u/isneeze_at_me

Two referrals from my neurologist. Two denials. Three evaluations. Four grievances. Four grievances denied. One Doctor lied about Medicare not covering. Complaints filed with the state and federal government. Two arbitrations. Two Grievance Managers. Another Doctor lying that he approved it when he didn't, multiple time. Doctor submitting approval incorrectly.

Sorry, Kaiser, I lived long enough to fight your lies and stall tactics until you had no other way to deny me. I know you were hoping I'd be too sick to fight for what I need. But today I won. If you can call it winning.

I was diagnosed with ALS in June of 2023. I currently only have some movement in my neck and nothing else. I use a head array to control my chair. Due to progression in my neck, it is getting harder and harder to control. So in November of last year my neurologist put in for an upgrade to an eye-gaze controller.

Physical Medicine denied my referral falsely stating it wasn't covered by Medicare. My grievance outcome stated it was covered but did not address whether it would be approved.

Without a denial letter, they wouldn't let me file a grievance even though it wasn't approved either. So I filed a complaint with DMHC and Medicare.

After receiving complaint Kaiser sent me the denial letter. So I filled a grievance and was denied again. So my neurologist sent in another referral. This time Physical Medicine refused to see me. He did send the wheelchair company to my house to evaluate me for cheaper options and it was determined that I needed eye-gaze but the doctor ghosted me. So I filed a grievance. After waiting the 30 days and not receiving a response I was put in touch with a manager.

She contacted the Dr. In charge of the approval who stated it had been approved and the wheelchair company was to blame. After much research it was found the Dr. Lied and didn't approve it. He lied about this several times over months. But he did send me a letter once stating he approved it and that was enough to get Member Services to advocate for me.

After lying to Member Services one more time that he approved it when he didn't, He finally put in the order on the 10th. Filing it incorrectly and then finally doing it the right way on the 23rd.

After 6 months, the wheelchair company called me today and they have my order. It's estimated to take 3 months for the wheelchair company to complete the order but at least it's happening.

So never give up fighting for the health care you need. Kaiser will fight you every step of the way. To make a terminal patient wait 6 months from when your doctor put in the order is just evil. Due to my condition being terminal I requested my grievances be expedited and each time it was denied and my grievance was responded to on the 30th day as required by law. I have no doubt this was a deliberate delay tactic to either get me to give up due to being too sick to continue to fight or if they delayed long enough, I'd be dead.

Recommendations for those going through this.

1. Always submit grievance in writing.

2. My grievance response letters all seemed ai generated and automated to respond on the 30th day. I don't see any evidence that a human is managing the first level of grievances. Any attempt to speak with my case worker resulted in a voice mail and no return call. Expect to be denied.

3. Once denied, file a written complaint to DMHC and a cival rights complaint with federal government.

4. Call Member Services and specifically ask for a manager. I was told they aren't allowed to transfer you to a manager unless you specifically ask.

5. The managers are actually wonderful. They care and genuinely try to help you. They will give you their contact information and will follow up. The hard part is to make that first contact.

6. Write down details of every interaction you have. Dates, names, conversations. You will need these details to be taken seriously.