Woman Claims Kaiser Denied Her Proper Treatment For Depression
By Matt Reynolds
2-16-2013 01:31:00
LOS ANGELES (CN) - A woman claims in court that Kaiser Foundation Health Plan violated California's mental health laws by declining her request for residential treatment for manic depression.
The plaintiff, who calls herself “Carly M,” claims that though she had a history of depression and binge eating Kaiser repeatedly refused her requests for residential treatment by claiming her plan did not cover it.
She also says that after she reported that a typical binge included more than 40 chicken wings and two fast food meals, Kaiser told her that “'wasn't too bad.'”
Kaiser representatives questioned her commitment to getting well, and refused her request for residential treatment - even after she told them she was suicidal, the 8-page complaint adds.
The woman says that “with the help of family and friends” she was eventually admitted into a treatment center in Logan, Utah and again asked Kaiser to authorize care under her health plan.
“On October 19, 2011, defendant denied the request on the grounds that the treatment is 'not a covered benefit.' Plaintiff appealed the denial. Defendant upheld the denial on appeal,” the lawsuit states.
She says that Kaiser was required to provide her coverage for major depression under the California Mental Health Parity Act, “despite any purported lack of coverage in the plan.”
She states that she was forced to pay her medical bills out of her own pocket.
“Due to the wrongful conduct of defendant, plaintiff is entitled to enforce her rights under the terms of the plan and to clarify her rights to future benefits under the terms of the plan,” the complaint says.
The plaintiff is represented by Lisa Kantor with Kantor & Kantor of Northridge, Calif.. She seeks payment of health insurance benefits and payment of prejudgment and post-judgment interest under the Employee Retirement Income Security Act.
Kaiser did not immediately respond to request for comment.
