Member rights and responsibilities and reporting concerns

Statement of member rights and responsibilities

We take patient rights very seriously, and we know that you, as a valued contracted provider in our networks, do as well. You can read our statement of members' rights and responsibilities on our Kaiser Permanente member site.

Member concerns or complaints

Kaiser Permanente has an established process for handling member complaints expressed either verbally or in writing. Documenting, resolving, and reporting member complaints helps us improve the services we provide.

Members are encouraged to let us know of any concerns or dissatisfaction right away and, ideally, work directly with the provider or clinic involved. This process often results in the most expeditious resolution. However, if members prefer not to address the concern directly or do not feel the concern was addressed to their satisfaction, they are welcome to contact Member Services toll-free at 1-888-901-4636, or Medicare Member Services toll-free at 1-888-901-4600, or through our website at www.kp.org/wa/feedback.

Member Services specialists can resolve complaints about health plan issues including billing, claims, demographic updates, plan rates and benefits, and enrollment/disenrollment concerns.

All member complaints communicated to Member Services are documented, and it is always our goal to inform members of the resolution within 30 days. Complaint data is routinely shared at all levels of the organization to represent "the voice of the customer" and inform quality improvement initiatives.

The Kaiser Permanente Privacy Office responds to member concerns involving breaches of privacy, confidentiality, and security; whether they are reported through Member Services or directly to the Privacy Office.

Reporting quality of care concerns

Member complaints are managed through Member Services and the member complaints process. We also have an unusual occurrence system, managed by our Patient Safety Office, to review quality of care concerns. Unusual occurrence reports identify system weaknesses and help us avoid future errors and ensure safe and effective care for our members.

We identify unusual occurrences through member complaints and provider or staff reports. As a member of the Kaiser Permanente network, we expect you to report unusual occurrences that involve our members and to participate in the review of such cases.

Upon receiving a report, the appropriate Kaiser Permanente medical staff will review and recommend any follow-up actions. The case review findings will be documented for purposes of system improvement and recredentialing.