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richanne96
richanne96, Attorney
Category: Personal Injury Law
Satisfied Customers: 280
Experience:  Attorney in private practice in Phoenix, AZ
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My name I wondering what I do Im a member of Kaiser

Customer Question

hi my name jeff I wondering what I do Im a member of Kaiser permanente and there machine is down for shock wave lithrophsy they change my appointment twice and machine is still down and they keep delaying me to refer me to other doctor out of network there refusing my care I need what do I do ?
Submitted: 9 months ago.
Category: Personal Injury Law
Expert:  richanne96 replied 9 months ago.

Is this procedure you need an emergency thing or can it wait? I would not go out of network because then you will be on the hook for a bigger chunk of the cost. I would call my primary care physician and ask him/her what they think is best.

Customer: replied 9 months ago.

done all that called primary called case manager filed grievance talked to every one from head to toe they still have done nothing

Expert:  richanne96 replied 9 months ago.

I looked up this procedure, which is done to break up kidney stones. If you are in significant pain from kidney stones that you can not pass, you may need to go to an emergency room to get the treatment you need. Does Kaiser cover emergency room visits in cases of extreme pain? You may have to pay for the procedure and then sue them to get the money back. This is called a "bad faith" claim -- where insurance does not pay claims if rightfully should pay. Kaiser should be arranging for you to have the procedure you need. If you do not get the procedure, there could be permanent damage as a result. This would be the nature of such a claim.

Customer: replied 9 months ago.

ya but they only have one of these machine in region and its broken other way is surgery which has a lot of side effects

Customer: replied 9 months ago.

what would you recommened

Expert:  richanne96 replied 9 months ago.

Earlier you said they were trying to refer you out of network, but now you say they have the only machine in the region. I do not know how big the region is, but it seems as if your only options are (1) to leave the region/network to obtain the procedure, perhaps at your own expense initially, and then sue Kaiser to recover the funds; or (2) go another route, such as surgery, that is available. There is nothing you can do legally to force them to fix the machine, and even if there were, it would take too long. Litigation is a very protracted process.

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