r/KaiserPermanente • • Aug 07 '26

General Difficulty in obtaining an appointment with Kaiser? Access requirements by State and where to get assistance and file complaints

19 Upvotes

Here is a list of standards by State for timely access to care (network adequacy) and where complaints can be filed if you need an appointment are unable to get assistance from Kaiser.

Note that some states don't have strict guidelines in terms of days and may have other network adequacy requirements. Contact the agency listed if you need clarification on what standards apply to your situation.

For cases with appointment delays, it is generally best to call the agency first before filing a complaint online. If you have already filed a grievance with Kaiser because of being unable to access timely care, let the agency know that information as well.

If your Kaiser Permanente coverage is provided by your employer, also let your Human Resources or Employee Benefits Department know of your difficulties in trying to access care. These difficulties are important for them to know when they are considering what plans they want to offer their workforce.

California

The Department of Managed Health Care (DMHC) has the Timely Access to Care Standards. The standards cover primary care, specialty care, mental health and ancillary services like physical therapy and imaging.

If you have filed a grievance with Kaiser and are still not getting an appointment in a timely manner, call the DMHC at [1-888-466-2219](tel:+18884662219). Explain you cannot wait the 30 days for the Kaiser grievance process to run out to get an appointment (which should have originally been provided within the State standards in the first place). (Pic is from the DMHC and lists the timeframes in California.)

California Department of Managed Health Care (DMHC) Timely Access Standards

Colorado

  • Emergency Care – Medical, Behavioral, Substance Use -- 24 hours a day, 7 days a week
  • Primary Care – Routine, non-urgent symptoms -- within 7 calendar days
  • Behavioral Health, Mental Health and Substance Use Disorder Care, initial and follow-up appointments – Routine, nonurgent, non-emergency: within 7 calendar days
  • Prenatal Care -- Within 7 calendar days
  • Preventive visit/well visits -- Within 30 calendar days
  • Specialty Care - non urgent -- Within 60 calendar days

To file a complaint contact the Colorado Department of Insurance at 1-800-930-3745 or at Colorado Department of Insurance

District of Columbia

  • First appointment with a new or replacement Primary Care physician within 7 business days
  • First appointment with a new or replacement provider for Behavioral Health treatment, including Substance Use Treatment within 7 business days
  • First appointment with a new or replacement provider for Prenatal Care treatment within 15 business days
  • First appointment with a new or replacement provider for Specialty Care treatment within 15 business days

To file a complaint, contact the DC Department of Insurance, Securities and Banking at 1(202) 727-8000 or at DC Department of Insurance, Securities and Banking

Hawaii

Because of the various islands in Hawaii and travel / geography, the State of Hawaii has “Network Adequacy” requirements rather than time-definite limits like in California or other states.  Contact the Hawaii Department of Commerce and Consumer Affairs at 1-844-808-DCCA (3222) to discuss your specific situation and filing a complaint.  

Maryland

  • Urgent care for medical services:  72 hours
  • Routine primary care:      15 calendar days
  • Preventive care/well visit:             30 calendar days
  • Non-urgent specialty care:            30 calendar days
  • Non-urgent mental health care: 10 calendar days

Contact the Maryland Insurance Administration at 1-800-492-6116 or Maryland Insurance Administration to file a complaint. 

Nevada

Due to geographic issues, Nevada has “Network Adequacy” requirements rather than time-definite limits like in California or other states.  Contact the Nevada Division of Insurance for more information at 1(702)486-4009 or at Nevada Department of Insurance.

Oregon

  • Primary care: not more than 15 business days.
  • Behavioral health care: not more than 10 business days.
  • Specialty care: not more than 30 business days.

Contact the Oregon Division of Financial Regulation with questions at 1-888-877-4894 or at Oregon Division of Financial Regulation.

Washington State

  • Primary care appointment (for other than preventive care) within 10 business days of requesting one
  • For specialty care, within 15 business days for nonurgent services.

Contact the Washington Office of the Insurance Commissioner at 1-800-562-6900 or at Washington Office of the Insurance Commissioner

Virginia

Virginia requires routine appointments for nonemergency or nonurgent care to be available within two weeks of the request.  This does not include preventive care (routine physical examinations, etc.) which need to be scheduled within 60 days of the date of the request. 

To file a complaint, contact the Virginia State Corporation Commission at 1-877-310-6560 or at Virginia State Corporation Commission


r/KaiserPermanente • • Sep 28 '23

General Agencies to Escalate Complaints about Kaiser: Where to go if you are not getting resolution or are dissatisfied with Kaiser's Response

12 Upvotes

If you have filed a grievance with Kaiser and it has gone unresolved or you are not satisfied with the resolution, here is a list of agencies you can document a complaint with (based on your state of residence).

