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Kaiser Permanente denying its members appropriate mental health care.

April 18, 2013

I read a disturbing article on Medscape yesterday about the situation with the Kaiser Permanente HMO in California.  The company has been cited by the California Department of Managed Health Care (DMHC) for its actions covering up the HMO’s failure to meet the requirements of the state’s “timely access” law.  KP kept separate paper records for instances in which patients called for appointments for mental health care and were placed on a waiting list or told to call back.  When a patient called and was able to make an appointment, this call was recorded in the electronic medical record.  KP of course denies wrongdoing.

The DMHC also sited Kaiser for other violations including providing it’s HMO members with “inaccurate education materials” which implied that the limits on mental health care benefits were more restrictive than permitted by law and “may have discouraged some enrollees from seeking and accessing medically necessary behavioral health services.”  These problems have evidently been going on for quite some time.  A November 2011 article in Huffington Post, “Kaiser Permanente Makes Billions in Profits While Overburdening Staff,” describes KP’s shoddy and deceptive practices, including forcing patients to wait weeks for appointments, providing inadequate new patient evaluations, and shunting patients into group therapy when individual therapy is indicated.  The Post cites findings of a report by the National Union of Healthcare Workers.

These alarming allegations and government oversight findings are likely the tip of the iceberg.  In my opinion, it is dangerous to allow an insurance company to also run the health services it requires its members to use.  I experienced this kind of abuse myself many years ago while a member of the Prucare HMO.  I was seeing a psychiatrist at the only psychiatric practice the plan covered. Routinely the doctor would order follow up in a certain amount of time, for example two weeks, and when I went to the appointment desk to schedule I would be told the wait for a follow up appointment with my doctor was many weeks longer than what he had recommended.  When I complained to the doctor, he said he had no control over that situation.  Eventually I gave up using the psychiatric services offered by my plan.  I did my psych follow up with a primary care physician who really did not have the expertise to manage my medications but was able to write for refills for my ineffective regimen.  I sought psychotherapy from an outside therapist and paid out-of-pocket.  This bad experience has left me leery of using insurance to cover my psychiatric care.  I have paid a psychiatrist who does not take insurance out-of-pocket for many years and have found her to be the most knowledgeable and thoughtful psychiatrist I have ever seen.

The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) is a federal law requiring insurers to cover mental health and addiction treatment at a level equivalent to the coverage provided for other medical care.  Here is an excerpt from the United States Department of Labor fact sheet:

The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) requires group health plans and health insurance issuers to ensure that financial requirements (such as co-pays, deductibles) and treatment limitations (such as visit limits) applicable to mental health or substance use disorder (MH/SUD) benefits are no more restrictive than the predominant requirements or limitations applied to substantially all medical/surgical benefits.

This law has made it much easier for people to obtain needed mental health care both from a cost perspective and in terms of limitations of treatment.  Mental health care is just as important as other aspects of health care that we take for granted, such as being able to see a doctor for the flu or for high blood pressure or a broken leg.  Shame on Kaiser and the doubtless many other companies seeking to skirt the intent of this and other patient advocacy laws.  One of the main problems in our health care system and a huge drain of money and resources is this monster network of insurance companies and the accompanying regulatory bureaucracy we have created.  As long as we have profit makers in charge of our health care, we will continue to experience ever upward spiraling costs and fraudulent actions which drain resources from all of us and deprive us of the care we should be able to get here in the United States.  As someone who has worked inside the system, I have seen the results too many times: people putting off care because of cost, sometimes suffering much worse health consequences as a result.  I feel helpless watching this situation and listening to the rhetoric bandied about by politicians (who incidentally usually have great health coverage).  I don’t know what kind of catastrophe it will take to change things.  It seems like that is the only thing that will get the attention of people in power.

4 Comments leave one →
  1. April 18, 2013 9:45 am

    Oh, my. This post gave me painful flashbacks. When my husband completely collapsed 18 years ago with multiple mental illness diagnoses, we were members of Kaiser Permanente. The extremely poor level of care he received put us on a track that led to 12 years of severe depression, anxiety, and inability to work. It’s exhausting trying to squeeze mental health care out of a broken system, and there were many periods of time when we simply gave up out of frustration. Thank you for sharing this information.

    • April 18, 2013 10:51 am

      Thank you for your comment. I am truly sorry for the hard road you and your husband have traveled with his mental illness. My husband and I had a similar experience trying to get him care for mental illness from the VA. What saved him and our marriage was getting him on my insurance and hospitalizing him. It is truly sad the poor care we allow in this country for severe mental illness.

      • April 18, 2013 11:27 am

        We had a similar experience. When I changed jobs and put him on my new insurance, which allows us to choose any practitioner, he was able to get on a path to recovery. The cost is exorbitant, sadly, but at least he is able to live a much better life now.

  2. Susan permalink
    May 2, 2013 10:50 pm

    I’m currently a mental health patient at Kaiser. I am undergoing a painful, life threatening grief and loss over a recent ended relationship. I am in need of more frequent than 6 week intervals to help me with this loss. I have become disabled because of clinical depression, OCD and anxiety. I am also a survivor of a large national disaster, Hurricane Katrina and the sudden death of my husband due to lack of appropriate health care after the storm (We were in Hot Springs, AR). I have been living in the Berkeley since 2010. In New Orleans I received an appointment with my psychologist once a month and more if needed. And that City was understaffed! Here, I’m given the corporate run around and my therapist (who I very much like) and cannot see for another 6 weeks! This is intolerable. I even went to a non-tradtional ‘John Bradshaw’ type therapy for 4 months and they gladly took my money and then told me they don’t treat OCD(Wow, it was on the questionairre they took).

    The point is that as a mental health patient I should be, BY LAW, able to have a follow up appointment within 2 weeks at least of today’s appointment. Kaiser should pay for their lack of personnel to treat me or send me to a facility where I can get the care I need.

    It’s just evil. They are putting their HIGH PROFITS before my life. Really? What am I paying a co-pay and premium for? They are not giving me what they advertised I am entitled to receive. I call that false advertising and shoddy business practice.

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