Kaiser Permanente is dedicated to providing comprehensive medical care programs to its members. Understanding your options when it comes to financial assistance is a key part of navigating your healthcare journey. If you’ve recently applied for medical financial assistance through Kaiser Permanente and your application was denied, or if you believe you qualify for a larger award than you received, you have the right to appeal that decision. This guide explains the process for appealing a decision related to Kaiser Permanente’s medical care program financial assistance.
You can initiate an appeal application by filling out the form available online. After submitting your name and email address, you will receive detailed instructions via email outlining the steps to formally file your appeal.
To proceed with your appeal, you will need to clearly state:
- The Reason for Your Appeal: Specify why you are appealing the decision. Common reasons include job loss or significant changes in your financial situation.
- Current Financial Documentation: Provide up-to-date financial documents that accurately reflect your total gross household income. This documentation is crucial to support your appeal and should align with the income documentation requirements previously outlined in the application process.
Appeals can also be filed if your out-of-pocket medical expenses, specifically those not covered by Kaiser Permanente, have exceeded 10% of your annual gross household income within the last 12 months.
For appeals based on high medical expenses, ensure you provide the following:
- Proof of Annual Gross Household Income: Documents verifying your total household income for the past year.
- Proof of Non-Kaiser Permanente Medical and/or Dental Expenses: Submit documentation for medical or dental expenses incurred outside of Kaiser Permanente.
- Itemized Bills: For all non-Kaiser Permanente medical expenses, you must provide itemized bills that include:
- The name and complete address of the healthcare provider.
- The patient’s full name.
- A clear description of the medical services or supplies that were provided.
It’s important to note that Kaiser Permanente will not provide refunds for any payments you make before your appeal is officially approved.
Time Limits for Filing an Appeal:
You have a strict timeframe of 30 days from the date of your initial decision to file an appeal. If you miss this 30-day deadline, you will be required to submit a completely new application for medical financial assistance.
However, if you are appealing to request a larger award amount, you have more flexibility. You can appeal at any point before the original award end date.
Submitting Additional Documentation:
If you initially failed to provide all necessary financial documentation with your application, or if your income situation has changed since your initial application, you can submit these updated or missing documents as part of your appeal. Refer to the application guidelines for a detailed list of acceptable income documentation.
How to Submit Your Appeal:
To submit your appeal, you have several options:
1. Online Form: The initial step is to start your appeal via the online form to receive further instructions.
2. Fax or Mail: For submitting your appeal letter and supporting documents, you can use fax or mail:
- By Fax: 1-800-687-9901
- By Mail: Kaiser Permanente MFA Program P.O. Box 30006 Walnut Creek, CA 94598
When sending your documents, please remember to:
- Send Copies: Do not send original documents; copies are sufficient for the appeal process.
- Include Identifying Information: On the first page of your proof of income documentation, clearly write the following information:
- Your First and Last Name
- Your Medical Record Number (if you have one)
- Your Home Address
- Your Date of Birth
Appeal Decision:
Once Kaiser Permanente receives all of your requested documentation, they will review your appeal. You can expect to receive a decision letter regarding your appeal within 30 days of submitting your complete appeal information. It is crucial to understand that if you file an appeal without providing any additional information or documentation to support your case, your appeal will be automatically denied. Furthermore, please be aware that all appeal decisions made by Kaiser Permanente are considered final.
