Date: 09/08/2022

Transcription of Conversation with Deshelle at Kaiser

                                        

Deshelle: [00:02:31]
Good afternoon. This is Deshelle. How may I assist you?

Deborah: [00:02:34]
Hi Deshelle. Do you need anything from me before I ask you for what I want?

Deshelle: [00:02:39]
Yes, I can go ahead and assist you. May I have you verify your name and date of birth in order to better assist 
with accessing some account information?

Deborah: [00:02:43]
Okay, it's Deborah Boling, and my date of birth is April 16, 1952.

Deshelle: [00:02:54]
Thank you, and how can I assist you today?

Deborah: [00:02:57]
You keep a call log there at the travel place, right? I guess you probably keep a travel, I mean a call log, everywhere. 
Can you check a date for me? It's either February 21 or 22nd when I called in, And I need to just know which date that was, 
I think it was the 22nd, but it might be the 21st.

Deshelle: [00:03:23]
Okay, I can look over your call history.

Deborah: [00:03:30]
Thank you. And your name again was?

Deshelle: [00:03:33]
Deshelle, I have a De-shelle. With a D, like David.

Deborah: [00:03:36]
Oh, De-shelle. Okay, got it.

Deshelle: [00:03:39]
I have that you called on the 22nd, February.

Deborah: [00:03:43]
I kept thinking the 21st, but okay 22 February of 2022.

Deshelle: [00:03:50] Correct.

Deborah: [00:03:55]
Do you keep notes about what it's about, I can see what the representative, was her name Karen, by some chance? 
That was my memory, but I could be wrong.

Deshelle: [00:04:07] It says Peggy.

Deborah: [00:04:09]
Oh, it was Peggy. Okay, I've talked to her before, I think actually, one moment.

Deshelle: [00:04:15]
The only thing that is noted is information about emergency and urgent care, and if you pay out of pocket, that's all.

Deborah: [00:04:34]
Okay, so it doesn't say where I was or anything.

Deshelle: [00:04:38]
It shows that you called to check about traveling and stuff like that. The initials of the state are MN.

Deborah: [00:04:46]
I'm sorry, honey, I'm sorry. The initials of the state as MN. Oh, Minnesota, I was at the Mayo Clinic in Minnesota. 
Okay. So the, I did yeah, because, I was trying to figure that out because I'm having trouble with Kaiser. 
They're saying that I never called, And I did. I mean that's my proof right there. when I called on the, you said, I think the 22nd,
I had just arrived at the Mayo Clinic, And I was trying to find out the protocol for what to do to get help, because I was  
really sick at the time, And I had been in Canada, And I couldn't get help here. And so for Mayo to help me, I had to travel 
across the border back into the United States. But anyway, that's all I needed. Honey, I don't have to explain it all to you, 
I'm sorry, but I just needed to know that you guys do keep a log. So I called that you wrote into that log or some Peggy 
wrote into the log that I was in Minnesota on February 22, 2022. And we did talk about me paying out of pocket and then 
filing claims or however, whatever you said.

Deshelle: [00:05:55] Correct.

Deborah: [00:05:56]
Okay, thank you very much. Deshelle, right Deshelle. Yes. Okay. Deshelle. Thank you, honey, for your time. 
So February 22, 2022. Does it have a time on it that I called? Because I think it was pretty early in the morning there.

Deshelle: [00:06:12]
Let me see. This was logged at 7:20 in the morning.

Deborah: [00:06:18]
7:20 in the morning. Okay. Thank you very much.

Deshelle: [00:06:22]
You're welcome. Is there anything else I can assist with?

