claim_delay","claim_denial"],"source":"https://www.law.cornell.edu/cfr/text/29/2560.503-1","last_verified":"2026-10-12"},{"kind":"deadline","claim":"Time to appeal a denial: group health plan and disability claimants must have at least 180 days after receiving the adverse benefit determination. Claimants under other plans must have \"at least 60 days following receipt of a notification\" of the adverse determination.","issues":["claim_denial"],"source":"https://www.law.cornell.edu/cfr/text/29/2560.503-1","last_verified":"2026-10-12"},{"kind":"deadline","claim":"Group health plan appeal decisions (one-level appeal): urgent care within 72 hours, pre-service within 30 days, post-service within 60 days after the plan receives the appeal. With two appeal levels, each level has 15 days (pre-service) or 30 days (post-service).","issues":["claim_denial","claim_delay"],"source":"https://www.law.cornell.edu/cfr/text/29/2560.503-1","last_verified":"2026-10-12"},{"kind":"deadline","claim":"Appeal decisions for other plans are due not later than 60 days after the request for review (up to 60 more days in special circumstances); for disability plans the period is 45 days.","issues":["claim_denial","claim_delay"],"source":"https://www.law.cornell.edu/cfr/text/29/2560.503-1","last_verified":"2026-10-12"},{"kind":"policy","claim":"On appeal, the plan must provide, \"upon request and free of charge, reasonable access to, and copies of, all documents\" relevant to the claim.","issues":["claim_denial"],"source":"https://www.law.cornell.edu/cfr/text/29/2560.503-1","last_verified":"2026-10-12"},{"kind":"policy","claim":"If the plan fails to establish or follow these claims procedures, \"a claimant shall be deemed to have exhausted the administrative remedies available under the plan\" and may bring a civil action under ERISA section 502(a).","issues":["claim_denial","claim_delay"],"source":"https://www.law.cornell.edu/cfr/text/29/2560.503-1","last_verified":"2026-10-12"}]}],"not_in_force":[]},"tips":[],"escalation":[{"index":0,"rung":"frontline","note":"Use the member services number on the back of the member ID card for your region, or send a secure message.","channel":{"id":"member-services-phone","type":"phone","label":"Member Services, California (Northern and Southern), English","value":"+1-800-464-4000","hours":"24 hours, 7 days; closed holidays","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill","poor_service"],"notes":"Listed as the English line on Northern and Southern California medical center member services pages. TTY 711.","source":"https://healthy.kaiserpermanente.org/northern-california/facilities/san-mateo-medical-offices-300395/departments/member-and-administrative-services-dlp-108917","last_verified":"2026-10-12"}},{"index":1,"rung":"written_complaint","note":"Grievance or appeal. Track it in the grievance case status page.","channel":{"id":"complaint-form","type":"web_form","label":"Submit a complaint (file a grievance report)","value":"https://healthy.kaiserpermanente.org/support/submit-a-complaint","purposes":["claim_denial","poor_service","billing_error"],"notes":"Linked from the support center as \"File a grievance report\".","source":"https://healthy.kaiserpermanente.org/support","last_verified":"2026-10-12"}},{"index":2,"rung":"state_agency","note":"External review for fully insured plans; complaint to the state. In California, HMO plans are regulated by the Department of Managed Health Care.","agency_kind":"insurance_department","agencies":"Ask for the person's state, then call find_regulators."},{"index":3,"rung":"regulator","note":"Employer self-funded (ERISA) plans.","regulator":{"id":"dol-ebsa","name":"U.S. Department of Labor, Employee Benefits Security Administration","level":"federal","when_to_use":"Use for a problem with a private-sector employer health or retirement plan (ERISA plan), such as a denied or delayed claim, after you follow the plan's own claim and appeal steps. Government and church plans are generally not covered.","channels":[{"id":"health-plan-form","type":"web_form","label":"Request help from a Benefits Advisor (health plan)","value":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=3","purposes":["claim_denial","claim_delay"],"notes":"Asks for name, ZIP, state, phone, email, the last four digits of the Social Security number, and an attestation that you are the person the information applies to. The account holder must confirm this personally.","source":"https://beta.dol.gov/about/agencies/ebsa/ask-ebsa","last_verified":"2026-10-12"},{"id":"retirement-plan-form","type":"web_form","label":"Request help from a Benefits Advisor (retirement plan)","value":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=4","source":"https://beta.dol.gov/about/agencies/ebsa/ask-ebsa","last_verified":"2026-10-12"},{"id":"phone","type":"phone","label":"EBSA Benefits Advisors","value":"+1-866-444-3272","source":"https://beta.dol.gov/about/agencies/ebsa/ask-ebsa","last_verified":"2026-10-12"}],"facts":[{"kind":"process","claim":"ERISA sets minimum standards for most voluntarily established retirement and health plans in private industry. In general it does not cover group health plans of government entities or church plans.","source":"https://www.dol.gov/general/topic/health-plans/erisa","last_verified":"2026-10-12"},{"kind":"process","claim":"For a complaint under Title I of ERISA, expect a status report from the assigned benefits advisor every 30 days.","source":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=3","last_verified":"2026-10-12"},{"kind":"process","claim":"EBSA can help you understand your rights, but you should still review the plan documents and meet the plan's claim and appeal deadlines.","issues":["claim_denial"],"source":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=3","last_verified":"2026-10-12"}],"notes":"On 2026-10-12, www.askebsa.dol.gov and the old Ask EBSA page redirected to https://beta.dol.gov/about/agencies/ebsa/ask-ebsa, which links to the WebIntake forms above. EBSA regional offices: https://www.dol.gov/agencies/ebsa/about-ebsa/about-us/regional-offices"}},{"index":4,"rung":"regulator","note":"Surprise bills under the No Surprises Act.","regulator":{"id":"cms-no-surprises","name":"CMS No Surprises Help Desk","level":"federal","when_to_use":"Use for an out-of-network surprise bill for emergency care, for care at an in-network hospital or surgery center, or for air ambulance. Uninsured or self-pay patients use the dispute process when a bill is at least $400 over the good faith estimate.","channels":[{"id":"complaint-form","type":"web_form","label":"Submit a No Surprises complaint","value":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint/get-started","purposes":["surprise_medical_bill"],"notes":"The form resets after 15 minutes of inactivity and the answers are deleted. Save the confirmation number.","source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"id":"complaint-update","type":"web_form","label":"Add documents to an existing complaint","value":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint/update","source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"id":"help-desk","type":"phone","label":"No Surprises Help Desk","value":"+1-800-985-3059","hours":"Phone support 7 days a week (hours not stated)","notes":"Help in English, Spanish and more than 350 other languages. Call with the confirmation number to check status.","source":"https://www.cms.gov/medical-bill-rights","last_verified":"2026-10-12"},{"id":"bill-dispute","type":"web_form","label":"Patient-provider bill dispute (uninsured or self-pay)","value":"https://nsa-idr.cms.gov/billdisputes/s/","purposes":["surprise_medical_bill"],"notes":"A $25 non-refundable fee applies. A mail or fax initiation form is at https://www.cms.gov/files/document/billing-dispute-initiation-form.pdf","source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"}],"facts":[{"kind":"process","claim":"The Help Desk reviews the complaint and documents, and may investigate compliance with federal law or refer the complaint to another federal or state authority. If it needs more information it contacts you within 60 days.