Kaiser, Don't Deny

Internal Complaints with Kaiser Permanente

All health plans are required to have an internal process for health plan members to file complaints and receive a response within 30 days. Call Kaiser’s “Member Services Department” at 1-800-464-4000 to file a complaint. You can also contact Member Services and file a complaint though your member account on kaiserpermanente.org or by visiting healthy.kaiserpermanente.org/support (follow the steps to select your region and then scroll down to the bottom to click on “File a complaint”).

External Complaints

In addition to filing a complaint with Kaiser Member Services, you should simultaneously file a complaint with the healthcare consumer protection agency that oversees your type of health plan:

• HMO Members (and some PPO members): Contact the California Department of Managed Health Care (DMHC) by phone at 1-888-466-2219 or visit the department’s website to file a complaint.
• Medi-Cal Managed Care Members: see #1 above for instructions for filing a complaint with the DMHC.

• PPO or High Deductible Plan Members: Contact the California Department of Insurance by visiting its website or calling 1-800-927-4357.
• Medicare Beneficiaries: Call the Health Insurance Counseling & Advocacy Program (HICAP) which is run through the California Department on Aging at 1-800-434-0222. Also see cahealthadvocates.org/hicap/. You can also contact the Medicare Rights Center National Helpline online at www.medicarerights.org/programs/national-helpline or call 1-800-333-4114
• CalPERS Members: In addition to filing a complaint with Kaiser member services and either the DMHC or Medicare, CalPERS members can immediately file a complaint with CalPERs. (You do not have to wait until the conclusion of the internal complaint process with Kaiser member services.)

Contact CalPERS

By email:

• • Health.Appeals@calpers.ca.gov

By mail:

• • CalPERS Health Benefit Compliance and Appeals Unit
    Attn: Health Appeals Coordinator
    P.O. Box 1953 Sacramento, CA 95812-1953