Deborah: [00:06:25]
I just wanted to confirm that because we've been going around and around, and it's like I keep saying no, I called, and 
everybody keeps saying, well, you didn't get authorization. And I'm like, Well, I don't know if it was authorization. 
I was sick, and I called to let you know I was there. And I just remember she did instruct me. Peggy did tell me. 
She said, just give them your card and have them call us. And I don't even remember what was said or whatever. 
And I'm assuming probably with Mayo Clinic, they're like, no, you need to pay up front. And then, I think I did talk to 
someone about that later, and they said, well, you go ahead and you pay, and then you submit claims or whatever afterwards. 
But I just wanted to make sure because on February 22, I definitely was in Rochester, Minnesota, and that was the Mayo Clinic. 
And I knew I called, but everybody kept telling me I didn't. So thank you very much, Deshelle, for your time.

Deshelle: [00:07:19]
You're very welcome. And then, I know you said that you were told that you didn't call for authorization. I can also get a grievance 
submitted for a case manager for you.

Deborah: [00:07:27]
What does that mean sweetie?

Deshelle: [00:07:30]
I'm not sure what that means. Are we not paying the bill?

Deborah: [00:07:31]
Yeah, you guys, aren't paying it. It says something about it says deny, and then it says pre-authorization, and then it says members liability, 
or something like that, I mean we're talking, like, I don't know, somewhere around $100,000, I was pretty sick, And I had to have surgery. 
And, I mean I didn't go there knowing I'd have to have surgery, I went there, I just went there and thought, I'd be there for a few days, 
and they'd give me a pill, and I'd come home, and it just turned into a lot more than I expected. So after the first couple of days there, 
I thought, okay, my partner said I'll just pay out of pocket, and we'll figure it out later. We're thinking a couple of thousand or something 
like that. And we didn't expect it to turn into what it turned into. And like I say, by the time the surgery and everything, it was close to $100,000, 
and I don't have that kind of money. But it's very confusing on that pre authorization, because also somewhere in the guidelines, 
because I call really quick dishevel before I go for the thing.
Does it show that I called back?, I think it was back maybe November, December, because that's when I started looking for somewhere to go. 
And I remember contacting Kaiser, do you have a call during that time? November, December, that would be of 21, and it could have 
been January of 22, I don't know, I just remember when I started talking around, trying to find someplace to go to get help outside of 
Canada, because Canada couldn't help me because I wasn't a citizen And I had to go. And I remember Kaiser saying, well, you have to be 
in the United States, which I thought was crazy because I thought it was COVID it was like we were shut down here, I mean I couldn't even go across the border
for that two years. And I was very sick and they wouldn't let me out of it. And then I had gone out the country because I wasn't a citizen, 
they wouldn't have let me back in. And I was very sick And I was with my partner and I couldn't have been by myself, I needed him 
to take care of me and he was Canadian so they would have let him back in, but they would have not let me in. So I was terrified to go 
anywhere. It just was a real bad situation. And I guess I'm trying to get to the point to show that it was COVID there was a lot of 
things going on to show the world didn't work like we were used to the world working. And I read somewhere in Hawaii with the insurance, 
I think it's called DCCA or something oversees, it helps us with problems if we're having with insurance company. And it was saying, 
you need to be flexible to the insurance companies, I mean how much more flexible could somebody have been than to have been me and be 
in Canada, not be a citizen, can't travel across the border, be so sick. And they told me here they couldn't help me. They just said 
I mean I went to emergency room here and they just ruled out that it wasn't my heart, but they couldn't help me. So they said, you are sick. 
We're going to admit you are sick. We don't know what's wrong with you, but you're very sick and you need to probably go back to the 
United States and get help. So I started looking for the first place I could get to get help.
And at first the Mayo Clinic even denied me and said, we're not taking international patients. And I was like, whoa, whoa, wait. 
You don't understand, I'm a citizen of the United States. I'm not a citizen of Canada. So they agreed to take me. So I was so sick 
I would have given my first born child away, oh, I should say at this point, my grandchildren, I was just so sick. And it's just so 
hard to know you have insurance and then to have them say, well, no, we can't pay it because you didn't do this or you didn't do that. 
And it was out, and it's like it was COVID, for goodness sakes. We didn't have any choices. It was like you did the best you could do 
with what you had. And when you're that sick, you just want help. You don't even really think about the bills and this and that. 
You just figure, oh, it'll get figured out, I'm just sick, I need help. But anyway but you were saying about filing a grievance to 
do with what? Honey, I'm not quite sure what you meant by that.