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"kind":"process","claim":"Attach the medical bill, a photo of the insurance card, and any explanation of benefits. If you have them, add the good faith estimate, a signed notice and consent form, provider letters, appeal decisions and evidence of coverage.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"kind":"deadline","claim":"A patient-provider dispute needs an initial bill dated within the last 120 calendar days, from a provider or facility that charged at least $400 more than its good faith estimate, for care on or after January 1, 2022 that you did not use insurance to pay for.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"},{"kind":"fee","claim":"The patient-provider dispute has a $25 non-refundable administrative fee and does not start until it is paid. If you win, the $25 is deducted from what you owe the provider.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"},{"kind":"policy","claim":"The No Surprises Act protects you from unexpected out-of-network bills for emergency room visits, for non-emergency care at an in-network hospital, hospital outpatient department or ambulatory surgical center, and for air ambulance services.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights","last_verified":"2026-10-12"}],"notes":"The independent dispute resolution (IDR) process on cms.gov/nosurprises is a separate payment dispute process between providers and plans; it is not the patient complaint path. CMS lists no TTY or mailing address for the Help Desk."}}],"known_blockers":["Member services messages, claims summaries and grievance status need a kp.org login.","Member services numbers differ by region and plan (Medicare, Medi-Cal, choice products); the number on the member ID card takes precedence. Numbers for Colorado, Georgia, Hawaii and Mid-Atlantic were not confirmed for HMO members.","The complaint page and EOB give the region-specific appeal procedure."],"security":{"official_domains":["kaiserpermanente.org","kp.org"],"never_asks":[{"kind":"policy","claim":"Kaiser Permanente will never ask for your password over the phone or by email.","source":"https://healthy.kaiserpermanente.org/pages/online-security/protecting-personal-information","last_verified":"2026-10-12"}],"known_scams":[{"kind":"policy","claim":"Callers claim to be from Kaiser Permanente, say an account needs to be confirmed and ask for personal information. Kaiser Permanente advises contacting customer service directly to check.","source":"https://healthy.kaiserpermanente.org/pages/online-security/protecting-personal-information","last_verified":"2026-10-12"},{"kind":"policy","claim":"Offers of \"free\" medical treatment are usually scams, according to Kaiser Permanente Washington's fraud page.","source":"https://wa.kaiserpermanente.org/html/public/customer-service/fraud","last_verified":"2026-10-12"}],"report_phishing":[{"id":"fraud-hotline","type":"phone","label":"Kaiser Permanente confidential fraud hotline (listed on the Washington region fraud page)","value":"+1-888-774-9100","notes":"The page does not say which regions the hotline covers.","source":"https://wa.kaiserpermanente.org/html/public/customer-service/fraud","last_verified":"2026-10-12"}]},"credibility":{"grade":"A","primary_share":0.941,"sources":{"primary":32,"reference":1,"other":1},"verified_from":{"page":18},"last_verified":"2026-10-12","oldest_verified":"2026-10-12","stale_items":0,"explanation":"Grade A (high: almost everything comes from official pages read directly). 94% of 34 sources are the organization's own pages or government sites.","dossier_last_verified":"2026-10-12"},"context":{"dossier":true,"sector_guide":true,"hint":"Call get_context for how this company handles complaints in practice and which scams use its name."},"notes":"Kaiser Permanente (Oakland, California) comprises Kaiser Foundation Health Plan, Inc., Kaiser Foundation Hospitals and The Permanente Medical Groups, serving 12.9 million members in nine regions (Northern and Southern California, Hawaii, Colorado, Georgia, Mid-Atlantic States, Northwest, Washington and Nevada). Each region has its own health plan company. Risant Health and its affiliates are outside these figures. Medicare and Medicaid members have their own appeal rules.","warnings":[]},"billing_error":{"company":{"id":"kaiser-permanente","name":"Kaiser Permanente","sector":"insurance_health","website":"https://healthy.kaiserpermanente.org","account_url":null},"issue":{"id":"billing_error","name":"Billing error"},"playbook_source":"company","summary":"Compare the bill with the claims summary, message member services, then file a complaint.","evidence":["bill","claims or visit-cost summary","member ID card"],"steps":[{"do":"Compare the bill with the visit-cost and claims summary.","channel":{"id":"claim-summary","type":"portal","label":"Review visit-cost and claims summary","value":"https://healthy.kaiserpermanente.org/secure/coverage-costs/claims-summary#/","purposes":["claim_delay","claim_denial","billing_error"],"access":"login","source":"https://healthy.kaiserpermanente.org/support","last_verified":"2026-10-12"}},{"do":"Send a secure message to member services that names the charge and the amount you expected.","channel":{"id":"member-services-message","type":"portal","label":"Email member services (secure message)","value":"https://healthy.kaiserpermanente.org/secure/messages?compose=member-services","purposes":["claim_denial","claim_delay","billing_error","poor_service"],"access":"login","notes":"For non-urgent questions. Kaiser Permanente says it responds within 3 days.","source":"https://healthy.kaiserpermanente.org/support","last_verified":"2026-10-12"}},{"do":"If it is not fixed, submit a complaint.","channel":{"id":"complaint-form","type":"web_form","label":"Submit a complaint (file a grievance report)","value":"https://healthy.kaiserpermanente.org/support/submit-a-complaint","purposes":["claim_denial","poor_service","billing_error"],"notes":"Linked from the support center as \"File a grievance report\".","source":"https://healthy.kaiserpermanente.org/support","last_verified":"2026-10-12"}}],"channels":[{"id":"member-services-phone","type":"phone","label":"Member Services, California (Northern and Southern), English","value":"+1-800-464-4000","hours":"24 hours, 7 days; closed holidays","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill","poor_service"],"notes":"Listed as the English line on Northern and Southern California medical center member services pages. TTY 711.","source":"https://healthy.kaiserpermanente.org/northern-california/facilities/san-mateo-medical-offices-300395/departments/member-and-administrative-services-dlp-108917","last_verified":"2026-10-12"},{"id":"ca-senior-advantage-phone","type":"phone","label":"Member Services, Medicare Senior Advantage (Southern California)","value":"+1-800-443-0815","purposes":["claim_denial","claim_delay","billing_error"],"source":"https://healthy.kaiserpermanente.org/southern-california/support/member-services-locations","last_verified":"2026-10-12"},{"id":"ca-medi-cal-phone","type":"phone","label":"Member Services, Medi-Cal members (California)","value":"+1-855-839-7613","hours":"24 hours a day, 7 days a week","purposes":["claim_denial","billing_error"],"notes":"TTY 711.","source":"https://healthy.kaiserpermanente.org/southern-california/shop-plans/medicaid/new-members","last_verified":"2026-10-12"},{"id":"wa-member-services-phone","type":"phone","label":"Member Services, Washington","value":"+1-888-901-4636","purposes":["claim_denial","claim_delay","billing_error"],"notes":"Washington Medicare members call 1-888-901-4600.","source":"https://healthy.kaiserpermanente.org/washington/support/member-services","last_verified":"2026-10-12"},{"id":"nw-member-services-phone","type":"phone","label":"Membership Services, Northwest (Oregon and Southwest Washington), outside Portland","value":"+1-800-813-2000","purposes":["claim_denial","claim_delay","billing_error"],"notes":"Portland area 503-813-2000. TTY 