Bad Faith Insurance: Kaiser Report Alleges Gaps in Mental Health Services

California has been ahead of the curve on mental health services when it comes to insurance coverage.

Though these changes have only recently begun at the national level, California mental health laws dictate that patients have “timely access” to appropriate mental health services.

However, the National Union of Healthcare Workers (NUHW), a labor union of thousands of medical professionals, released a report alleging that insurance giant Kaiser Permanente had dropped the ball on certain mental health services.

The NUHW report makes a variety of serious bad faith insurance allegations that Kaiser Permanente has dodged the rules.

Bad Faith Insurance Allegations

Among the key bad faith insurance allegations from the 2011 NUHW report are that “Kaiser [Permanente] often violates California laws requiring HMOs to provide patients with ‘timely access’ to appropriate mental health services,” “Kaiser reportedly falsified patient scheduling,” and the union further alleged that Kaiser Permanente’s efforts ultimately added up to “substandard care.”

The allegations regarding California mental health law and the provision for “timely access” involves a regulation stating that there is a maximum legal wait time of 10 business days for most types of mental health appointments unless a medical professional says that a delay will not worsen the patient’s mental health issues.

Nearly 90 percent of the respondents to the NUHW’s survey reported that clinics had insufficient staffing, and that group orientation sessions were often substituted for initial mental health evaluations.

The NUHW report also makes serious allegations that Kaiser Permanente maintained a “shadow” set of records that “deliberately miscategorized appointments” and included “false appointment cancellations.”

Allegedly, Kaiser Permanente would record that patients in need of mental health services canceled their appointments to officially explain delays to hide excessive wait times that violated California law.

Further, bad faith allegations hold that Kaiser Permanente would encourage various types of substandard care for people suffering from mental health issues.

This included allegedly “performing initial patient evaluations and other mental health standards that not only fall short of recommend clinical standards, but are coded incorrectly and possible in violation of Kaiser’s contracts with both private and government purchases.”

That included allegedly having clinical workers spending half as much time evaluating patients as recommended, and funneling patients into group therapy when individual therapy would be more appropriate.

The NUHW report holds that Kaiser Permanente’s bad faith insurance practices surrounding mental health issues are “part of an ongoing pattern of substandard care.”

The NUHW has a history of conflict with Kaiser Permanente, including a near-strike in 2013, two years after the report on Kaiser’s handling of mental health services. The report calls for action from both state and federal agencies.

The NUHW report was based on surveys from workers with Kaiser Permanente’s psychiatric and treatment facilities. Researchers also had “unstructured conversations” with Kaiser Permanente patients from California by telephone and email. Researchers also drew from a review of medical research papers to put their results into context.

The study’s authors then turned to statistical analysis to evaluate the results of their survey. The report listed comments from patients, some of who described their dealings with Kaiser Permanente as a “fiasco.” Kaiser employees stated that their workloads and backlogs were such that providers felt guilty if they took more than a week off at a time.

Join a Free California Bad Faith Insurance Lawsuit Investigation

A bad faith lawsuit investigation has been launched into allegations that some California insurance companies are refusing to pay valid medical claims or offering to pay far less than the claim is worth. Some of the companies being investigated for potential violations include:

• Aetna
• Anthem Blue Cross
• Blue Cross of California
• Blue Shield of California
• Cigna
• Health Net
• Kaiser Permanente
• Secured Horizons
• United Healthcare
• WellPoint
• Others

If you or a loved one were denied coverage for autism treatment, mental health treatment, plastic surgery skin removal after weight loss, proton therapy for cancer, or some other medically necessary treatment, you may have a legal claim.

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