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The Maryland Insurance Administration ruled on September 26, 2008 that "Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. has violated Maryland insurance law" in this case.

We take Kaiser Permanente to
the Maryland Insurance Administration

MARYLAND INSURANCE ADMINISTRATION
525 St. Paul Place
Baltimore, MD 21202-2272

Dear Mr. Orr,

With this letter, I would like to bring to your attention some great irregularities with the service provided by my insurance provider, Kaiser Permanente (hereinafter referred to as "KP"). Such unethical behavior I have not experienced in my decades of international experience. As a licensed insurance producer I know such unethical practices are not acceptable.

I began employment with [my employer] (hereinafter referred to as [employer]) in November, 2006 and became eligible for insurance the following month. I picked up a copy of the "step UP to Benefits Enrollment" book "Plan Year 2006-2007" (hereinafter referred to as "step UP"). Additionally, I retrieved a Kaiser Permanente packet which contained:

  • a letter from the VP of Sales, Marketing, and Business Development
  • Benefits and Services YOUR SUMMARY which lists the same IVF benefits as in the UMMC benefits book.
  • a GROUP ENROLLMENT APPLICATION AND CHANGE FORM
  • a brochure entitled "In every way we excel, you thrive" showing HOW MUCH [KP] OUTPERFORMED EVERY OTHER HEALTH PLAN IN THE STATE (emphasis theirs)
  • LIFE CALLS FOR HEALTH.
  • and a PHYSICIAN DIRECTORY

    a total of over 400 pages of information about their plan. A larger packet I've never seen in the 4 medical plans my wife and I have had lately, but I painstakingly reviewed every page. One would think that such an exhaustive and exhausting tome were complete, and we both know that by federal law, if it were an individual plan, it would be illegal to try to add, subtract or modify the policy after an insured signs it. In every country in which I have lived, such conduct is illegal. Below, I will outline how they proceeded to do just that.

    The "step UP" book, which covers all types of benefits, including retirement programs, education reimbursement, time-off, health benefits, and pay mentions "insurance contracts and plan documents, which are available for examination upon request." Therefore, before signing up for the insurance, I spoke with both the [employer] Benefits Office (Ms. [name withheld to protect the innocent]) and with Kaiser Permanente (a conversation KP claims to have recorded for quality control purposes) and requested any more insurance contracts and plan documents that they may have, especially as they may pertain to the reproductive care. This was going to be a more expensive plan for us, so we wanted to make sure we were going to get what was being promised in the advertising literature and policy. Ms. [name] had informed me that KP was notorious for not fulfilling their promises, but I knew in the USA like any other country, parties to a contract are legally bound to signed contracts. So, I felt assured that I could count on the policy I had before me.

    We spoke specifically about reproductive treatment, which we had already started. Both sources informed me that they had no further information beyond the hundreds of pages of literature in the KP packet. The Benefits and Services booklet refers to a "KFHP-MAS Evidence of Coverage" but when I asked for any more details, both sources assured me that the "In-Vitro Fertilization (3 attempts per lifetime)" under KP insurance was covered "50% copay for all services except hospitalization; $100,000 lifetime maximum" as p. 12-13 of "step UP" claimed without any further exclusions or conditions. (There are no asterisks or other signs of small print exclusions anywhere.) (See exhibit A.)

    In January, a month after I had begun paying my insurance premiums, I ordered some medication for my wife and the pharmacy told me that MedImpact, Kaiser's pharmacy branch didn't have us registered in their system. I called customer service on January 2nd and they told me that MedImpact would have me in their system that evening. The next day, my pharmacy called MedImpact and was told that we still weren't in their system and so they couldn't get my wife the medication refill she needed. So, I called Mitchell Alston (301) 816-7129, [employer]'s connection to KP, and he told me that he would get the job done and reported back that we'd be on the system within 48 hours. This did not happen and my wife was not able to get a refill of her medication. This required us to postpone our Intra-Uterine Insemination (IUI) a month. This enabled KP to save money they would have had to pay for a covered procedure and likely contributed to our being refused for In-Vitro Fertilization (IVF) and the deterioration of my wife's fertility to a point of not being able to conceive. This I shall explain later.

    Concurrently compounding the issue, Dr. [name withheld to protect the innocent], the specialist we had been seeing before being insured by KP informed us that in order to continue using his services, KP required that we get a referral. This started another time-delaying, exhausting, and traumatizing escapade with Kaiser Permanente. First we were assigned Dr. L. Singletary as our primary physician. (See exhibit B.) She hadn't worked in that clinic for 5 years, so on January 3rd they gave me the name of Dr. Davis, of the same Johns Hopkins clinic. We went for our appointment and when we arrived the admitting clerk told me that Dr. Davis doesn't do physicals or referrals any more but is a family-care doctor now. So, KP told me to call the [name withheld to protect the innocent] in Owings Mills, Maryland. I called there and was told, "Kaiser should know that we don't take appointments for primary care, just do emergency treatments." So, KP told me to go to Dr. [name withheld to protect the innocent] of [name withheld to protect the innocent]. I called them and discovered that although Dr. [name] wasn't taking new patients, Dr. [name withheld to protect the innocent] was with KP and could take us. I called KP customer service to inform them of our choice, but they told me that she hasn't kept her registration up-to-date and thus couldn't be our doctor. (I am told that all these conversations are recorded, so your office should be able to obtain and review them.)

    It was clear that I was paying for insurance that my wife and I couldn't use. We were being defrauded.

    By now it had become obvious that not only doesn't Kaiser Permanente not know who their own doctors are, but on the other side of the coin, even the doctors affiliated with them don't know if they can treat Kaiser insureds or not!!! I asked to speak with a KP supervisor, but the customer care people said that a supervisor couldn't help because the problem is in the database and the supervisor would be using the same database. When I finally found a doctor, I called for an appointment and the lady told me that customer service still hadn't enabled appointments to be made, so she transferred me back to customer service. This doctor finally found me an OB/GYN who gave us a referral on February 13, 2007, but another month was lost in our treatment and my wife's fertility continued to deteriorate. All this time, we were required to pay for insurance we could not use. Yet, there was more.

    Continued...





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