A consumer filed a complaint with the insurance commissioner stating that Kaiser failed to notify him that he had five days to provide supporting information to an Independent Review Organization (IRO), one of consumers’ health insurance appeal rights.
The insurance commissioner looked at Kaiser’s IRO files from January 2016 through March 2017 and found the company violated several rules related to IRO appeals, including:
- All but one consumer were not told of their right to provide additional information to the IRO within five business days.
- Kaiser failed to send files to the IRO within three business days.
- All but one of the expedited files took longer than 72 hours to complete.
- Half of the consumers who filed were not given the IRO name and contact information within one business day.
The insurance commissioner suspended $30,000 of a $100,000 fine as long as Kaiser complies with the terms of the compliance plan and doesn’t commit additional law violations within two years.