Saturday, October 26, 2013

Class Action lawsuit filed against Kaiser over mental health care wait times

Class Action lawsuit filed against Kaiser over mental health care wait times
By Rachel Raskin-Zrihen

A lawsuit served at Kaiser Permanente's Oakland headquarters Thursday alleges that Kaiser Foundation Health Plan facilities, including Vallejo's, routinely deny its members timely access to mental health services.

Kaiser officials call the suit a ploy in ongoing contract negotiations.

The Oakland-based law firm of Siegel LeWitter Malkani that works closely with the National Union of Healthcare Workers (NUHW) -- which represents Kaiser's mental health professionals and optical workers -- filed the suit earlier this month on behalf of "three named plaintiffs and thousands of other Kaiser members who have been harmed" by this alleged practice, attorney Jonathan Siegel said Thursday.

The union represents some 70 members at Kaiser Permanente Vallejo Medical Center. The firm has sued Kaiser before, Siegel said.

Kaiser officials called the suit the "NUHW's latest attempt to use inaccurate claims about our mental health care services to apply pressure in their protracted labor negotiations with Kaiser Permanente."

The union's actions do "nothing to further the negotiations that should be taking place at the table," they said.

The lawsuit alleges that Kaiser routinely violates state law by refusing to provide critical mental health services to its members within the time frame set by law.

"As a result, Kaiser members have been denied urgent services, forced to wait for long periods of time to receive needed services, discouraged from seeking services altogether, or compelled to incur out-of-pocket expenses for treatment outside of the Kaiser system," according to the suit.

The lead plaintiff, