Sunday, May 27, 2012

Kaiser Permanente settles therapy dispute with California Dept of Managed Health Care

The DOMHC has thrown Kaiser patients a small bone (see story below), but most of the time the DMHC [DOMHC] supports Kaiser's policy of making money by denying health care.

Why would the DOMHC support Kaiser's wrongdoing?

Well, let's see. Let's start by asking, "Who's in charge of the DOMHC?" None other than former Kaiser Health Plan lawyer, Brent Barnhart. Before he worked for Kaiser, Barnhart was an attorney and lobbyist for the health insurance industry in Sacramento – as legislative affairs director for Blue Cross of California, and as counsel and secretary to the Association of California Life and Health Insurance Companies.


DOMHC Director Brent A. Barnhart

This isn't the smile Brent Barnhart gives to Kaiser patients who've been injured by substandard care. DOMHC chief Brent A. Barnhart spent 13 years as senior counsel for the Kaiser Foundation Health Plan. It appears that he's still defending Kaiser in his position as overseer of health care plans. It would be interesting to learn about the cases he presided over when he represented Kaiser, but the cases are secret. Kaiser patients have to agree to binding arbitration instead of bringing their cases to the justice system.







We pay taxes to run the DOMHC Help Center, but the Help Center's goal is clearly to support Kaiser. Attorney Andrew George, an Assistant Deputy Director of DOMHC who is in charge of the Help Center, and Carol Massey-McCants, manager of the Complaint Resolution Branch, frequently ignore written complaints. Kaiser Permanente makes lots of high-profile gifts to government entities and has its own employees, in powerful positions in the DOMHC.



Dr. Bernadette Loftus, Kaiser administrator and member of DOMHC Medical Advisory Board











Kaiser, state settle therapy dispute
By Sandy Kleffman
Bay Area News Group
05/25/2012

Kaiser Permanente has agreed to reimburse some patients who were denied physical, occupational and speech therapy and paid for it themselves, state regulators announced Friday.

The HMO reached a settlement with the California Department of Managed Health Care after the state agency accused Kaiser in February of improperly refusing therapy to members who lack a "physical condition."

As a result, patients who might stutter or lisp or who had developmental delays, for example, were unable to get speech therapy, regulators said. Some people with mental illnesses also were excluded from therapy, the state said.

"The agreement ensures that Kaiser members will get the care they are entitled to under the law," said Managed Health Care Director Brent Barnhart, in a written statement.

Kaiser disputes the state's description of its policies.

"Although we continue to believe that Kaiser Permanente's approach to providing these services to our members was appropriate, we have reached an agreement with the DMHC to reimburse some members who incurred out-of-pocket expenses," said Kaiser spokesman John Nelson, in a written statement.

Under the agreement, Kaiser members who were denied medically necessary therapy since January 2009 may be eligible for reimbursement if they were named in the state enforcement action, or filed a complaint, or paid out-of-pocket for such therapy.

Members have until Jan. 31 to seek reimbursement.

[Maura Larkins comment: And what of those who could not afford to pay for their own therapy? Too bad, too sad. The DOMHC has apparently decided that they get nothing, and will simply have to live with the results of Kaiser's denial of care.]

Kaiser said it has identified nearly 90 members who may be eligible to receive payment for their out-of-pocket expenses. It will also review claims submitted by other members who are not on the list.In July, Kaiser will contact people who filed complaints.. It will also put a notice in its summer Partners in Health bulletin.

People who want more information can call the Managed Health Care Help Center at 1-888-466-2219 or go to www.HealthHelp.ca.gov.


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