711.","source":"https://healthy.kaiserpermanente.org/oregon-washington/facilities/Interstate-Medical-Office-Central-100269/departments/member-and-administrative-services-dlp-106149","last_verified":"2026-10-12"},{"id":"complaint-form","type":"web_form","label":"Submit a complaint (file a grievance report)","value":"https://healthy.kaiserpermanente.org/support/submit-a-complaint","purposes":["claim_denial","poor_service","billing_error"],"notes":"Linked from the support center as \"File a grievance report\".","source":"https://healthy.kaiserpermanente.org/support","last_verified":"2026-10-12"},{"id":"member-services-message","type":"portal","label":"Email member services (secure message)","value":"https://healthy.kaiserpermanente.org/secure/messages?compose=member-services","purposes":["claim_denial","claim_delay","billing_error","poor_service"],"access":"login","notes":"For non-urgent questions. Kaiser Permanente says it responds within 3 days.","source":"https://healthy.kaiserpermanente.org/support","last_verified":"2026-10-12"},{"id":"claim-summary","type":"portal","label":"Review visit-cost and claims summary","value":"https://healthy.kaiserpermanente.org/secure/coverage-costs/claims-summary#/","purposes":["claim_delay","claim_denial","billing_error"],"access":"login","source":"https://healthy.kaiserpermanente.org/support","last_verified":"2026-10-12"},{"id":"billing","type":"portal","label":"Pay premium and medical bills","value":"https://healthy.kaiserpermanente.org/secure/billing","purposes":["billing_error"],"access":"login","source":"https://healthy.kaiserpermanente.org/support","last_verified":"2026-10-12"},{"id":"advice-phone","type":"phone","label":"Call for advice (getting care; not a claims or billing line)","value":"+1-800-218-1059","notes":"TTY 711.","source":"https://healthy.kaiserpermanente.org/support","last_verified":"2026-10-12"}],"facts":[],"rules":{"in_force":[{"id":"no-surprises-act","title":"No Surprises Act (surprise billing protections and good faith estimates)","citation":"45 CFR part 149 (including 149.420 and 149.610)","jurisdiction":"us-federal","status":"in_effect","summary":"Protects patients from out-of-network surprise bills for emergency care, for non-emergency care by out-of-network providers at in-network hospitals and surgery centers, and for air ambulance services. People who are uninsured or not using insurance get a good faith estimate and can dispute a bill that is at least $400 over the estimate.","source":"https://www.cms.gov/initiatives/your-patient-rights/medical-bill-rights","last_verified":"2026-10-12","points_omitted":5,"points":[{"kind":"deadline","claim":"Uninsured or self-pay patients must get a written good faith estimate: not later than 1 business day after scheduling when care is scheduled at least 3 business days ahead; not later than 3 business days after scheduling when scheduled at least 10 business days ahead; and not later than 3 business days after a request.","issues":["surprise_medical_bill","billing_error"],"source":"https://www.law.cornell.edu/cfr/text/45/149.610","last_verified":"2026-10-12"},{"kind":"deadline","claim":"Patient-provider dispute resolution is available when the provider charged \"$400 or more\" than its good faith estimate, for care on or after January 1, 2022, with an initial bill dated within the last 120 calendar days. The patient pays a \"$25 non-refundable administrative fee\".","issues":["surprise_medical_bill","billing_error"],"source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"},{"kind":"policy","claim":"While a patient-provider dispute is in progress, the provider or facility may not move the bill to collections or threaten to, and must stop pursuing payment of a bill already in collections until the dispute is resolved.","issues":["surprise_medical_bill","billing_error"],"source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"}]},{"id":"rosca-negative-option","title":"Restore Online Shoppers' Confidence Act (ROSCA) negative option requirements","citation":"15 U.S.C. 8401-8405","jurisdiction":"us-federal","status":"in_effect","summary":"A seller that charges consumers online through a negative option feature (for example an automatic renewal or a free trial that converts to paid) must clearly disclose all material terms before taking billing information, get the consumer's express informed consent before charging, and provide simple mechanisms to stop recurring charges. The FTC enforces ROSCA.","source":"https://www.law.cornell.edu/uscode/text/15/8403","last_verified":"2026-10-12","points_omitted":4,"points":[{"kind":"policy","claim":"The seller must obtain \"a consumer's express informed consent before charging the consumer's credit card, debit card, bank account, or other financial account\".","issues":["unauthorized_charge","billing_error"],"source":"https://www.law.cornell.edu/uscode/text/15/8403","last_verified":"2026-10-12"}]}],"not_in_force":[]},"tips":[],"escalation":[{"index":0,"rung":"frontline","note":"Use the member services number on the back of the member ID card for your region, or send a secure message.","channel":{"id":"member-services-phone","type":"phone","label":"Member Services, California (Northern and Southern), English","value":"+1-800-464-4000","hours":"24 hours, 7 days; closed holidays","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill","poor_service"],"notes":"Listed as the English line on Northern and Southern California medical center member services pages. TTY 711.","source":"https://healthy.kaiserpermanente.org/northern-california/facilities/san-mateo-medical-offices-300395/departments/member-and-administrative-services-dlp-108917","last_verified":"2026-10-12"}},{"index":1,"rung":"written_complaint","note":"Grievance or appeal. Track it in the grievance case status page.","channel":{"id":"complaint-form","type":"web_form","label":"Submit a complaint (file a grievance report)","value":"https://healthy.kaiserpermanente.org/support/submit-a-complaint","purposes":["claim_denial","poor_service","billing_error"],"notes":"Linked from the support center as \"File a grievance report\".","source":"https://healthy.kaiserpermanente.org/support","last_verified":"2026-10-12"}},{"index":2,"rung":"state_agency","note":"External review for fully insured plans; complaint to the state. In California, HMO plans are regulated by the Department of Managed Health Care.","agency_kind":"insurance_department","agencies":"Ask for the person's state, then call find_regulators."},{"index":3,"rung":"regulator","note":"Employer self-funded (ERISA) plans.","regulator":{"id":"dol-ebsa","name":"U.S. Department of Labor, Employee Benefits Security Administration","level":"federal","when_to_use":"Use for a problem with a private-sector employer health or retirement plan (ERISA plan), such as a denied or delayed claim, after you follow the plan's own claim and appeal steps. Government and church plans are generally not covered.","channels":[{"id":"health-plan-form","type":"web_form","label":"Request help from a Benefits Advisor (health plan)","value":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=3","purposes":["claim_denial","claim_delay"],"notes":"Asks for name, ZIP, state, phone, email, the last four digits of the Social Security number, and an attestation that you are the person the information applies to. The account holder must confirm this personally.","source":"https://beta.dol.gov/about/agencies/ebsa/ask-ebsa","last_verified":"2026-10-12"},{"id":"retirement-plan-form","type":"web_form","label":"Request help from a Benefits Advisor (retirement plan)","value":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=4","source":"https://beta.dol.gov/about/agencies/ebsa/ask-ebsa","last_verified":"2026-10-12"},{"id":"phone","type":"phone","label":"EBSA Benefits Advisors","value":"+1-866-444-3272","source":"https://beta.dol.gov/about/agencies/ebsa/ask-ebsa","last_verified":"2026-10-12"}],"facts":[{"kind":"process","claim":"ERISA sets minimum standards for most voluntarily established retirement and health plans in private industry. In general it does not cover group health plans of government entities or church plans.","source":"https://www.dol.gov/general/topic/health-plans/erisa","last_verified":"2026-10-12"},{"kind":"process","claim":"For a complaint under Title I of ERISA, expect a status report from the assigned benefits advisor every 30 days.","source":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=3","last_verified":"2026-10-12"},{"kind":"process","claim":"EBSA can help you understand your rights, but you should still review the plan documents and meet the plan's claim and appeal deadlines.","issues":["claim_denial"],"source":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=3","last_verified":"2026-10-12"}],"notes":"On 2026-10-12, www.askebsa.dol.gov and the old Ask EBSA page redirected to https://beta.dol.gov/about/agencies/ebsa/ask-ebsa, which links to the WebIntake forms above. EBSA regional offices: https://www.dol.gov/agencies/ebsa/about-ebsa/about-us/regional-offices"}},{"index":4,"rung":"regulator","note":"Surprise bills under the No Surprises Act.","regulator":{"id":"cms-no-surprises","name":"CMS No Surprises Help Desk","level":"federal","when_to_use":"Use for an out-of-network surprise bill for emergency care, for care at an in-network hospital or surgery center, or for air ambulance. Uninsured or self-pay patients use the dispute process when a bill is at least $400 over the good faith estimate.","channels":[{"id":"complaint-form","type":"web_form","label":"Submit a No Surprises complaint","value":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint/get-started","purposes":["surprise_medical_bill"],"notes":"The form resets after 15 minutes of inactivity and the answers are deleted. Save the confirmation number.","source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"id":"complaint-update","type":"web_form","label":"Add documents to an existing complaint","value":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint/update","source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"id":"help-desk","type":"phone","label":"No Surprises Help Desk","value":"+1-800-985-3059","hours":"Phone support 7 days a week (hours not stated)","notes":"Help in English, Spanish and more than 350 other languages. Call with the confirmation number to check status.","source":"https://www.cms.gov/medical-bill-rights","last_verified":"2026-10-12"},{"id":"bill-dispute","type":"web_form","label":"Patient-provider bill dispute (uninsured or self-pay)","value":"https://nsa-idr.cms.gov/billdisputes/s/","purposes":["surprise_medical_bill"],"notes":"A $25 non-refundable fee applies. A mail or fax initiation form is at https://www.cms.gov/files/document/billing-dispute-initiation-form.pdf","source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"}],"facts":[{"kind":"process","claim":"The Help Desk reviews the complaint and documents, and may investigate compliance with federal law or refer the complaint to another federal or state authority. If it needs more information it contacts you within 60 days.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"kind":"process","claim":"Attach the medical bill, a photo of the insurance card, and any explanation of benefits. If you have them, add the good faith estimate, a signed notice and consent form, provider letters, appeal decisions and evidence of coverage.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"kind":"deadline","claim":"A patient-provider dispute needs an initial bill dated within the last 120 calendar days, from a provider or facility that charged at least $400 more than its good faith estimate, for care on or after January 1, 2022 that you did not use insurance to pay for.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"},{"kind":"fee","claim":"The patient-provider dispute has a $25 non-refundable administrative fee and does not start until it is paid. If you win, the $25 is deducted from what you owe the provider.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"},{"kind":"policy","claim":"The No Surprises Act protects you from unexpected out-of-network bills for emergency room visits, for non-emergency care at an in-network hospital, hospital outpatient department or ambulatory surgical center, and for air ambulance services.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights","last_verified":"2026-10-12"}],"notes":"The independent dispute resolution (IDR) process on cms.gov/nosurprises is a separate payment dispute process between providers and plans; it is not the patient complaint path. CMS lists no TTY or mailing address for the Help Desk."}}],"known_blockers":["Member services messages, claims summaries and grievance status need a kp.org login.","Member services numbers differ by region and plan (Medicare, Medi-Cal, choice products); the number on the member ID card takes precedence. Numbers for Colorado, Georgia, Hawaii and Mid-Atlantic were not confirmed for HMO members.","The complaint page and EOB give the region-specific appeal procedure."],"security":{"official_domains":["kaiserpermanente.org","kp.org"],"never_asks":[{"kind":"policy","claim":"Kaiser Permanente will never ask for your password over the phone or by email.","source":"https://healthy.kaiserpermanente.org/pages/online-security/protecting-personal-information","last_verified":"2026-10-12"}],"known_scams":[{"kind":"policy","claim":"Callers claim to be from Kaiser Permanente, say an account needs to be confirmed and ask for personal information. Kaiser Permanente advises contacting customer service directly to check.","source":"https://healthy.kaiserpermanente.org/pages/online-security/protecting-personal-information","last_verified":"2026-10-12"},{"kind":"policy","claim":"Offers of \"free\" medical treatment are usually scams, according to Kaiser Permanente Washington's fraud page.","source":"https://wa.kaiserpermanente.org/html/public/customer-service/fraud","last_verified":"2026-10-12"}],"report_phishing":[{"id":"fraud-hotline","type":"phone","label":"Kaiser Permanente confidential fraud hotline (listed on the Washington region fraud page)","value":"+1-888-774-9100","notes":"The page does not say which regions the hotline covers.","source":"https://wa.kaiserpermanente.org/html/public/customer-service/fraud","last_verified":"2026-10-12"}]},"credibility":{"grade":"A","primary_share":0.941,"sources":{"primary":32,"reference":1,"other":1},"verified_from":{"page":18},"last_verified":"2026-10-12","oldest_verified":"2026-10-12","stale_items":0,"explanation":"Grade A (high: almost everything comes from official pages read directly). 94% of 34 sources are the organization's own pages or government sites.","dossier_last_verified":"2026-10-12"},"context":{"dossier":true,"sector_guide":true,"hint":"Call get_context for how this company handles complaints in practice and which scams use its name."},"notes":"Kaiser Permanente (Oakland, California) comprises Kaiser Foundation Health Plan, Inc., Kaiser Foundation Hospitals and The Permanente Medical Groups, serving 12.9 million members in nine regions (Northern and Southern California, Hawaii, Colorado, Georgia, Mid-Atlantic States, Northwest, Washington and Nevada). Each region has its own health plan company. Risant Health and its affiliates are outside these figures. Medicare and Medicaid members have their own appeal rules.","warnings":[]},"surprise_medical_bill":{"company":{"id":"kaiser-permanente","name":"Kaiser Permanente","sector":"insurance_health","website":"https://healthy.kaiserpermanente.org","account_url":null},"issue":{"id":"surprise_medical_bill","name":"Surprise medical bill"},"playbook_source":"company","summary":"For out-of-network emergency care, submit the claim to Kaiser Permanente, compare the bill with the EOB, then contact the CMS help desk.","evidence":["the bill","EOB","member ID card","emergency visit records"],"steps":[{"do":"Submit the out-of-plan emergency claim to Kaiser Permanente for reimbursement (see claims help).","channel":{"id":"claims-help","type":"web_form","label":"Claims help (submitting claims and appeal