Kaiser to pay more than $31 million to settle charges it failed to provide adequate access to mental health and substance abuse services
The Kaiser Foundation Health Plan Inc. has agreed to resolve investigations into the company’s failure to provide timely and appropriate access to mental health and substance abuse services.
The settlement between the U.S. Department of Labor’s Employee Benefits Security Administration and Kaiser affects millions of members in California who receive coverage through their employer. It also sets up a claims process for members to seek reimbursement for some out-of-network expenses.
The agreement resolves charges that Kaiser didn’t maintain adequate provider networks for mental health and substance abuse care and used patient responses to questionnaires to prevent patients from receiving care. As a result, many members weren’t able to access in-network mental health or substance abuse and were forced to seek care outside Kaiser’s network, often at higher out-of-pocket costs, according to the agency’s investigations.
Under the settlement, Kaiser will pay at least $28 million for costs its members incurred when seeking out-of-network mental health and substance abuse services. Kaiser will also pay a $2.8 million penalty to the federal government.
In addition, Kaiser agreed to reform company policies and practices to improve access to mental health and substance abuse care. The reforms include steps to: reduce appointment wait times, improve care review processes, and monitor network adequacy.
Kaiser has provided notices to members in California who participated in the plan after Jan. 1, 2021, and were likely to have paid for out-of-network mental health and substance abuse services after trying to obtain in-network services to let them know they may be eligible for reimbursement.
Learn more about the settlement or how to file a claim by visiting the settlement website: www.outofnetworkhealthclaims.com, or calling Kaiser at 877-684-4129.