Deshelle: [00:11:46]
So I know you said that they were getting some pushback in regards to paying the Mayo Clinic because they said you didn't get prior 
authorization. But you said you knew you spoke to someone and you were told the protocol was to just go pay and then be reimbursed or submit a 
claim. So what this would do, this will get forwarded to a case manager. A case manager would like to know what is it that you're 
requesting as your resolution? And then they'll look in to see what happened, and then they'll go ahead and follow up with you.

Deborah: [00:12:18]
Okay, yeah, you might as well, I guess. At this point, they've denied me twice. So I'm in the appeals process. The first time 
I submitted, I didn't even think about saying anything about this phone call I made and getting authorization. So in the second 
one, they said, well, no, you're denied because you didn't get pre-authorization, I said well, but I did, I called And I couldn't 
remember what date I called on, I said, I know, I called and I did exactly what she told me to do, which was to present my card. 
And she said, but if they don't pay it, you'll have to pay it, and then you'll file a claim when you get back. And so, like I said, 
I was very sick. So for me, that was good enough. It was saying, okay, I can move forward with this. Because like I said at the time, 
it was my partner, and he was paying it out of his pocket, and it was getting crazy, I mean it was $2000, it was $5000. It was another 
$7000, I think he was up to almost $20,000. And they hadn't even figured out what was wrong with me yet. That was just in the testing. 
And then about the next testing, that was $7,000. They went, here's your problem. You need to go to surgery right away.
So I did that, and then the surgery was $56,000 or something. You do what you got to do, I mean, I was very sick, and it was obvious, 
I needed surgery because I'm better now, now that they fixed the problem. So, like I said, for that two years during COVI, I just 
sat still. And, I mean I was suffering, I was so sick and frail by the time I got there. It was just awful. So if you think me filing 
something would help, I'm at this point, like I said, I've already moved on, I'm ready to file my paperwork with I think it's called DCCA, 
which is do you know what that is, I guess it's like a consumer's affair office for when the insurance denies you payment. Then 
it's almost like an arbitration, I guess, where you ask to resubmit your stuff and have somebody have a look at it. So I thought, 
well, it might help. I had that date showing that, I was in Minnesota. And I did call how the girl that instructed me what to do. 
Maybe that wasn't proper, I don't know. But I did what it said, I followed what it said to do, I called the travel line and said, 
okay, I'm traveling, I'm sick, what do I do? And, I did what she asked me to do.

Deshelle: [00:14:43]
Thank you. And that is correct. When you are away from home, you can be seen at emergency or urgent care and we do ask that if you pay 
out of pocket, just keep the receipts and submit claims.

Deborah: [00:14:50] I did that.

Deshelle: [00:14:53]
Or normally they may submit a claim on your behalf as well.

