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Kaiser Health Plan Class Action Lawsuit Overview:
- Who: Kaiser Foundation Health Plan, Inc. and Kaiser Foundation Health Plan Northern California Region face a class action lawsuit lodged by wheelchair users.
- Why: The plaintiffs say the company has denied meaningful coverage of wheelchairs in violation of federal law banning discrimination by health plan providers.
- Where: The lawsuit is pending in California.
Kaiser discriminates against people with disabilities through offering measly and inadequate wheelchair coverage in its health plans, a new class action lawsuit alleges.
Plaintiffs Grace Smith and Russell Rawlings — both people who use wheelchairs — filed the class action complaint against Kaiser and the California Department of Managed Health Care (DMHC) Oct. 7, alleging violations of the Affordable Care Act and the Employee Retirement Income Security Act.
The plaintiffs say the department has broken the law by excluding wheelchairs as an essential health benefit, and Kaiser has violated the law through denying meaningful coverage of wheelchairs in its health plans.
Kaiser Health Plans Leave Wheelchair Users Stranded
Smith and Rawlings are people with disabilities who are enrolled in a Kaiser health plan in California. They’re looking to represent other California residents covered by Kaiser who have been denied wheelchair coverage.
The pair say they require wheelchairs due to their disabilities, but their Kaiser health plans either exclude or place a $2,000 annual limitation and “home use” rule on the coverage of medically necessary wheelchairs.
They say the actual cost of a wheelchair can exceed $40,000 — meaning people with disabilities must either seek alternative sources of health insurance coverage, pay the remaining cost out-of-pocket, or go without the mobility device that they need.
“This can leave individuals bankrupt, immobile, and/or resorting to the use of an inferior or broken wheelchair that puts their health and safety at risk,” the class action says.
Smith says she urgently needs to replace her 9-year-old wheelchair and needs to pay $15,000 out of pocket under her Kaiser health plan. Rawlings needs $8,000 to replace his 8-year-old wheelchair.
The plaintiffs are seeking injunctive relief requiring DMHC and Kaiser to amend their wheelchair policies and practices in order to achieve compliance with federal laws.
“These changes are necessary to remedy violations of law and ensure that persons with disabilities have access to the equipment they need to move around, leave their homes, maintain employment, and participate in their communities,” the plaintiffs say.
They are asking a judge to certify the class action, and provide for fees, costs and a jury trial.
Insurance providers have been accused of discimination as well In September, Aetna Inc. was accused of discriminating against LGBTQ customers by offering health plans that fail to provide equal access to fertility treatment, according to a class action lawsuit.
What do you think about the Kaiser health plans’ lack of coverage for wheelchairs? Let us know in the comments!
The plaintiffs are represented by Ernest James Galvan and Michael S. Nunez of Rosen Bien Galvan & Grunfeld LLP, and Carly A. Myers, Claudia Center and Silvia Yee of the Disability Rights Education and Defense Fund.
The Kaiser Health Plans Class Action Lawsuit is Smith et al. v. Watanabe et al., Case No. 3:21-cv-07872, in the U.S. District court for the Northern District of California.
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