Kaiser Faces Scrutiny For Denying & Delaying Mental Health Services

California’s largest HMO provider, Kaiser Permanente, which provides health coverage to more than 7 million members is under scrutiny for reportedly engaging in bad faith insurance practices by denying or delaying mental health services.

According to the National Union of Healthcare Workers (NUHW), Kaiser repeatedly either denies or delays mental health services, including treatment for depression, autism, anxiety, bipolar disorder, schizophrenia and suicidal thoughts.

For their research, the NUHW surveyed hundreds of California Kaiser Permanente clinics, analyzed court documents and took into account patient experiences. Researchers found that the lengthy delays of receiving services forced many patients to either go without care or pay for treatment on their own at a different facility.

Kaiser Permanente’s Bad Faith Insurance Practices

The NUHW study found that Kaiser Permanente fails to comply with California laws, which state that patients must receive “timely access” to services. Researchers found that Kaiser Permanente patients were often required to wait four weeks or more for follow-up appointments regardless of the California law that mandates a maximum wait time of 10 business days for both the initial and return visits.

Delays for scheduling appointments may be the result of understaffing. According to 300 surveyed Kaiser Permanente clinicians, 90 percent responded that there were not enough employees at their site to provide patients with timely return visits.

In addition, more than 75 percent of those surveyed stated that they “frequently” or “very frequently” are “forced to schedule return visits further into the future than you believe is appropriate.”

The delays and denials of mental health services at Kaiser Permanente occurred despite obtaining more than $10 billion each year from Medicare in order to provide services including mental health to California patients.

NUHW researchers found that in order to avoid being cited by California regulators for the delays of services, Kaiser Permanente clinicians reported that they deliberately miscategorize appointments or falsify appointment cancellations in order to stay under the legal radar.

In addition to these bad faith insurance practices, Kaiser Permanente reportedly instructed clinicians in San Diego to spend only half of the amount of “recommended” time to assess and diagnose a patient.

However, NUHW says that speeding up an evaluation can have serious consequences, including misdiagnosing a patient’s condition.

While it is known to occur in San Diego, NUHW reports that interviews with other California clinicians suggest that Kaiser Permanente may be encouraging this bad faith insurance practice at other sites.

Kaiser Permanente has been cited multiple times in regards to substandard care and delays in mental health services. In 2010, Kaiser Permanente was fined $75,000 for delaying a pediatric autism diagnosis for nearly 11 months.

NUHW states that “Kaiser’s substandard care also comes at the same time that the HMO is reporting record profits.”

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
• 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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