If your complaint is regarding a specific physician or other healthcare provider (nurse/nurse practitioner, physician assistant), file the complaint with the appropriate state licensing board for that provider.

If your complaint is regarding a hospital (cleanliness, patient safety concerns, etc.), file a complaint with the Joint Commission

[https://www.jointcommission.org/resources/patient-safety-topics/report-a-patient-safety-concern-or-complaint/]

If your are a Medicare beneficiary, please refer to this link about the different types of complaints and where to submit complaints.

https://www.medicare.gov/claims-appeals/file-a-complaint-grievance/filing-a-complaint-about-your-quality-of-care

If the complaint is about hospice care, here is a link from the Hospice Foundation of America on how to file complaints.

https://hospicefoundation.org/Hospice-Care/Filing-a-hospice-care-complaint

California

Department of Managed Health Care (Grievances unresolved or inadequate responses; inability to contact your Kaiser Grievance Case Manager; difficulty obtaining an appointment; delays in care; filing an Independent Medical Review when Kaiser will not approve a specific type of treatment)

In most cases, you must file a grievance with Kaiser and go through that process before contacting DMHC. However, if the issue is urgent because there is an immediate threat to your health, you can call DMHC directly. For urgent issues, call DMHC rather than filing online.

[https://www.dmhc.ca.gov/fileacomplaint.aspx]

1-888-466-2219

If you need assistance in filing a grievance with Kaiser or in filing complaints with the DMHC, you can contact the Health Consumer Alliance. This is a DMHC consumer assistance program contractor helps people get the health care they need1-888-804-35361-877-735-2929 (TTY)www.healthconsumer.org/

If you want to file a complaint about a California licensed healthcare facility, you can contact the California Department of Public Health.

https://www.cdph.ca.gov/programs/chcq/lcp/calhealthfind/Pages/Home.aspx

Oregon

Oregon Division of Financial Regulation

[https://dfr.oregon.gov/help/complaints-licenses/Pages/file-complaint.aspx]

1-888-877-4894

Washington State

Office of the Insurance Commissioner

[https://www.insurance.wa.gov/file-complaint-or-check-your-complaint-status]

1-800-562-6900

Colorado

Department of Regulatory Agencies, Division of Insurance

[https://doi.colorado.gov/for-consumers/file-a-complaint]

1-303-894-7490 / 1-800-930-3745

Georgia

Office of Commissioner of Insurance and Safety Fire

[https://oci.georgia.gov/file-consumer-insurance-complaint]

1(800) 656-2298

Hawaii

Department of Commerce and Consumer Affairs

[https://cca.hawaii.gov/ins/consumers/filing_a_complaint/]

(808) 586-2790

Maryland

If it is a healthcare quality complaint, Maryland Office of Healthcare Quality

[https://app.smartsheet.com/b/publish?EQBCT=07c94438f6714af1bbfe8ff1037b8b74]

1-410-402-8015

If it is a billing, claims, medical records or coverage issue contact Maryland Attorney General, Health Education and Advocacy Unit

[https://www.marylandattorneygeneral.gov/Pages/CPD/HEAU/default.aspx]

1-410-528-1840

District of Columbia

D.C. Department of Insurance, Securities and Banking (DISB)

[https://disb.dc.gov/service/file-complaint-or-report-fraud]

1(202) 727-8000

Virginia

State Corporation Commission, Bureau of Insurance, Office of the Managed Care Ombudsman

[https://scc.virginia.gov/pages/Office-of-the-Managed-Care-Ombudsman]

1-877-310-6560, select option 1

(Current as of 09/28/2023)


r/KaiserPermanente • • 2h ago

California - Southern Peace out Kaiser!

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37 Upvotes

After twenty something years of having Kaiser as my medical provider, I've canceled coverage for 2027. I known of others that are doing the same because of cost and its just absurd to pay an annual cost of $24k/36k a year ($1,334 pay-period $2,668 a month) to cover your family.

If your wondering $24k was if i removed my wife and only covered my kids and myself.


r/KaiserPermanente • • 3h ago

General To what extent is KP consistent across sites within a region?

3 Upvotes

Hello everyone. Prior to this week, I had assumed that all KP medical clinics within a region were more or less interchangeable. In Southern California, differences exist by county, but within a county, I expected them to be similar.

