Kaiser Makes Millions Denying Members Psychotherapy, Patients Say
11-12-2013 23:49:00
LOS ANGELES (CN) - Kaiser Foundation Health Plan collects money for treating mental health patients, but sends them somewhere else to get help, alleges a woman in a Los Angeles County Superior Court class action complaint.
Lead plaintiff, known only as “D.E.,” suffers from Bipolar Disorder. She says Kaiser illegally denies “medically necessary” weekly psychotherapy sessions it is obligated to provide under the California Mental Health Parity Act and the Affordable Care Act.
“Kaiser does not provide such psychotherapy and instead directs its members to receive weekly psychotherapy outside of Kaiser from government funded or community funded clinics. Kaiser is ignoring its contractual and legal obligations to pay for this treatment, reaping huge profits, and forcing the taxpayers and its members to shoulder the cost of treatment that Kaiser is paid to provide,” according to the complaint.
D.E. says Kaiser is making big bucks while patients with mental illness suffer.
“Kaiser’s illegal practice is hurting people with severe mental illness who desperately need regular and consistent individualized psychotherapy, forcing such people to pay out of pocket for such services at the same time they are paying Kaiser’s premiums, and overburdening government and community clinics solely to increase Kaiser’s profit margin,” the complaint states.
D.E. claims Kaiser even admits it does not provide long-term care for patients with mental illness.
“Kaiser unequivocally admitted that ‘we do not offer long-term individual psychotherapy’ regardless of a member’s need. Kaiser further states that it does ‘not begin treatment with individuals whose problems are of such a long-term nature that short-term treatment would probably not be helpful (such as chronic mental illness, lifelong personality problems etc.)’ Instead, Kaiser admits that it ‘will refer such individuals to an appropriate non-Kaiser facility, although this treatment will not be a Kaiser covered benefit and will not be paid for by Kaiser,’” according to the complaint.
The complaint adds that Kaiser’s own clinicians have recognized the company’s profit-maximizing practices and that there is insufficient staffing to provide patients with timely return visits. D.E. says it sometimes takes over a month to get an initial appointment and then several weeks between appointments, and that many patients are “pushed off” into group therapy.
She said getting help outside of Kaiser is problematic because the waiting time to get an actual session at a non-Kaiser clinic takes between one to three months. D.E. asked a Kaiser therapist if it would be possible to schedule appointments at other Kaiser facilities to fill in the gaps, but was given a list of private therapists she would have to pay for out of pocket.
“Kaiser misleads persons with severe mental illness into paying Kaiser to provide mental health treatment for their conditions, but while Kaiser accepts millions of dollars a year from such subscribers, it has created a system of delay and misdirection so as to avoid its promise to provide necessary psychotherapy. Kaiser has successfully reaped incredible profits by unlawfully pushing people with mental illness into government run and third party run low cost clinics, and providing insufficient access to mental health clinics so that weekly, individualized psychotherapy is impossible for subscribers to obtain,” the complaint states.
Plaintiff is suing for violation of the California Mental Health Parity Act, the California Health and Safety Code, the California Insurance Code, for unlawful business practices under California’s Unfair Competition Law, breach of implied covenant of good faith and fair dealing, and breach of contract.
Scott Glovsky and Ari Dybnis, in Pasadena, represent the class.