rights)","value":"https://healthy.kaiserpermanente.org/support/claims-summary-help","purposes":["claim_denial","claim_delay"],"access":"open","source":"https://healthy.kaiserpermanente.org/support","last_verified":"2026-10-12"}},{"do":"Compare the provider bill with the EOB. Tell Kaiser Permanente and the provider that the bill may be a surprise bill.","channel":{"id":"member-services-message","type":"portal","label":"Email member services (secure message)","value":"https://healthy.kaiserpermanente.org/secure/messages?compose=member-services","purposes":["claim_denial","claim_delay","billing_error","poor_service"],"access":"login","notes":"For non-urgent questions. Kaiser Permanente says it responds within 3 days.","source":"https://healthy.kaiserpermanente.org/support","last_verified":"2026-10-12"}},{"do":"Contact the CMS No Surprises Help Desk.","regulator":{"id":"cms-no-surprises","name":"CMS No Surprises Help Desk","level":"federal","when_to_use":"Use for an out-of-network surprise bill for emergency care, for care at an in-network hospital or surgery center, or for air ambulance. Uninsured or self-pay patients use the dispute process when a bill is at least $400 over the good faith estimate.","channels":[{"id":"complaint-form","type":"web_form","label":"Submit a No Surprises complaint","value":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint/get-started","purposes":["surprise_medical_bill"],"notes":"The form resets after 15 minutes of inactivity and the answers are deleted. Save the confirmation number.","source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"id":"complaint-update","type":"web_form","label":"Add documents to an existing complaint","value":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint/update","source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"id":"help-desk","type":"phone","label":"No Surprises Help Desk","value":"+1-800-985-3059","hours":"Phone support 7 days a week (hours not stated)","notes":"Help in English, Spanish and more than 350 other languages. Call with the confirmation number to check status.","source":"https://www.cms.gov/medical-bill-rights","last_verified":"2026-10-12"},{"id":"bill-dispute","type":"web_form","label":"Patient-provider bill dispute (uninsured or self-pay)","value":"https://nsa-idr.cms.gov/billdisputes/s/","purposes":["surprise_medical_bill"],"notes":"A $25 non-refundable fee applies. A mail or fax initiation form is at https://www.cms.gov/files/document/billing-dispute-initiation-form.pdf","source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"}],"facts":[{"kind":"process","claim":"The Help Desk reviews the complaint and documents, and may investigate compliance with federal law or refer the complaint to another federal or state authority. If it needs more information it contacts you within 60 days.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"kind":"process","claim":"Attach the medical bill, a photo of the insurance card, and any explanation of benefits. If you have them, add the good faith estimate, a signed notice and consent form, provider letters, appeal decisions and evidence of coverage.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"kind":"deadline","claim":"A patient-provider dispute needs an initial bill dated within the last 120 calendar days, from a provider or facility that charged at least $400 more than its good faith estimate, for care on or after January 1, 2022 that you did not use insurance to pay for.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"},{"kind":"fee","claim":"The patient-provider dispute has a $25 non-refundable administrative fee and does not start until it is paid. If you win, the $25 is deducted from what you owe the provider.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"},{"kind":"policy","claim":"The No Surprises Act protects you from unexpected out-of-network bills for emergency room visits, for non-emergency care at an in-network hospital, hospital outpatient department or ambulatory surgical center, and for air ambulance services.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights","last_verified":"2026-10-12"}],"notes":"The independent dispute resolution (IDR) process on cms.gov/nosurprises is a separate payment dispute process between providers and plans; it is not the patient complaint path. CMS lists no TTY or mailing address for the Help Desk."}}],"channels":[{"id":"member-services-phone","type":"phone","label":"Member Services, California (Northern and Southern), English","value":"+1-800-464-4000","hours":"24 hours, 7 days; closed holidays","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill","poor_service"],"notes":"Listed as the English line on Northern and Southern California medical center member services pages. TTY 711.","source":"https://healthy.kaiserpermanente.org/northern-california/facilities/san-mateo-medical-offices-300395/departments/member-and-administrative-services-dlp-108917","last_verified":"2026-10-12"},{"id":"advice-phone","type":"phone","label":"Call for advice (getting care; not a claims or billing line)","value":"+1-800-218-1059","notes":"TTY 711.","source":"https://healthy.kaiserpermanente.org/support","last_verified":"2026-10-12"}],"facts":[],"rules":{"in_force":[{"id":"no-surprises-act","title":"No Surprises Act (surprise billing protections and good faith estimates)","citation":"45 CFR part 149 (including 149.420 and 149.610)","jurisdiction":"us-federal","status":"in_effect","summary":"Protects patients from out-of-network surprise bills for emergency care, for non-emergency care by out-of-network providers at in-network hospitals and surgery centers, and for air ambulance services. People who are uninsured or not using insurance get a good faith estimate and can dispute a bill that is at least $400 over the estimate.","source":"https://www.cms.gov/initiatives/your-patient-rights/medical-bill-rights","last_verified":"2026-10-12","points":[{"kind":"limit","claim":"For emergency services, \"you can't be charged any more for emergency medical services than the in-network 'cost-sharing' rate\". This covers the hospital, the providers who treat you there, and air ambulance providers.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/initiatives/your-patient-rights/medical-bill-rights/know-your-rights/insurance","last_verified":"2026-10-12"},{"kind":"policy","claim":"The protections cover non-emergency care related to a visit to an in-network hospital, hospital outpatient department or ambulatory surgical center, and air ambulance services. Ground ambulance services generally are not covered by the No Surprises Act billing protections.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/know-your-rights","last_verified":"2026-10-12"},{"kind":"policy","claim":"A patient gives up the protections for non-emergency care only by signing a notice-and-consent form. Providers of ancillary services cannot use that form: emergency medicine, anesthesiology, pathology, radiology and neonatology; assistant surgeons, hospitalists and intensivists; diagnostic services including radiology and laboratory; and any out-of-network provider when no in-network provider is available at the facility.","issues":["surprise_medical_bill"],"source":"https://www.law.cornell.edu/cfr/text/45/149.420","last_verified":"2026-10-12"},{"kind":"deadline","claim":"A notice-and-consent form for services scheduled at least 72 hours in advance must be given not later than 72 hours before the services. For services scheduled within 72 hours, it must be given on the day of scheduling, and no later than 3 hours before the services if given on the same day.","issues":["surprise_medical_bill"],"source":"https://www.law.cornell.edu/cfr/text/45/149.420","last_verified":"2026-10-12"},{"kind":"deadline","claim":"Uninsured or self-pay patients must get a written good faith estimate: not later than 1 business day after scheduling when care is scheduled at least 3 business days ahead; not later than 3 business days after scheduling when scheduled at least 10 business days ahead; and not later than 3 business days after a request.","issues":["surprise_medical_bill","billing_error"],"source":"https://www.law.cornell.edu/cfr/text/45/149.610","last_verified":"2026-10-12"},{"kind":"deadline","claim":"Patient-provider dispute resolution is available when the provider charged \"$400 or more\" than its good faith estimate, for care on or after January 1, 2022, with an initial bill dated within the last 120 calendar days. The patient pays a \"$25 non-refundable administrative fee\".","issues":["surprise_medical_bill","billing_error"],"source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"},{"kind":"policy","claim":"While a patient-provider dispute is in progress, the provider or facility may not move the bill to collections or threaten to, and must stop pursuing payment of a bill already in collections until the dispute is resolved.","issues":["surprise_medical_bill","billing_error"],"source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"},{"kind":"contact","claim":"No Surprises Help Desk: 1-800-985-3059, weekdays 8:00 am to 8:00 pm ET and weekends 10:00 am to 6:00 pm ET. Complaints can also be filed online through CMS.