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KAISER ATTEMPTED TO DISENROLL LINDA HOBBS,  A SENIOR CITIIZEN, MEDICARE PATIENT WITHOUT CAUSE

Linda Hobbs, a Kaiser Senior Advantage patient pays her insurance four months in advance.  She lives in the town of San Pedro which is at the beach, just outside the City of Los Angeles.  It is 23 miles from the Civic Center in Los Angeles and about the same distance from Kaiser's main facility on Sunset to her home.  It is another 5 or 10 miles to the Kaiser Pasadena Offices.

Eight miles from her home, Ms. Hobbs opened a P.O. Box in Long Beach, California.  In Southern California that is not unusual for a variety of very normal reasons.  Kaiser though felt that was enough to terminate her Senior Advantage, prepaid for four months medical coverage.  

Ms. Tn White, Kaiser Supervisor, mailed to Ms. Hobbs (3) letters threatening her with termination of benefits because Kaiser believed "she had moved 400 miles away to Northern California and had moved "outside their Southern California Service area because the US Post Office informed them she had a US Post Office box in Long Beach, CA (8 miles from her home).   During this time, Ms. Hobbs visited Kaiser monthly near her home in San Pedro, CA which is part of the Southern California Service area.

This is not the first time that we at the Kaiser Papers have heard of this happening to patients.  One man placed his mail box across the street in the Victorville area and that was enough for them to try to terminate his coverage.  He had survived polio and was crippled, needing their services and they cut him off cold.  Medicare also helped this patient restore his medical coverage.

This appears to be a creative  method  to get rid of Senior Advantage  patients who just may be using the medical services more than Kaiser and the Permanente would like.  Using methods such as this, certainly appear to be a way for Kaiser to later claim that denial of medical care, which could result in medical complications or death are nothing more than clerical errors, which they are not.  Shame on Kaiser and shame on the Permanente for allowing this to happen.

Because this problem continued for a long time, continued after being formally addressed within the Kaiser system and appropriate and correct change was apparently resisted after Medicare made a ruling, it is highly doubtful that any normal clerical error took place or that an untrained, inexperienced and/or poorly supervised employee was handling this matter.  It does appear to be an intentional action taken by Kaiser against a Medicare patient.

On December 5, 2015, Medicare had advised Kaiser that Ms Hobbs could not be disenrolled due to her opening a post office box.

Ms. Hobbs  asked Medicare if they would be sending  a letter to her advising their decision. Medicare stated that Kaiser would send the letter.  On December 17, Ms. Hobbs sent Ms. Richards an email requesting a copy of a letter stating that her benefits would not be rescinded.   Ms. Richards referred Ms. Hobbs to Ms. Martha Gallegos, Operational Director, Kaiser Member Services, Harbor City, CA which is  3 miles from Ms. Hobbs home.  Today, Ms. Hobbs asked Ms. Gallegos for that same letter.  Her email response was that the California Service Center, San Diego, is not able to verify if she is enrolled in the Kaiser Senior Advantage Plan.    Ms. Hobbs then spoke with another supervisor at Medicare.  She advised her to send Ms. Richards, Ms. Karina Montenegro and Ms. Gallegos another email.

In summary, when Tn White, Supervisor, Kaiser Customer Service, threatened Ms. Hobbs with termination of her medical benefits,  she sent a fax to CEO Tyson in October, 2015 from Ms. Martha Gallegos' Kaiser Member Services Office.  By sending the fax via Kaiser Member Services, she has a record that the CEO received her fax.   She has a copy. 
 
Because she had been threatened with termination of her medical benefits over the phone by Ms. Tn White, Supervisor, Kaiser Customer Service,  Ms. Hobbs insisted that all Kaiser communication occur by email.  Ms. Richards did not support that idea.  Kaiser advised Ms. Hobbs via email that they do not use emails for their investigation of Ms. Tn White's action.  Kaiser advised Ms. Hobbs that she needed to discuss the matter over the phone.  If that had happened, Ms. Hobbs would have no record of the discussion.
 
