Kaiser Permanente is a well-regarded integrated managed care consortium in the United States, known for its comprehensive approach to healthcare. A key component of their commitment to community health is the Medical Financial Assistance (MFA) program, designed to provide support to eligible patients who may face financial challenges in accessing necessary medical care. Understanding What Is Kaiser Permanente Medical Care Program in the context of financial assistance is crucial for those seeking support and navigating the appeals process if needed.
The Medical Financial Assistance program is intended to ensure that individuals can access essential medical services, even if they are unable to afford the full cost of care. This program considers various factors to determine eligibility and the level of assistance provided. However, applications are sometimes denied, or the awarded assistance may be less than what is needed. In such cases, Kaiser Permanente provides a formal appeal process.
You have the right to appeal if your application for Medical Financial Assistance has been denied, or if you believe you qualify for a larger award. To initiate an appeal, you will need to provide specific information and documentation to support your request.
Appealing a Medical Financial Assistance Decision
To start an appeal, you should prepare the following:
Reasons for Appealing
Clearly state the reason for your appeal. Common reasons include:
- Job Loss: If you have recently experienced job loss and a subsequent decrease in income, this is a valid reason to appeal.
- Insufficient Award Amount: If you believe the awarded financial assistance is not sufficient to meet your needs, you can appeal for a larger award.
Required Documentation for Appeal
You must provide current financial documentation to support your appeal. This documentation should accurately reflect your total gross household income. The specific documents required are detailed in the “What information will I need to apply” section of the full application guidelines, and generally include proof of income such as pay stubs, tax returns, or bank statements.
Appealing Due to High Medical Expenses
You can also appeal if your out-of-pocket medical expenses from non-Kaiser Permanente providers exceed 10% of your annual gross household income over the past 12 months. To appeal on this basis, you will need to submit:
- Proof of your annual gross household income.
- Proof of non-Kaiser Permanente medical and/or dental expenses. This must be in the form of an itemized bill that includes:
- Provider’s name and address
- Patient’s name
- A clear description of the services or supplies provided
It is important to note that Kaiser Permanente will not refund any payments made before an appeal is approved.
How to Submit Your Appeal
You have 30 days from the date of your initial decision to file an appeal. After 30 days, you will need to submit a new application for Medical Financial Assistance. If you are appealing for a larger award, you can do so at any time before the award end date.
To submit your appeal, you can either fax or mail your appeal request. You should have received an Appeal Request form with your award letter. Complete this form and include all supporting documentation.
Contact Information for Appeals:
- By fax: 1-800-687-9901
- By mail:
Kaiser Permanente MFA Program
P.O. Box 30006
Walnut Creek, CA 94598
When submitting your documents, please remember to:
- Send copies of official documents; originals are not required.
- Write the following information on the first page of your proof of income:
- First and last name
- Medical record number (if applicable)
- Home address
- Date of birth
Important Information Regarding Appeals
After Kaiser Permanente receives your appeal documentation, they will review your case and send you a decision letter within 30 days. It is critical to provide all necessary information with your appeal. If you file an appeal without including additional information, it will be automatically denied. Please be aware that all appeal decisions are final.
Conclusion
Understanding what is Kaiser Permanente medical care program includes knowing about the Medical Financial Assistance program and the options available if you believe you are eligible for financial support. If you have been denied assistance or feel your award is insufficient, the appeal process provides a pathway to have your case reconsidered. Ensure you gather all required documentation and submit your appeal within 30 days of the initial decision to ensure your appeal is properly reviewed.