Deborah: [00:14:59]
Yeah, I see, I don't think they would do that because even after I got home and went to submit my claims, I forget a gentleman I talked to, 
I've got notes somewhere And I wrote all this down and he said, well, ask him to send it to us on this form. And he gave me some numbers 
of a form And I asked them to do that. And I don't guess they never did it because they haven't gotten paid yet. And now, of course, they're 
coming after me in collections and stuff because it's been several months.I don't blame them. They did the surgery And I'm much better for it. 
But no, I have my insurance company saying, well, you were out of network and well, you should have come back to Hawaii. And that was another thing, 
I couldn't have even gotten on a plane, I would have never gotten on a plane and flew 5 hours, I was coughing so bad. First of all, I was 
coughing so bad I don't think they would have let me on a plane. And it had nothing to do with COVID it was my stomach. But just to get to 
Minnesota, I had to take three flights because I couldn't be on a plane that long, I mean about as long a, I could last on a plane was about two, 
two and a half hours without going into the coughing, because I couldn't sit very long or lay down at that time. So I had to break it up into 
like segments and it ended up taking us what should have taken us 6 or 7 hours to get there ended up taking us three days, because after the flight, 
then I would have to stay in a hotel just different things because I was very sick. And it's just like nobody's ever really taken the time to 
listen to me about it or really hear my story, and it's just like I don't know what to do, I just know that right now I owe a lot of people a 
lot of money, And I don't have it, I'm 70 years old, I still have some issues, And I don't even know what to do to follow up on it, I plan on 
trying to get back to Hawaii in November, I'm hoping,I could usesome sunshine and some ocean. It would be nice, but hopefully I'll be better by then. 
But up till now, I just haven't been able to travel, I've been too sick.

Deshelle: [00:16:59] Okay.

Deborah: [00:17:00]
So do you think I would do a good to file that and have someone call me and talk to them about I mean it probably would be better 
to do that than get everybody involved, I guess maybe the main thing I try to say, Deshelle, is they keep saying, like, I didn't 
do that. And it's like if you say I called on the 22nd and we talked about Peggy And I talked about paying up front and then file a 
claim or this or that well, I can prove that on February 22, I was in Minnesota at the Mayo Clinic, I can prove that. So I feel like 
I did my part. Now, if it was something different and then it's kind of confusing to show.I don't even know if you know this or not,
 honey, but it's like s, I know in their guidelines somewhere, And I had read that, so I wasn't too worried about it, maybe. And then 
 I started thinking about it after I got there and the money was clicking along, I thought I better call them. But in there it said, 
 if you need emergency or urgent care, you don't have to get prior authorization.
So, I thought, well, this is an emergency, I didn't know I'd already gone to the emergency room here, and they said, you're sick. 
You need help, but we can't help you. So to me, it was urgent, I needed to get help because I sure thought I was dying. That's 
for sure.

Deshelle: [00:18:17] Okay. Yes.

Deborah: [00:18:20]
I'm sorry. Go ahead. Well, it's just a couple of times I have filed a grievance, honey. Nobody ever calls me and follows up on it. 
And I ask them not to send it to my home address because the mail is being held there, because we're in Canada still. 
We've been here since COVID So my mail is being held. They were supposed to correspond with me electronically, like I said, 
right now, plan on being back in November, I think I should be well by then, that I can go home. But if you think filing
another thing and getting someone's attention but I'm getting down to that timeline where I need to file with that DCCA. 
But if somebody from Kaiser would at least listen to all of this and check and realize I did call on the 22nd. 
You have proof of that? That I did. Now, I've also noticed a couple of times since then I've called about getting help because 
I'm still here in Canada And I can't get help here, I need to go across the border. And now we can because the COVID part sort of 
calmed down. But it's like no one can really tell me the protocol, what to do, I went through three people, I went through care, 
and then she put me over to Tracy, and then Tracy put me over to Jerry, and it's like nobody could really tell me what to go 
do you know what I'm saying? It's sort of like they want us to do certain things, but yet when I call in, you've been very 
knowledgeable. Thank you. But a lot of people don't seem to know how to direct me as to what I should do.

Deshelle: [00:20:05]
Okay. Yeah, I would recommend the grievance since you have did your claims twice and they were denied. So a case manager can 
just look into this as well. And then I am noting that you do want someone to call you.