Ms. Hobbs called Medicare.   On October, 2015, via fax,  Ms. Hobbs had provided a written statement to CEO Tyson.  Ms. Gallegos' staff faxed the documentation to Ms. Hobbs and provided a written record that CEO Tyson received notice that Ms. Tn White was attempting to terminate her medical benefits.   Furthermore, Medicare advised that MS. HOBBS DID NOT have to engage in verbal discussions with Kaiser about the termination of her benefits.  Ms. Hobbs wanted to minimize Kaiser's opportunity to change the facts to protect their actions.
 
Two months later, after Medicare made a decision, Ms. Hobbs emailed Ms. Richards on December 17, 2015.   She referred it to Ms. Gallegos.   Ms. Gallegos' staff had let Ms. Hobbs know in October, 2015 that they felt she was in the wrong and Kaiser was legally disenrolling her.   So, when Ms. Richards referred Ms. Hobbs to Ms. Gallegos, Ms. Hobbs contacted Karina Montenegro.  Ms. Montenegro wanted Ms. Hobbs to contact Ms. Gallegos. But, she did not have Ms. Gallegos' email address.    So, Ms. Montenegro contacted Ms. Richards and Ms. Hobbs then received an email from Ms. Gallegos requesting that Ms. Hobbs call her.  Once Ms. Hobbs had Ms. Gallegos' email address, she sent Ms. Gallegos the "first letter."

Ms. Hobbs has requested that I place on this site coorespondence between her and these three Kaiser employees Martha.R.Gallegos, April Richards and Karina Montenegro.  This series of e-mails begin at 4:34 PM, December 17, 2015 and conclude at 3:54 PM on December 22, 2015.  

Here are the letters:


From: Linda Hobbs <XXXXXXX@aol.com>
To: April.L.Richards <April.L.Richards@kp.org>
Sent: Thu, Dec 17, 2015 4:34 pm
Subject: Linda Hobbs, Kaiser # XXXXXXXX/Medicare

Dear Ms. Richards:

I hope your holidays are going well.

1. I have been in communication with the local US Post Office Management. Since I opened the post office box, my mail has been improperly returned or misdirected.

2. I spoke with a supervisor from Medicare. She advised me that the "termination of benefits" letter from Kaiser has been rescinded.

3. Because of the postal problem, would you please fax the following Kaiser letters to Martha Gallegos, Manager, Kaiser South Bay:

A) Kaiser's letter indicating my medical benefits will continue as defined in September, 2015;

B) Any notices about changes in medical premiums or services which ALL Kaiser Medicare members would/should receive;

C) Copies of all 3 letters Kaiser mailed to my home address advising my medical benefits would be terminated.

Please ask Ms. Gallegos or her staff to email me at XXXXXXX@aol.com when all the above correspondence has arrived in their office. When I receive the email, I will pick up the correspondence.

I am in hopes all correspondence, particularly the letter indicating my medical benefits will not be terminated, will arrive in Ms. Gallegos' office by Tuesday, December 22, 2015.

Thank you for your assistance.

Linda Hobbs

From:        Linda Hobbs <XXXXXXX@aol.com>
To:        April L Richards/CA/KAIPERM@KAIPERM
Date:        12/19/2015 10:54 AM
Subject:        Did you receive my email on Friday Dec. 18?

From: April.L.Richards <April.L.Richards@kp.org>
To: XXXXXXX<XXXXXXX@aol.com>
Sent: Mon, Dec 21, 2015 8:52 am
Subject: Re: Did you receive my email on Friday Dec. 18?

Good Morning Mrs. Hobbs,
Yes, I received your email and forwarded it to Martha Gallegos for her response to you.
Thank you,
---------
April Richards
Customer Service Executive Liaison
Kaiser Permanente
Kaiser Foundation Health Plan Southern California
951-403-9302 (office)
951-279-4863 (fax)
---------
kp.org/thrive

From: . <XXXXXXX@aol.com>
To: Karina.N.Montenegro <Karina.N.Montenegro@kp.org>
Sent: Tue, Dec 22, 2015 10:03 am
Subject: Fwd: Linda Hobbs, Kaiser # XXXXXXXX/Medicare

