California orders Kaiser to stop denying physical, occupational and speech therapy to certain patients

California orders Kaiser to stop denying physical, occupational and speech therapy to certain patients
By Sandy Kleffman
Bay Area News Group
02/28/2012

State regulators on Monday ordered Kaiser Foundation Health Plan to stop denying physical, occupational and speech therapy to certain patients.

Kaiser has declined such therapy to members who lack a "physical condition," according to documents filed by the state Department of Managed Health Care.

That means that people who may stutter or lisp or who have developmental delays don't receive speech therapy, for example, said Anthony Manzanetti, chief of enforcement for the state agency.

It also excludes those who have mental illnesses.

A Kaiser executive, who said he was surprised and disappointed by the state action, disputed the agency's description of Kaiser policies.

"The department appears to have misunderstood or mischaracterized Kaiser Permanente's approach to providing speech, physical and occupational therapy to our members," said John Nelson, Kaiser vice president, in a written statement.

"These therapies are not limited only to patients with physical conditions," he said.
Nelson said Kaiser will continue discussions with the state agency with the goal of "reaching a shared understanding. In the interim, we will continue to cover medically necessary health care services."

Since 2009, more than 100 Kaiser members have filed complaints with the Department of Managed Health Care after being denied physical, occupational and speech therapy, the state agency reported.

Consumers can appeal a health plan's refusal to provide services. They also have the right to receive an independent medical review if they disagree with their plan's decision.