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help","last_verified":"2026-10-12"}]}],"not_in_force":[]},"tips":[],"escalation":[{"index":0,"rung":"frontline","note":"Use the member services number on the back of the member ID card for your region, or send a secure message.","channel":{"id":"member-services-phone","type":"phone","label":"Member Services, California (Northern and Southern), English","value":"+1-800-464-4000","hours":"24 hours, 7 days; closed holidays","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill","poor_service"],"notes":"Listed as the English line on Northern and Southern California medical center member services pages. TTY 711.","source":"https://healthy.kaiserpermanente.org/northern-california/facilities/san-mateo-medical-offices-300395/departments/member-and-administrative-services-dlp-108917","last_verified":"2026-10-12"}},{"index":1,"rung":"written_complaint","note":"Grievance or appeal. Track it in the grievance case status page.","channel":{"id":"complaint-form","type":"web_form","label":"Submit a complaint (file a grievance report)","value":"https://healthy.kaiserpermanente.org/support/submit-a-complaint","purposes":["claim_denial","poor_service","billing_error"],"notes":"Linked from the support center as \"File a grievance report\".","source":"https://healthy.kaiserpermanente.org/support","last_verified":"2026-10-12"}},{"index":2,"rung":"state_agency","note":"External review for fully insured plans; complaint to the state. In California, HMO plans are regulated by the Department of Managed Health Care.","agency_kind":"insurance_department","agencies":"Ask for the person's state, then call find_regulators."},{"index":3,"rung":"regulator","note":"Employer self-funded (ERISA) plans.","regulator":{"id":"dol-ebsa","name":"U.S. Department of Labor, Employee Benefits Security Administration","level":"federal","when_to_use":"Use for a problem with a private-sector employer health or retirement plan (ERISA plan), such as a denied or delayed claim, after you follow the plan's own claim and appeal steps. Government and church plans are generally not covered.","channels":[{"id":"health-plan-form","type":"web_form","label":"Request help from a Benefits Advisor (health plan)","value":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=3","purposes":["claim_denial","claim_delay"],"notes":"Asks for name, ZIP, state, phone, email, the last four digits of the Social Security number, and an attestation that you are the person the information applies to. The account holder must confirm this personally.","source":"https://beta.dol.gov/about/agencies/ebsa/ask-ebsa","last_verified":"2026-10-12"},{"id":"retirement-plan-form","type":"web_form","label":"Request help from a Benefits Advisor (retirement plan)","value":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=4","source":"https://beta.dol.gov/about/agencies/ebsa/ask-ebsa","last_verified":"2026-10-12"},{"id":"phone","type":"phone","label":"EBSA Benefits Advisors","value":"+1-866-444-3272","source":"https://beta.dol.gov/about/agencies/ebsa/ask-ebsa","last_verified":"2026-10-12"}],"facts":[{"kind":"process","claim":"ERISA sets minimum standards for most voluntarily established retirement and health plans in private industry. In general it does not cover group health plans of government entities or church plans.","source":"https://www.dol.gov/general/topic/health-plans/erisa","last_verified":"2026-10-12"},{"kind":"process","claim":"For a complaint under Title I of ERISA, expect a status report from the assigned benefits advisor every 30 days.","source":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=3","last_verified":"2026-10-12"},{"kind":"process","claim":"EBSA can help you understand your rights, but you should still review the plan documents and meet the plan's claim and appeal deadlines.","issues":["claim_denial"],"source":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=3","last_verified":"2026-10-12"}],"notes":"On 2026-10-12, www.askebsa.dol.gov and the old Ask EBSA page redirected to https://beta.dol.gov/about/agencies/ebsa/ask-ebsa, which links to the WebIntake forms above. EBSA regional offices: https://www.dol.gov/agencies/ebsa/about-ebsa/about-us/regional-offices"}},{"index":4,"rung":"regulator","note":"Surprise bills under the No Surprises Act.","regulator":{"id":"cms-no-surprises","name":"CMS No Surprises Help Desk","level":"federal","when_to_use":"Use for an out-of-network surprise bill for emergency care, for care at an in-network hospital or surgery center, or for air ambulance. Uninsured or self-pay patients use the dispute process when a bill is at least $400 over the good faith estimate.","channels":[{"id":"complaint-form","type":"web_form","label":"Submit a No Surprises complaint","value":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint/get-started","purposes":["surprise_medical_bill"],"notes":"The form resets after 15 minutes of inactivity and the answers are deleted. Save the confirmation number.","source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"id":"complaint-update","type":"web_form","label":"Add documents to an existing complaint","value":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint/update","source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"id":"help-desk","type":"phone","label":"No Surprises Help Desk","value":"+1-800-985-3059","hours":"Phone support 7 days a week (hours not stated)","notes":"Help in English, Spanish and more than 350 other languages. Call with the confirmation number to check status.","source":"https://www.cms.gov/medical-bill-rights","last_verified":"2026-10-12"},{"id":"bill-dispute","type":"web_form","label":"Patient-provider bill dispute (uninsured or self-pay)","value":"https://nsa-idr.cms.gov/billdisputes/s/","purposes":["surprise_medical_bill"],"notes":"A $25 non-refundable fee applies. A mail or fax initiation form is at https://www.cms.gov/files/document/billing-dispute-initiation-form.pdf","source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"}],"facts":[{"kind":"process","claim":"The Help Desk reviews the complaint and documents, and may investigate compliance with federal law or refer the complaint to another federal or state authority. If it needs more information it contacts you within 60 days.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"kind":"process","claim":"Attach the medical bill, a photo of the insurance card, and any explanation of benefits. If you have them, add the good faith estimate, a signed notice and consent form, provider letters, appeal decisions and evidence of coverage.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"kind":"deadline","claim":"A patient-provider dispute needs an initial bill dated within the last 120 calendar days, from a provider or facility that charged at least $400 more than its good faith estimate, for care on or after January 1, 2022 that you did not use insurance to pay for.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"},{"kind":"fee","claim":"The patient-provider dispute has a $25 non-refundable administrative fee and does not start until it is paid. If you win, the $25 is deducted from what you owe the provider.