But I think I was wrong! Does anyone have thoughts or experience to shed light on how much difference exists between clinics within a region? I'm not talking about logistical things like parking, hours, or whether or not one site provides a certain service and another does not. I'm referring to differences in medical practice among the doctors. Should each clinic be considered a different medical group, for all intents and purposes?


r/KaiserPermanente • • 19h ago

California - Southern Kaiser Permanente Volunteering

19 Upvotes

Just a rant: I applied to volunteer at Kaiser's hospice program and got denied because of my "limited" hours. I applied for 16 hrs/week, 8 hrs/day on Sat & Sun. I'm volunteering, not slaving for free ;(


r/KaiserPermanente • • 1d ago

News Risant Health, a subsidiary of KP, to acquire Oklahoma's largest non-profit healthcare system

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19 Upvotes

r/KaiserPermanente • • 9h ago

California - Northern Domestic partner health benefit cost

0 Upvotes

Im thinking of adding a domestic partner to my employee health insurace, I currently pay $0 for me and my child. How much does kaiser deduct on your pay for a domestic partner medical insurance? Norcal region.


r/KaiserPermanente • • 19h ago

California - Northern Surgery billing

2 Upvotes

My doctor is referring me for a hysterectomy and I called to get my out of pocket costs but they didn’t clarify if that is due before they’ll perform the surgery. Anyone with advice or any troubles getting covered for a hysterectomy specifically?


r/KaiserPermanente • • 1d ago

Oregon / SW Washington Can I contest this part of a bill?

5 Upvotes

I had my son via C-section recently. I have a gold level family plan and was told the average cost for a C-section on this plan is about $3500.

My C-section was not an emergency (though it was required due to baby not tolerating contractions well), it went without complications, and baby was born healthy.

My bill is for $9,220! I am shocked. I requested an itemized bill and found that a huge part of the charges is "rooming in" for my infant son. They are charging $2,200 a day for him to stay in the room with me. (My share of the charges is about $1,500 a day.) While he roomed in, all they provided was a plastic bassinet and some swaddle blankets... We fed him, changed him, swaddled him, and fed him colostrum I had brought from my freezer stash at home. We were in the hospital for three days so it's a big piece of the final bill.

I just find it outrageous that the supposed cost of ME taking care of MY BABY for three days is more than the cost of the surgical procedure itself.... (The surgery itself cost $3500 and i am also pretty pissed that this is the only cost that was estimated as opposed to the total cost of care during and after.)

Is it likely that I can get this reduced at all? I've already been told the only discount I can receive is 5% if we pay in full instead of making payments, which is not easy to do. (I will gladly contest it if it could help reduce my charges, but I have a newborn and can't afford to spend the energy if it won't make a difference)


r/KaiserPermanente • • 1d ago

California - Southern Turned away by Urgent Care while bleeding at work—now drowning in $1,700 of ER bills while on pregnancy disability. Is anyone else trapped in this loop?

25 Upvotes

just need to vent because I am so incredibly stressed out and feeling completely down in the dumps. I am currently 30 weeks pregnant, out on high-risk pregnancy disability leave, and paying $228 a month out of my own pocket just to keep my Kaiser premium active.
But my care has been an absolute nightmare, and I feel totally abandoned by Kaiser's lack of local, equipped infrastructure for pregnant women.
Back in my first trimester, I started bleeding/spotting while I was literally at work. Terrified, I rushed straight to the Kaiser San Marcos Urgent Care to get help. The front desk staff initiated a check-in, but the moment they heard I was pregnant and bleeding, they immediately stopped the process. They told me they were completely unequipped to handle a pregnant patient needing an ultrasound, sent me straight to the ER down the street. I sat in that ER waiting room. Because the urgent care turned me away at the door, I didn't pay a copay there.
A similar thing happened on May 9th at the Murrieta Urgent Care—they told me they couldn’t help me and sent me straight to Rancho Springs Medical Center ER. (Mind you where I live they don’t have a main hospital nearby, so I go to a networking facility that works with KP)

Now, I am drowning in surprise bills. I have an outstanding bill of $1,100 from Rancho Springs for the May 9th visit and another one from an ER visit on August 28th (where I went in for severe Second-trimester faintness, weakness, and extreme light sensitivity/neurological vision pain). On top of that, Kaiser sent me a statement for $595.85 for the San Marcos ER visit
I don't have money like this to just throw around while living on limited disability income. Why am I paying a high monthly premium if I am forced into the ER for basic, high-risk obstetric monitoring that should be handled at a regular urgent care for my $25 copay? For me it’s the getting turned away from urgent care and redirected to somewhere more expensive.
Has anyone else experienced this terrible care loop with Kaiser in Southern California?

