(image attribution: iStock.com/clearstockconcepts)
Kaiser Permanente Insurance Co. was hit with a class action lawsuit in California on Tuesday, alleging the company of strong-arming the most disabled psychiatric patients into canceling their plans with the large insurance provider.
Plaintiffs Douglass Kerr and Matthew Szitzkar-Kerr allege in their class action lawsuit that psychiatric patients who are covered by Kaiser’s insurance plan are told by Kaiser that they will only receive care if they cancel their insurance. Then, allege the plaintiffs, psychiatric patients become uninsured and eligible for public assistance, including Medicare and California’s Medicaid program “Medi-Cal.”
The lawsuit was filed in September but KP is shamelessly continuing the practice, as evidenced by the following denial letter, dated October 18, 2014, that was posted to our Facebook Page by a family member of a patient unrelated to the lawsuit. You can read the entire letter by clicking on the images at the bottom of this post, but this is the meat of it:
We denied this request because it is not a covered benefit of her Plan with Kaiser Permanente. Our review determined that your daughter’s treatment team at the Kaiser Permanente Los Angeles Medical Center Hospital has considered transfer to an IMD facility for further management. However, the IMD is requiring that your daughter be disenrolled through her coverage with Kaiser Permanente so that the services will be covered by Medi-Cal as her primary coverage.
First of all, so much for KP’s old and tired claim that health care decisions are only made by doctors. The patient’s treatment team recommended transferring her case to a facility that provides services that KP cannot accommodate in-house (long term hospitalization). Health plans in California are required by law to provide mental health care coverage, but because it is more expensive outside of the Kaiser system, as they can’t pinch every penny at the expense of the patients, they are trying to intimidate members into dropping their Kaiser coverage so Medi-Cal (California’s version of Medicaid) will have to pay.
Of course, as always, they attempt to deflect responsibility as they have done here by claiming, “…the IMD is requiring that your daughter be disenrolled,” when it has done no such thing. A more honest way to word that would be, “..the IMD requires payment for services rendered, and because KP is refusing to pay, Medi-Cal is your only other option.” Another lie, because when the grievance was turned over to the California Department of Managed Health Care, Kaiser suddenly agreed to pay (within the last few days), but only AFTER subjecting the family to wasted time and multiple denials, apparently hoping they would just go away.
Do you suppose that miraculous change of heart had anything to do with recent sanctions and fines for similar shenanigans?
Gotta love the “We’re here for a HEALTHIER you” at the top of the letterhead. They should add, “as long as we don’t have to pay for it!”
I went to Kaiser E.R. Riverside suffering from mental confusion and was put in a exam room for 1 hour by myself. No nurse or doctor ever came.I had been admitted to the hospital.I WALKED OUT. THEY DIDNT MISS ME.OR DID THEY CALL TO SEE IF I WAS OK. IM AFRAID TO GO BACK TO THAT HOSPITAL.
My husband, who suffers from . A million serious mental illnesses, (stay off internet dating sites ladies) was supposedly being treated by Kaiser Permanente mental health in Georgia. I found out they were doing absolutely nothing and knew nothing about the real person he was. It took a doctor in one of their horrible “approved” mental health facilities to diagnose his serious mental illnesses. He tried to strangle me one night (police were involved) and then he stabbed me with a pen (back in another mental hospital). I hate Kaiser. This past winter, he was in one of their mental hospitals again and they sent him home to me with no notice and NO MEDS!! A horrible storm was bearing down on us at the time and when I went to the closest Kaiser, they only had one med!! Had surgery to remove a blood clot thing this summer…the so-called surgeon cut in to me and I could feel everything..I was screaming in pain. You should see my arm. And now I can’t use my right thumb..I’m going to sue Kaiser in 2015!!
By the way, Kaiser had my hubby under mental health care for 14 years.
This is a common letter in California. It is a bit of a cluster, yes, and unfortunately kaiser doesn’t know how to convey messages like this tactfully. Read the letter again… Kaiser CAN provide care under the insurance plan, but kaiser IS NOT equipped to handle long term in-clinic psychiatric patients. So, in order for the patient to get the best care possible, ( because kaiser can’t handle complex mental health problems ) they are referred to an outside treatment center. The reason why kaiser gives a denial letter is so that the PATIENT doesn’t have to fit the bill for treatment since treatment is very expensive. I’d also like to add that the STATE, (state of California) requires a medical provider to deny coverage (simply because they can’t provide the needed treatment) in order for the patient to be covered by medi-cal/Medicaid. If kaiser was passing the buck and dumping this case off on “taxpayers”, they would have never referred the patient to an outside facility. Because by reffering them to the outside facility and denying coverage the patient can have the treatment covered by medi-cal/Medicaid, which by the way is NOT paid by taxpayers. It’s paid from a fund that is set up from the govt.
And where does this magical government fund come from? Government is funded by the taxpayers.
As for the rest of it, it is my understanding that when Kaiser is required to provide certain coverage but can’t accommodate, it must pay for outside treatment. They did in fact agree to pay after the complaint was turned over to the Department of Managed Health Care. If the state required KP to deny the coverage as you say, the DMHC wouldn’t have made them pay. Kaiser shouldn’t be allowed to get away with paying for some and not others depending on who complains the loudest. The class action lawsuit should take care of that.