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"},{"kind":"policy","claim":"The No Surprises Act protects you from unexpected out-of-network bills for emergency room visits, for non-emergency care at an in-network hospital, hospital outpatient department or ambulatory surgical center, and for air ambulance services.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights","last_verified":"2026-10-12"}],"notes":"The independent dispute resolution (IDR) process on cms.gov/nosurprises is a separate payment dispute process between providers and plans; it is not the patient complaint path. CMS lists no TTY or mailing address for the Help Desk."}}],"known_blockers":["Member services messages, claims summaries and grievance status need a kp.org login.","Member services numbers differ by region and plan (Medicare, Medi-Cal, choice products); the number on the member ID card takes precedence. Numbers for Colorado, Georgia, Hawaii and Mid-Atlantic were not confirmed for HMO members.","The complaint page and EOB give the region-specific appeal procedure."],"security":{"official_domains":["kaiserpermanente.org","kp.org"],"never_asks":[{"kind":"policy","claim":"Kaiser Permanente will never ask for your password over the phone or by email.","source":"https://healthy.kaiserpermanente.org/pages/online-security/protecting-personal-information","last_verified":"2026-10-12"}],"known_scams":[{"kind":"policy","claim":"Callers claim to be from Kaiser Permanente, say an account needs to be confirmed and ask for personal information. Kaiser Permanente advises contacting customer service directly to check.","source":"https://healthy.kaiserpermanente.org/pages/online-security/protecting-personal-information","last_verified":"2026-10-12"},{"kind":"policy","claim":"Offers of \"free\" medical treatment are usually scams, according to Kaiser Permanente Washington's fraud page.","source":"https://wa.kaiserpermanente.org/html/public/customer-service/fraud","last_verified":"2026-10-12"}],"report_phishing":[{"id":"fraud-hotline","type":"phone","label":"Kaiser Permanente confidential fraud hotline (listed on the Washington region fraud page)","value":"+1-888-774-9100","notes":"The page does not say which regions the hotline covers.","source":"https://wa.kaiserpermanente.org/html/public/customer-service/fraud","last_verified":"2026-10-12"}]},"credibility":{"grade":"A","primary_share":0.941,"sources":{"primary":32,"reference":1,"other":1},"verified_from":{"page":18},"last_verified":"2026-10-12","oldest_verified":"2026-10-12","stale_items":0,"explanation":"Grade A (high: almost everything comes from official pages read directly). 94% of 34 sources are the organization's own pages or government sites.","dossier_last_verified":"2026-10-12"},"context":{"dossier":true,"sector_guide":true,"hint":"Call get_context for how this company handles complaints in practice and which scams use its name."},"notes":"Kaiser Permanente (Oakland, California) comprises Kaiser Foundation Health Plan, Inc., Kaiser Foundation Hospitals and The Permanente Medical Groups, serving 12.9 million members in nine regions (Northern and Southern California, Hawaii, Colorado, Georgia, Mid-Atlantic States, Northwest, Washington and Nevada). Each region has its own health plan company. Risant Health and its affiliates are outside these figures. Medicare and Medicaid members have their own appeal rules.","warnings":[]}},"escalation":[{"index":0,"rung":"frontline","note":"Use the member services number on the back of the member ID card for your region, or send a secure message.","channel":{"id":"member-services-phone","type":"phone","label":"Member Services, California (Northern and Southern), English","value":"+1-800-464-4000","hours":"24 hours, 7 days; closed holidays","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill","poor_service"],"notes":"Listed as the English line on Northern and Southern California medical center member services pages. TTY 711.","source":"https://healthy.kaiserpermanente.org/northern-california/facilities/san-mateo-medical-offices-300395/departments/member-and-administrative-services-dlp-108917","last_verified":"2026-10-12"}},{"index":1,"rung":"written_complaint","note":"Grievance or appeal. Track it in the grievance case status page.","channel":{"id":"complaint-form","type":"web_form","label":"Submit a complaint (file a grievance report)","value":"https://healthy.kaiserpermanente.org/support/submit-a-complaint","purposes":["claim_denial","poor_service","billing_error"],"notes":"Linked from the support center as \"File a grievance report\".","source":"https://healthy.kaiserpermanente.org/support","last_verified":"2026-10-12"}},{"index":2,"rung":"state_agency","note":"External review for fully insured plans; complaint to the state. In California, HMO plans are regulated by the Department of Managed Health Care.","agency_kind":"insurance_department","agencies":"Ask for the person's state, then call find_regulators."},{"index":3,"rung":"regulator","note":"Employer self-funded (ERISA) plans.","regulator":{"id":"dol-ebsa","name":"U.S. Department of Labor, Employee Benefits Security Administration","level":"federal","when_to_use":"Use for a problem with a private-sector employer health or retirement plan (ERISA plan), such as a denied or delayed claim, after you follow the plan's own claim and appeal steps. Government and church plans are generally not covered.","channels":[{"id":"health-plan-form","type":"web_form","label":"Request help from a Benefits Advisor (health plan)","value":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=3","purposes":["claim_denial","claim_delay"],"notes":"Asks for name, ZIP, state, phone, email, the last four digits of the Social Security number, and an attestation that you are the person the information applies to. The account holder must confirm this personally.","source":"https://beta.dol.gov/about/agencies/ebsa/ask-ebsa","last_verified":"2026-10-12"},{"id":"retirement-plan-form","type":"web_form","label":"Request help from a Benefits Advisor (retirement plan)","value":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=4","source":"https://beta.dol.gov/about/agencies/ebsa/ask-ebsa","last_verified":"2026-10-12"},{"id":"phone","type":"phone","label":"EBSA Benefits Advisors","value":"+1-866-444-3272","source":"https://beta.dol.gov/about/agencies/ebsa/ask-ebsa","last_verified":"2026-10-12"}],"facts":[{"kind":"process","claim":"ERISA sets minimum standards for most voluntarily established retirement and health plans in private industry. In general it does not cover group health plans of government entities or church plans.","source":"https://www.dol.gov/general/topic/health-plans/erisa","last_verified":"2026-10-12"},{"kind":"process","claim":"For a complaint under Title I of ERISA, expect a status report from the assigned benefits advisor every 30 days.","source":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=3","last_verified":"2026-10-12"},{"kind":"process","claim":"EBSA can help you understand your rights, but you should still review the plan documents and meet the plan's claim and appeal deadlines.","issues":["claim_denial"],"source":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=3","last_verified":"2026-10-12"}],"notes":"On 2026-10-12, www.askebsa.dol.gov and the old Ask EBSA page redirected to https://beta.dol.gov/about/agencies/ebsa/ask-ebsa, which links to the WebIntake forms above. EBSA regional offices: https://www.dol.gov/agencies/ebsa/about-ebsa/about-us/regional-offices"}},{"index":4,"rung":"regulator","note":"Surprise bills under the No Surprises Act.","regulator":{"id":"cms-no-surprises","name":"CMS No Surprises Help Desk","level":"federal","when_to_use":"Use for an out-of-network surprise bill for emergency care, for care at an in-network hospital or surgery center, or for air ambulance. Uninsured or self-pay patients use the dispute process when a bill is at least $400 over the good faith estimate.","channels":[{"id":"complaint-form","type":"web_form","label":"Submit a No Surprises