Deborah: [00:20:20]
Yeah, that's what happened the last time I kept seeing them, and the time was ticking by, and it said they were supposed to 
answer me in 30 days after they received my documentation or whatever. And it was almost 60 days. And I'm thinking, 
jeez, they don't even live up to their own protocol. They yell at me for not doing something. And it's like they say, 
30 days. And they say, oh, well, we sent you by mail. And I said, But I told you everything had to be electronic because,
I'm not at my home to receive mail right now. But I called and called, I mean I must have called six times. And then I sent 
three or four emails, And I kept all that and documented it so I could prove it. And like you say, if you have someone call me, 
I can show that I did that, I just sort of feel like Kaiser kind of didn't live up to their end of things either. 
They can't on one hand tell me, well, if it's urgent care or emergency, you don't get have to get prior approval. 
And then to me, it was definitely urgent care, I mean I think any doctor they would talk to would tell you, I was real sick, 
so I don't know how much more urgent it could have been than that. They may not have liked the choice of where I went, 
but like I said, it was COVID, I did the best I could do with who would see me.

Deshelle: [00:21:23]
Yes, ma'am. Completely understand. So would you have a grievance or complaint against anyone or is this just general?

Deborah: [00:20:20]
It's just in general that they just keep denying me, but it's like they don't seem to want to know why, I don't know, 
I just feel like nobody really took the time to dig into, and maybe when I told my story the first time,
maybe, I was too emotional instead of being factual. When you owe us $100,000 and you're like, wow, what am I going to do 
with this? And I was really sick. It's not like I'm making it up, I was very sick, I needed surgery, I got surgery. 
They can check all of that out through the Mayo Clinic,
I mean I needed help. And you go somewhere like that, they have their protocol, I can't tell them how to do it. Believe me, 
I didn't want to keep paying all that money to do all that testing, I didn't want to do it at
all, I just wanted to give me some medicine, let me go home. But it didn't work out that way so,I guess, yeah, I mean 
maybe if somebody could look into it a little bit deeper than what they are and actually listen to the story like you say 
you put in there. Yeah, I did call on the 22nd, And I was in May, and like I said, I can prove I was at the Mayo Clinic at 
that time.

Deshelle: [00:22:46]
A case manager would like to know, what is it that you're requesting as a resolution to just get the medical bills paid.

Deborah: [00:20:20]
I mean I owe a person, like, I don't know, $25,000-$30,000, and we have the bills and shows he paid them, and it's not his 
responsibility to pay my medical bills. But he knew I was very sick, And I don't think he expected it to be that much. 
And then the hospital bill was like I said at first, the hospital bill was $65,000. They brought it down to $56,000, and it's
still outstanding. And that was in March, and this is now September. That's a long time. Mayo Clinic don't usually take 
people just to take people. They really had to scrutinize me to let me in, and they had to realize I was really sick and 
wasn't getting help anywhere.

Deshelle: [00:23:50]
Thank you. And then when you are home in Hawaii, where do you normally go, which clinic?

Deborah: [00:23:57]
I go to Kona, I'm actually looking forward to seeing Dr. Breville and go get all my mammograms and things done, because 
I haven't had a mammogram, I haven't had anything since, I've been in Canada, I haven't had a mammogram since lockdown. 
Well, I arrived here in September,
I think, right around the lockdown time and stuff. Like I said, I wasn't a citizen, so I'm not a priority, you know what 
I'm saying? And they were telling us anyway, unless it was emergency during COVID they didn't want us going nowhere. 
Mammograms weren't being done, PAP smears weren't being done. None of that stuff was being done. So I haven't had anything for, 
what, almost three years? Thank God I'm old and probably and past all those things.

Deshelle: [00:24:49]
So I'm going to go ahead and get this submitted for you and then I have a good contact phone number for you.