Dear Ms. Montenegro:   Thanks for your assistance.  Have a lovely holiday season.   Linda Hobbs


From: Martha.R.Gallegos <Martha.R.Gallegos@kp.org>
To: XXXXXXX@aol.com>
Sent: Tue, Dec 22, 2015 12:01 pm
Subject: Linda Hobbs-Medicare information

Hello Ms. Hobbs,

Can you please contact me at 424) 251-7738, regarding your request for notices about changes in medical premiums or services which ALL Kaiser Medicare members would/should receive.  I will be in the office today, until 3:00 and on  12/23 & 12/24 from 9:00  to 4:30 p.m.

Thank you,
--------
Martha Gallegos
Operations Director
Kaiser Permanente
HPPSA-Member Service & Performance Improvement
25975 South Normandie Avenue
Harbor City, CA 90710
(424) 251-7738 (office)
8-341-7738 (tie-line)
(424) 251-7747 (fax)
---------
kp.org/thrive

NOTICE TO RECIPIENT:  If you are not the intended recipient of this e-mail, you are prohibited from sharing, copying, or otherwise using or disclosing its contents.  If you have received this e-mail in error, please notify the sender immediately by reply e-mail and permanently delete this e-mail and any attachments without reading, forwarding or saving them.  Thank you.


To: Martha.R.Gallegos <Martha.R.Gallegos@kp.org>; april.l.richards <april.l.richards@kp.org>; karina.n.montenegro <karina.n.montenegro@kp.org>
Sent: Tue, Dec 22, 2015 1:33 pm
Subject: Re: Linda Hobbs, # XXXXXXXX -Seeking Letter or Email Indicating My Kaiser/Medicare Benefits Will Not be Terminated

Dear Ms. Gallegos:
.
I hope your are having a great holiday season.  As you may not know, unfortunately, the US Post Office has had several problems with my mail delivery service.  Therefore, I am not certain if all Kaiser's letters have been sent to me.  Ms. April Richards and I have exchanged several emails.   Therefore, I was hoping she could obtain the letters and have then forwarded to your office.  As your office is near my home, pick up would be easy for me.  For clarification, I will attempt to summarize my request again.
 
1.  As CEO Tyson and Ms. Richards are aware,  Ms. Tn White, Kaiser supervisor, sent me (3) letters advising that Kaiser was planning to terminate my medical benefits because Kaiser felt I had moved outside the Kaiser Southern California Service Area.
 
2.  I filed a complaint with Medicare, my representative in Congress and asked CEO Tyson to estop termination of my benefits until Medicare had investigated and made a decision.
 
3.  Medicare advised me that on December 5, 2015, Medicare and Kaiser reached an agreement that my medical benefits would not be terminated.  Medicare advised that a letter would be sent to me from Kaiser, not Medicare, stating that my medical benefits would continue as they existed in September, 2015 prior to Ms. Tn White's letters advising that my medical benefits would be terminated.
 
4. To my knowledge, only CEO Tyson, Ms. April Richards or the Director of Kaiser's Medicare Department would know a) if Kaiser has prepared such a letter and b) if prepared, the date it was mailed to my home address which is XXX South Miraleste, Unit XXX, San Pedro, CA  90732.  That is the reason that I made a request of the letter from Ms. April Richards.
 
5.    I have no idea which employee in the Kaiser system has the authority to write such a letter.   If no such letter has been prepared, I am asking Ms. Richards and Ms. Montenegro to ask CEO Tyson to designate the appropriate employee to prepare the letter as soon as possible. 
 
6.  Ms. Gallegos, are you aware of such a letter?   Do you have a copy in your office?   Can you print a copy and advise me by email at XXXXXXX@aol.com that the letter is ready for pick-up?
 
7.  Ms. Gallegos, your staff did have a copy of one of Ms. Tn White's letter advising that my medical benefits would be terminated.  Would you please ask either Ms. White or her supervisor to forward to your office a copy of ALL THREE LETTERS MS. WHITE SENT TO ME ADVISING THAT MY MEDICAL BENEFITS WOULD BE TERMINATED INCLUDING THE FORM LETTER?   I am certain Ms. White or her supervisor have a record of all the letters they sent to me.
 