complaint","value":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint/get-started","purposes":["surprise_medical_bill"],"notes":"The form resets after 15 minutes of inactivity and the answers are deleted. Save the confirmation number.","source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"id":"complaint-update","type":"web_form","label":"Add documents to an existing complaint","value":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint/update","source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"id":"help-desk","type":"phone","label":"No Surprises Help Desk","value":"+1-800-985-3059","hours":"Phone support 7 days a week (hours not stated)","notes":"Help in English, Spanish and more than 350 other languages. Call with the confirmation number to check status.","source":"https://www.cms.gov/medical-bill-rights","last_verified":"2026-10-12"},{"id":"bill-dispute","type":"web_form","label":"Patient-provider bill dispute (uninsured or self-pay)","value":"https://nsa-idr.cms.gov/billdisputes/s/","purposes":["surprise_medical_bill"],"notes":"A $25 non-refundable fee applies. A mail or fax initiation form is at https://www.cms.gov/files/document/billing-dispute-initiation-form.pdf","source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"}],"facts":[{"kind":"process","claim":"The Help Desk reviews the complaint and documents, and may investigate compliance with federal law or refer the complaint to another federal or state authority. If it needs more information it contacts you within 60 days.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"kind":"process","claim":"Attach the medical bill, a photo of the insurance card, and any explanation of benefits. If you have them, add the good faith estimate, a signed notice and consent form, provider letters, appeal decisions and evidence of coverage.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"kind":"deadline","claim":"A patient-provider dispute needs an initial bill dated within the last 120 calendar days, from a provider or facility that charged at least $400 more than its good faith estimate, for care on or after January 1, 2022 that you did not use insurance to pay for.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"},{"kind":"fee","claim":"The patient-provider dispute has a $25 non-refundable administrative fee and does not start until it is paid. If you win, the $25 is deducted from what you owe the provider.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"},{"kind":"policy","claim":"The No Surprises Act protects you from unexpected out-of-network bills for emergency room visits, for non-emergency care at an in-network hospital, hospital outpatient department or ambulatory surgical center, and for air ambulance services.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights","last_verified":"2026-10-12"}],"notes":"The independent dispute resolution (IDR) process on cms.gov/nosurprises is a separate payment dispute process between providers and plans; it is not the patient complaint path. CMS lists no TTY or mailing address for the Help Desk."}}],"security":{"official_domains":["kaiserpermanente.org","kp.org"],"never_asks":[{"kind":"policy","claim":"Kaiser Permanente will never ask for your password over the phone or by email.","source":"https://healthy.kaiserpermanente.org/pages/online-security/protecting-personal-information","last_verified":"2026-10-12"}],"known_scams":[{"kind":"policy","claim":"Callers claim to be from Kaiser Permanente, say an account needs to be confirmed and ask for personal information. Kaiser Permanente advises contacting customer service directly to check.","source":"https://healthy.kaiserpermanente.org/pages/online-security/protecting-personal-information","last_verified":"2026-10-12"},{"kind":"policy","claim":"Offers of \"free\" medical treatment are usually scams, according to Kaiser Permanente Washington's fraud page.","source":"https://wa.kaiserpermanente.org/html/public/customer-service/fraud","last_verified":"2026-10-12"}],"report_phishing":[{"id":"fraud-hotline","type":"phone","label":"Kaiser Permanente confidential fraud hotline (listed on the Washington region fraud page)","value":"+1-888-774-9100","notes":"The page does not say which regions the hotline covers.","source":"https://wa.kaiserpermanente.org/html/public/customer-service/fraud","last_verified":"2026-10-12"}]},"credibility":{"grade":"A","primary_share":0.941,"sources":{"primary":32,"reference":1,"other":1},"verified_from":{"page":18},"last_verified":"2026-10-12","oldest_verified":"2026-10-12","stale_items":0,"explanation":"Grade A (high: almost everything comes from official pages read directly). 94% of 34 sources are the organization's own pages or government sites.","dossier_last_verified":"2026-10-12"},"dossier":{"title":"Kaiser Permanente — how complaints actually go","last_verified":"2026-10-12","file":"dossiers/kaiser-permanente.md","markdown":"## In short\n\nKaiser 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.\n\n## How complaints actually go\n\n- 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](https://healthy.kaiserpermanente.org/support/claims-summary-help)\n- 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](https://healthy.kaiserpermanente.org/content/dam/kporg/final/documents/community-providers/ncal/2023/member-rights-and-responsibilities-en-2023.pdf)\n- 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](https://healthy.kaiserpermanente.org/content/dam/kporg/final/documents/community-providers/ncal/2023/member-rights-and-responsibilities-en-2023.pdf)\n- 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](https://www.healthcare.gov/appeal-insurance-company-decision/internal-appeals/) [HealthCare.gov: external review](https://www.healthcare.gov/appeal-insurance-company-decision/external-review/)\n\n## What tends to work\n\n- 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](https://healthy.kaiserpermanente.org/content/dam/kporg/final/documents/community-providers/ncal/2023/member-rights-and-responsibilities-en-2023.pdf)\n- 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](https://calmatters.org/health/2023/10/kaiser-permanente-california-behavioral-health-settlement/)\n- Appeal Medicare Advantage prior authorization denials: in 2025 data, Kaiser Permanente overturned 40 percent of appealed denials in Medicare Advantage. [KFF, August 2026](https://www.kff.org/patient-consumer-protections/prior-authorization-metrics-provide-new-insights-into-insurer-practices-but-gaps-remain/)\n\n## Traps and fine print\n\n- 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](https://healthy.kaiserpermanente.org/content/dam/kporg/final/documents/community-providers/ncal/2023/member-rights-and-responsibilities-en-2023.pdf) [Kaiser Permanente claims help](https://healthy.kaiserpermanente.org/support/claims-summary-help)\n- IMR is for medical-necessity, experimental-treatment and emergency-payment denials; other complaints stay in the grievance process. [Kaiser Permanente provider manual, 2023](https://healthy.kaiserpermanente.org/content/dam/kporg/final/documents/community-providers/ncal/2023/member-rights-and-responsibilities-en-2023.pdf)\n\n## By the numbers\n\n- 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](https://www.gov.ca.gov/2023/10/12/governor-newsom-statement-on-kaiser-mental-health-settlement/)\n- 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](https://oig.hhs.gov/documents/audit/11694/OEI-09-24-00331.pdf)\n\n## Scams that target customers\n\n- 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](https://healthy.kaiserpermanente.org/pages/online-security/protecting-personal-information)\n- 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](https://wa.kaiserpermanente.org/html/public/customer-service/fraud)\n- \"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](https://oig.hhs.gov/fraud/consumer-alerts/fraud-alert-genetic-testing-scam/)\n"},"guide":{"key":"insurance_health","title":"Health insurance — how complaints work","last_verified":"2026-10-12","file":"guides/insurance_health.md","page":"https://escalate.alexgaoth.com/#/guides/insurance_health"}}