I think what you’re referring to is something the father explained to me as Medi-Cal sometimes being the payer of last resort, but I don’t think it applied in this situation, and even if it did, that shouldn’t have required him to drop his daughter from his coverage completely.
Kp diagnosed me w/ fibro, chronic pain and ptsd but will not treat me for pain or depression… they instead brought in a cop to sit in on my dr. visit w/ a paranoid Dr. Kleinman in Salmon creek, wa.
After my primary care provider suggested a psych evaluation, I met with a psychiatrist at the Santa Ana medical office. His first question to me was the reason I was there. I stated the reason was because my primary suggested and made the initiative for me to be there. Dr. Kerly (sp?) then reworded his initial question and asked “Come on, you’re a smart guy. What’s the real reason you’re here?” So, I informed the psychiatrist of a book I published in 2012 about a homicide and the medical/ real estate fraud being committed against the estate. I continued, “I deliberately exposed the real identities of high profile politicians involved and covering it up so it appears as if the real reason I am here is because there might be an effort to misdiagnose me with having a clinical condition.” At the time I had (and still have) a pending SS Disability claim caused by a defective hernia patch used to repair an inguinal hernia, 6 months after the product had been recalled. At the end of evaluation Dr. Kerly (sp?) gave me a proposition. He said “I [Dr. Kerly] can put you on permanent disability today–” I cut him off and interjected “Except my mental health is above average and my disability is not psychiatric, it is a physical disability.” He didn’t like my answer and to make a long story short, about 10 inappropriate CT scans later, now I have two large masses on both testicles, one of which is growing at an alarming rate that is causing unbearable pain. St. Joseph’s is scared to touch me and I may have permanent kidney damage from a drug I told them, would damage my kidneys. After 6 months of asking for treatment options aside from that particular drug, Kaiser refused to give me alternative treatments options and now that my blood/urea is reaching dangerous levels I am refusing to stop taking the drug because at this point what’s worse: death and no more suffering, or living the rest of my life praying for death?
Bonafides:
I paid my first premium to Kaiser in 1977. it is 80/20 with them. In psychiatry 40/60.
1. My teenage child with suicidal ideation sits on a Kaiser waiting list and will soon see their (?SW intern?)/therapist for the 2nd time in 8 months.
2. My autistic 20 year old with a speech defect was denied speech therapy by Kaiser at age 10 because his condition could not be improved in 6 weeks.
The issue:
I have worked in acute care psychiatry for > 20 years. In LA County (and others) the wait time for an IMD bed is rarely less than 6 months. Those who get accepted have already been conserved (WIC 5150) and must be inpatient for that.
This case sounds like a shell game. No way n IMD would accept that patient. Further Kaiser contracts with local private hospitals to provide psychiatric care for their clients. It is amazing that they never seem to have thought to contract with any IMDs. The very private hospitals they use are the sources for IMD admissions so this story sounds fishy.
Kaiser members beware!!!! I am a retired Kaiser employee. My daughter has been a kaiser patient since birth–20+ years. She has consistently been under treated by the Kaiser mental health services – including when she has been suicidal twice. i.e. offered an out patient appointment 2 weeks out after crisis team assessment for a new suicide attempt with ongoing suicidal ideation. That 2 weeks out appointment then was cancelled by an automated message in which she was told to call back to reschedule. After 2 more suicide attempts and a trip to a community crisis clinic and to an out of network ED per a community officer 911 transfer, my daughter was required by Kaiser to again be assessed by a Kaiser MD to determine her need for hospitalization. She was then set up for a weekly OUTPATIENT therapy appointment and a IOP outpatient group 3 x weekly! Her Kaiser therapist confirmed to her that she was ‘not appropriate for out patient therapies, under the circumstances’, but stated that Kaiser does not provide, NOR refer to residential treatment programs. I ask if it is any wonder that Kaiser mental health patients resist going to Kaiser for mental health helps. There is a strong Kaiser posture of lack of care and concern. Mental health patient do NOT ‘thrive’ at Kaiser. A Member Services rep, suggested that we find my daughter another insurance provider after hearing the details. We are now upward of $100,000 in out of pocket expenses for appropriate level of treatment for my daughter’s crisis and illness. We will recoup one way or another! We are currently in the appeals process for reimbursement and appropriate referrals to comprehensive DBT Programs which include residential and outpatient therapies. NOTE: Kaiser states they offer DBT skills groups. Beware! they are not trained in DBT Program, nor do they offer the complete, effective DBT program. Marsha Linehan, founder of the DBT Program has provided researched evidence that after 2-5 years of appropriate level DBT Program therapy, patients are no longer found to have the traits and dysregulation episodes leading to recurrent suicidal episodes. I ask why would Kaiser-a major HMO insurance force in the US NOT want to provide this complete program. If they looked at the $$$ that might be saved (aside from the lives that might be saved) – perhaps they would change their coverage – or, better yet, send a group of therapists for training and set up their own complete and effective DBT treatment program!
Mr. Mc Mullins,
Kaiser keeps care away from paying clients, particularly young people on purpose. I have experienced this myself as well as seen other young people go through this, it is a breach of contract, am I right?
Kaiser is still doing this. My fiance is on Medi-Cal and they are denying her a much needed PHP program because of the county we live in. If we lived in the next county over she would be able to get it. This makes no sense