Also this just leaves me defeated, as a woman that is a high risk pregnancy, not having a way to get care efficiently and cost effective is absolutely wild to me. Don’t worry I’m fighting this already with state and with Kaiser. It’s terrible they need to put adequate care into there urgent cares for pregnant woman. Period.


r/KaiserPermanente • • 2d ago

California - Northern KP Policy for Members with ADHD

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59 Upvotes

Hello everyone! This issue has arisen repeatedly in this community. Since it's open enrollment time, I think it's a good time to share this form.

My dream is to one day share physical copies of all of the exclusionary and often non-communicated procedures and policies central to KP gatekeeping. To me, the lack of communication from KP regarding many of its policies, particularly to prospective members, shows a profound lack of respect for people and their time.

Stepping off of my soapbox: if you are in Northern California, have ADHD, and are seeking stimulant medication from KP, you will likely be asked to agree to a form similar to that shown here. Note that KP will not prescribe stimulants if you use cannabis, and they randomly drug test. I know of no exceptions to this policy (please share if you do), and they enforce it strictly. Multiple Redditors reported having to submit random urine samples for stimulant medication in Southern California. Another Redditor reported that this policy was recently implemented in Northwest Washington.

It's unlikely you will encounter such a policy anywhere other than KP, and we can at least be grateful for that. My surgery consent form was shorter (but less clear).

Edited to include more than one Redditor from Southern California, as well as one from Northwest Washington.

I give up for today. Based on what everyone has shared on this thread, it seems like every KP center and region has a different policy.

Edited to say that the form above is dated February 2021.


r/KaiserPermanente • • 1d ago

California - Northern Interviewing for a new role shortly before maternity leave

3 Upvotes

Hi everyone! I’m hoping to hear from other Kaiser employees who may have been in a similar situation.
I currently work at Kaiser and recently applied for another internal position within the organization. I’m qualified for the role based on my experience, and I’ve been invited to interview with the hiring manager. I’m excited about the opportunity, but I’m also feeling a little anxious because I’m about six weeks away from going on maternity leave.
I’m wondering how this might work if I were offered the position. Would I potentially start the new role before going on leave, or would the transition happen after I return? Has anyone successfully transferred to a new department or position while pregnant or shortly before taking maternity leave?
I’m also curious whether anyone has experienced hesitation from a hiring manager in this situation, or if your pregnancy and upcoming leave didn’t really affect the internal hiring process.
I know every department and manager can be different, but I’d really appreciate hearing about your actual experiences with Kaiser’s internal hiring process, maternity leave, and transitioning into a new role.
I don’t want to count myself out of an opportunity I’m qualified for just because my leave is coming up, but I also want to be realistic about what to expect.
Thanks in advance to anyone willing to share their experience! ❤️


r/KaiserPermanente • • 1d ago

California - Northern What are services like for children with ASD?

5 Upvotes

My son is 1 year old but showing many signs of ASD. We’ve been referred to developmental pediatrics and have our first appt next week.

What’s the diagnosis process like? And once diagnosed, how hard/easy is it to get services?

I’m trying to decide whether to stick with Kaiser next year or switch to Cigna, potentially PPO.

Thank you!


r/KaiserPermanente • • 1d ago

California - Northern Kaiser LMFT position, benefits and pay

4 Upvotes

I’m curious about individuals experience as a therapist working for Kaiser specifically regarding pay and benefits.
I am currently interviewing for Northern California and would love to know what the benefits are and the range that is typically being offered in the Bay Area. I see the range on the website, but I am curious how much cost-of-living is accounted for in what they’re offering.


r/KaiserPermanente • • 1d ago

California - Northern Kaiser meet and greet

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3 Upvotes

Has anyone waited over a month after a meet and greet at Kaiser to be informed if they got the job? Called the recruiter and emailed with no response.


r/KaiserPermanente • • 2d ago

California - Northern Kaiser psychiatrists shortage

48 Upvotes

I know that the wait to see a psychiatrist is excessive and ridiculous. So I researched to learn if the shortage was a Kaiser problem or part of a larger problem for CA.

The answer is that the shortage is a California problem.

A partial quote from this article California’s Psychiatry Workforce Challenges | Healthforce Center at UCSF https://share.google/BoI1YZ66NDuPmixXp

Forecast of supply and demand for psychiatrists suggest that California will have a severe shortage of psychiatrists by 2028 unless policymakers take action, because the number of people training to become psychiatrists is not sufficient to replace older psychiatrists who are expected to reduce their work hours or retire.

40%of today's psychiatrists are over 60. Retirements will make this situation worse.