Deborah: [00:24:54]
You do? Okay. Yes, it's my cell phone. It's 808-633-3512. Thank you. Yeah, I mean it would be nice to have someone to talk to. 
like I said, I'm running out of time. According to Kaiser's things, you have to have all this done, I think, within 180 days, 
I mean I'm not real sure I said after their last And I only have 60 days, which I think that puts me about the 1st October. 
But I want to get it moved along, I feel bad that,I owe someone that kind of money And I just don't want to miss the timelines. 
But when you're sick and you're trying to do all of this and you can't get anyone to listen. So I would like someone to at 
least call me. Even if they say they deny it again And I need to move on and go ahead and go on with DCCA, I will do that. 
But if you think that someone now that we've proven that I did call on that date, maybe once they know that, they'll understand. 
And like I said, I just think it's sort of hard for Kaiser to try to hold everybody to such a line of protocol. It was COVID 
none of us knew how the world was working. No matter where we were, nothing was working the way we were used to. 
I mean we were all afraid of each other. Think about that. Especially if you were my age.

Deshelle: [00:26:28]
May I have you verify your home address and then I'll get this submitted for a case manager.

Deborah: [00:26:34]
Oh, gosh, I can't even think of it right now. Do you have it? Well, you know what, I don't want them to send me anything 
though, because I won't be able to get anything. It's fine, but I don't want them to send anything to that address.

Deshelle: [00:26:54]
Right, I noted that you were still in Canada and that you want someone to call you.

Deborah: [00:27:02]
Yeah, I know it's at all. Okay. Yeah. Just because they're holding the mail and stuff And I wouldn't get it. He doesn't 
pick it up that often because it's so expensive to have it sent here. But it's 68-1376 S. Pauoa Rd. It should be the same address. 
P-A-U-O-A Road, #C21, Kamuela 96743 but yeah, please put in there to not send I won't get the mail. And I think that's what
happened with the response to the when I filed my claim. And I kept thinking, why haven't they sent it to me? 
And they said, oh, well, we sent it on this date. And I said, but you were supposed to we had been correspondent 
electronically because everywhere I've told everybody and even the stuff I sent them by snail mail, I said it was from 
Canada, and they even returned some stuff to me from Canada to Canada so they knew I was here. So for them to send my 
answer to my home address didn't make any sense.

Deshelle: [00:28:05]
Okay, I did submit the grievance for a case manager to also look into the situation. With your denials and your request 
to have your medical bills paid.

Deborah: [00:28:17]
Do you put anything in there, kind of like the fact that I had called on that date. Do you put that in there?

Deshelle: [00:28:22]
Yes, I noted that information.

Deborah: [00:28:30]
Thank you very much, I think that's important because I keep saying I didn't do it, And I'm like, yes, I did. Yes, I did. 
Thank you so much. You have been more helpful than anyone I think I've ever talked to at Kaiser. Thank you very much.

Deshelle: [00:28:45]
You're welcome. And is there anything else I can assist with at this time?

Deborah: [00:28:55]
No, I think that's all, honey. like I said, I guess I don't want to wait too long for someone to at least call me. 
Even if they say no, we're still going to deny it. And you need to file with DCCA on the whatever. The consumer affairs thing. 
Just let me know because I don't want to start drawing that up, because it's going to be very time consuming to document 
all these dates and all these different things, I didn't make some recordings of some conversations that I had with 
people a few times because I didn't want to get in that situation again when somebody said, well, you didn't call us, 
And I'm like, yes, I did. Unfortunately, I didn't on that first call. You know what I'm saying? And that's why I needed 
that date, because I knew that I had called, I mean I could have gone back to my phone records, but I just didn't feel like 
doing all that. So that's all to show I'm sorry, honey, to keep running on, but I guess I get nervous and start talking too 
fast and too much because I feel like I just got to get my story out there. It's like so much money and it's so much pressure, 
and it's causing me a lot of anxiety to owe that kind of money.

Deshelle: [00:29:51]
Yes, completely understand. So hopefully the case manager can get this situated or help get this and know all the 
information that you did do your due to.

Deborah: [00:30:03]
Thank you very much, sweetie. Yeah, I mean I'm 70 years old, honey, I don't know where I'm going to get that at this age. 
Okay. Thank you so much for your time. You are very helpful.

Deshelle: [00:30:22]
You're very welcome. And thank you for calling Kaiser Permanente. You have a nice day and take care.