8.   There is no rush for Ms. Tn White's letters.  Two weeks is sufficient time for me to pick those up.  When you have them, please email me and I will pick them up.
 
9.  Regarding the possible "premium increase notices" which would have been sent to ALL KAISER members, as I mentioned to Ms. Richards, I have been experiencing mail delivery problems.  Kaiser may or may not have sent members announcements about CHANGES IN KAISER MEDICARE PLAN FOR 2016.  If Kaiser did send any notices about Medicare changes to all Kaiser members,  I would like to have that information as soon as possible.
 
Ms. Gallegos, I hope this email provides answers you needed.  If you have any additional questions, please submit them via email.   I look forward to receiving the Kaiser letter, which rescinds Ms. White's threat to terminate my medical benefits, by tomorrow at 5 p.m.    Ms. Gallegos, if that is not possible, would you please email as soon as possible and advise when that letter will be available for pick-up. 
 
Thanks for your assistance.
 
Sincerely,
 
Linda Hobbs, Kaiser Member #  XXXXXXXX


From: Martha.R.Gallegos <Martha.R.Gallegos@kp.org>
To: XXXXXXX@aol.com>
Cc: April.L.Richards <April.L.Richards@kp.org>; Karina.N.Montenegro <Karina.N.Montenegro@kp.org>
Sent: Tue, Dec 22, 2015 2:37 pm
Subject: Re: Linda Hobbs, # XXXXXXXX -Seeking Letter or Email Indicating My Kaiser/Medicare Benefits Will Not be Terminated

Hello Ms, Hobbs,

Hope all is well.  I have 1 letter confirming your Kaiser Permanente Senior Advantage Plan is currently active, based on the information provided.  The letter is dated November 24, 2015:

In addition, I have a copy of the Evidence of Coverage and Annual Notice of Changes for 2016.

Please let me know when you would like to pick up the documents.  I will be in the office all day on Wednesday, December 23 and Thursday, December 24.
--------
Martha Gallegos
Operations Director
Kaiser Permanente
HPPSA-Member Service & Performance Improvement
25975 South Normandie Avenue
Harbor City, CA 90710
(424) 251-7738 (office)
8-341-7738 (tie-line)
(424) 251-7747 (fax)
---------
kp.org/thrive

NOTICE TO RECIPIENT:  If you are not the intended recipient of this e-mail, you are prohibited from sharing, copying, or otherwise using or disclosing its contents.  If you have received this e-mail in error, please notify the sender immediately by reply e-mail and permanently delete this e-mail and any attachments without reading, forwarding or saving them.  Thank you.

From: Martha.R.Gallegos <Martha.R.Gallegos@kp.org>
To: XXXXXXX@aol.com>
Cc: April.L.Richards <April.L.Richards@kp.org>; Karina.N.Montenegro <Karina.N.Montenegro@kp.org>
Sent: Tue, Dec 22, 2015 2:37 pm
Subject: Re: Linda Hobbs, # XXXXXXXX -Seeking Letter or Email Indicating My Kaiser/Medicare Benefits Will Not be Terminated

Hello Ms, Hobbs,

Hope all is well.  I have 1 letter confirming your Kaiser Permanente Senior Advantage Plan is currently active, based on the information provided.  The letter is dated November 24, 2015:

In addition, I have a copy of the Evidence of Coverage and Annual Notice of Changes for 2016.

Please let me know when you would like to pick up the documents.  I will be in the office all day on Wednesday, December 23 and Thursday, December 24.
--------
Martha Gallegos
Operations Director
Kaiser Permanente
HPPSA-Member Service & Performance Improvement
25975 South Normandie Avenue
Harbor City, CA 90710
(424) 251-7738 (office)
8-341-7738 (tie-line)
(424) 251-7747 (fax)
---------
kp.org/thrive

NOTICE TO RECIPIENT:  If you are not the intended recipient of this e-mail, you are prohibited from sharing, copying, or otherwise using or disclosing its contents.  If you have received this e-mail in error, please notify the sender immediately by reply e-mail and permanently delete this e-mail and any attachments without reading, forwarding or saving them.  Thank you.