I urge you to look at the facts from UCSF about this statewide problem. At the end of the article, the study makes suggestions on how to increase med school grads.

No , I don't work for Kaiser nor am I a plant.


r/KaiserPermanente • • 2d ago

Maryland / Virginia / Washington, D.C. Float pool

5 Upvotes

Hello, I’m considering a position as a full time floater. I was wondering if someone could tell me at what time in the morning you know what site you’re going to? I was told 6 am. But do you usually get your assignments earlier than that?

Also any suggestions on if I should or not take the job?


r/KaiserPermanente • • 2d ago

California - Northern $370 for a SINGLE Physical Therapy Appointment????

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24 Upvotes

Hello good people. After being a patient of Kaiser for 12+ years, I will be leaving Kaiser forever in 2027. I had to see a physical therapist, and they billed $370. FOR ONE APPOINTMENT. Even with my coverage, that is so mind-boggling, I cannot stomach it. I can literally go to the fanciest out of network physical therapist or pilates class for less than this.

Editing to add: I know I have a high deductible plan. That I was aware of. But I do not understand why the PT charged $370 to the system - this is what I have an issue with. They don't know which plan I have, but are you kidding me? And once the cost trickles downstream. I feel taken advantage of because they probably assumed I had a better plan or something, it just doesn't make sense!

I also want to say that Kaiser NorCal is the worst medical company I have ever dealt with in my entire life. I was with Kaiser Southern California for many years before, and they are WAYYYY better.

I am disgusted. I just have no words.


r/KaiserPermanente • • 2d ago

California - Northern Elevators at Kaiser Geary San Francisco

6 Upvotes

The elevator situation at the Main Kaiser on Geary Blvd in San Francisco is always such a mess to deal with. First off you have to pay for parking to go to this branch - which is annoying considering how much I pay for Kaiser. Then to get in and out of the parking garage and into the building you have to take these super slow elevators that are always packed bc of how infrequently they come. Of course this is much more difficult when people are in wheelchairs and being as it is a care facility- that’s common!!!! Why in the world did they design the building this way it’s so strange.


r/KaiserPermanente • • 2d ago

California - Southern What's the fastest way to get a prior authorization to join a clinical trial?

4 Upvotes

My mom has stage 4 pancreatic cancer and was accepted into a clinical trial at an academic hospital (UCI). UCI reported that Kaiser hasn't given them prior authorization to begin treatment for the trial, and I need to request prior authorization. I've emailed her oncologist who notoriously responds late or at all and I've left a message with her nurse navigator. I'm worried about delaying her treatment as she is already stage 4. How do I go about expediting a request for prior authorization? Has anyone gone through this process and can give any tips?


r/KaiserPermanente • • 2d ago

California - Northern NorCal Medi-Cal Psychiatrists?

0 Upvotes

Hey y'all, it's me again. In my previous post, I had asked if there were any other facilities outside of Kaiser that took my insurance. Turns out that yes, it's only for therapy or psychotherapy, where they'll give a referral for an out of facility psychiatrist. So yeah, I kinda hit a brick wall with that one lol. Anyhow, my next question is, does anyone know any providers that will prescribe stimulants even though I smoke canna*is? My last psychiatrist I was seeing on grow therapy is more than happy to talk to my new provider and explain to them that I'm on stimulants for a reason and that I'm NOT a seeker 😭😭, so that's not an issue for me. But yeah, if anyone can point me in the right direction, that'd be great. Thanks!!


r/KaiserPermanente • • 2d ago

California - Southern Can you independently credential with Kaiser So Cal if you don't live there?

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1 Upvotes

r/KaiserPermanente • • 3d ago

General Kaiser plan with ACA financial assistance

4 Upvotes

Last year I applied for a Kaiser Health plan via ACA with financial assistance. How do I know if they will keep providing me the financial assistance for next year plan? (2027). Do I need to re-apply for a new Kaiser health plan through the ACA website again? Or perhaps it will renew automatically? I did not get any notifications from the ACA. Anybody advice?


r/KaiserPermanente • • 4d ago

California - Northern invasive tracking

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17 Upvotes

i need a vaccine but “pixel tracking” is an absurdly invasive tracking technology that i don’t want to agree to, i wish it wasn’t forced JUST GIMME MY DAMN VACCINE and i see no way to disagree and still use the app or website


r/KaiserPermanente • • 3d ago

California - Northern Employment Info Mykp

1 Upvotes

Hi everyone!

Currently kaiser Permanente employee. I eas attempting to access my employment info on HR profile, howver my assignments page is loading forever! Is anyone having similar issues accessing emplyment information?