Kaiser's fees for services?

The company I work for offers heath care through Kaiser.  With world events, we have been monitoring or expenses.  In late March I was in need of a minor procedure.  I contacted member services and was told based on the insurance plan I was on I would  have to pay over $4,000.  Going to a doctor on my own, the procedure would be around $250.  I talked to my primary care doctor who told me the $4,000 fee didn't sound right and to contact member services again.  I did, twice. I told them the exact procedure and both representatives me with my insurance coverage I would have to pay $125-$250.  That seemed reasonable so I made the appointment.  When I arrived, I was asked to make a $140 payment.  I asked if the $140 fee was for the entire cost of the procedure I was about to have.  The person taking my payment assured me it was.

It's May and Kaiser is saying I owe an additional $543.  They are now saying the fee for the procedure is $683.  If I knew it was going to be that much I would not have had the procedure or gone elsewhere.  The doctor told me the procedure was easy and there ware no complications. 

Member services told me they see my phone calls requesting the price.  They refuse to listen to the actual conversation I had with the representatives saying the notes say the $125 - $250 was just an estimate and that I was told there could be additional fees.  

Member services is saying I don't and that Kaiser just under estimated the cost.This just doesn't seem fair or right to me.  Let me say the doctor and the care I received from Kaiser was wonderful. 

Has this happened to anyone else? 
Do I have any recourse?   


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RE: Kaiser's fees for services? ()

I don’t work in the insurance industry, but have been a Kaiser member for 41 years so have some experience there.  It doesn’t sound to me that what you were told was incorrect.  You were given an estimate, which turned out to be wrong once the procedure was completed and bills submitted (internally).  If you’ve filed a grievance with Kaiser, you will have received your written documentation of their decision; all insurance companies are required by law to provide you with the contact information for the Department of Managed Care when a grievance is filed. You didn’t state, but it sounds like this may have been an elective procedure; Kaiser’s coverage for those won’t be as good as non-elective of course, so members are expected to have a higher co-pay then. Good luck to you.

RE: Kaiser's fees for services? ()

The only, and I mean ONLY way to get through for these things at Kaiser is twitter. They tried to charge me $3000 more than the quoted price for bunion surgery and I fought it for six months. Then tweeted at them, got sent to a billing specialist, NOT member services, and she fixed it.

If you don’t use twitter, make an account just for this.

RE: Kaiser's fees for services? ()

I'm sorry this happened to you. Kaiser is normally much better about price transparency than other insurers/providers. I would recommend you reach out to the Benefits Manager at your employer. They have some pull with their broker to escalate this to Kaiser administration and may be able to help resolve it. You may get the same answer, but at least you'll have tried a different angle. Kaiser also has a claims appeal process, which I can't tell if you've officially gone through by your post. If you go that route, whatever the outcome is is final and you are obligated to pay if that is the determination. Good Luck!