From:        "." <XXXXXXX@aol.com>
To:        Martha R Gallegos/CA/KAIPERM@KAIPERM, April L Richards/CA/KAIPERM@KAIPERM, Karina N Montenegro/CA/KAIPERM@KAIPERM
Date:        12/22/2015 02:50 PM
Subject:        Re: Linda Hobbs, # XXXXXXXX -Seeking Letter or Email Indicating My Kaiser/Medicare Benefits Will Not be Terminated



Dear Ms. Gallegos:
 
Thanks for such a quick response.
 
1.   Does the letter mention that the Tn White termination letters?  Does it mention "after discussion with Medicare", Kaiser has decided not to terminate Linda Hobbs Kaiser/Medicare benefits?
 
2.  What is the name and title of the person who signed the letter?
 
Thanks.


From: Martha.R.Gallegos <Martha.R.Gallegos@kp.org>
To: XXXXXXX@aol.com>
Cc: April.L.Richards <April.L.Richards@kp.org>; Karina.N.Montenegro <Karina.N.Montenegro@kp.org>
Sent: Tue, Dec 22, 2015 2:58 pm
Subject: Re: Linda Hobbs, # XXXXXXXX -Seeking Letter or Email Indicating My Kaiser/Medicare Benefits Will Not be Terminated

The letter is from the California Service Center, San Diego.  It states: The results of our investigation are as follows: 
        Based on the information provided to Kaiser Permanente, as well as other information on file, we were able to confirm that you are currently enrolled on the Kaiser Permanente Senior Advantage (HMO) Plan.
--------
Martha Gallegos
Operations Director
Kaiser Permanente
HPPSA-Member Service & Performance Improvement
25975 South Normandie Avenue
Harbor City, CA 90710
(424) 251-7738 (office)
8-341-7738 (tie-line)
(424) 251-7747 (fax)
---------
kp.org/thrive

NOTICE TO RECIPIENT:  If you are not the intended recipient of this e-mail, you are prohibited from sharing, copying, or otherwise using or disclosing its contents.  If you have received this e-mail in error, please notify the sender immediately by reply e-mail and permanently delete this e-mail and any attachments without reading, forwarding or saving them.  Thank you.


To: karina.n.montenegro <karina.n.montenegro@kp.org>; april.l.richards <april.l.richards@kp.org>; martha.r.gallegos <martha.r.gallegos@kp.org>
Sent: Tue, Dec 22, 2015 3:54 pm
Subject: Fwd: Linda Hobbs, # XXXXXXXX -Seeking Letter or Email Indicating My Kaiser/Medicare Benefits Will Not be Terminated

Dear Ms. Montenegro and Ms. Richards:
 
Would you please refer this matter to CEO Tyson for response.  The letter provided by Ms. Gallegos does NOT confirm my medical benefits with Kaiser.   I will graciously accept an email or letter with a Kaiser employee's name and title confirming or denying the following questions.  I need the letter for my Congresswoman and Medicare.  Please have Ms. Gallegos' email me at XXXXXXX@aol.com  when the email or letter has arrived in her office.
 
According to the email sent to me by Martha Gallegos, Operations Director, Member Services, Kaiser Permanente Harbor City, Kaiser's records are unable to confirm that  I have medical coverage.
 
 
I just spoke with a Supervisor at Medicare.   She asked me to ask Kaiser very specific questions:
 
1.   Am I currently enrolled or disenrolled from Kaiser's Senior Advantage HMO Plan?
 
2.  What is the reason I was disenrolled?
 
3.  What is the date of the disenrollment?
 
4.  On what date did Kaiser inform Medicare that I was disenrolled?
 
5.  If I am not disenrolled, what is the reason that the California Service Center, San Diego is unable to confirm or deny if I have medical coverage?
 
6.  I plan to visit a medical professional tomorrow and have blood work as required by my medical doctor.  Do I have coverage to cover the costs of this visit and procedure tomorrow?
 
Thank you for your speedy assistance.  

 




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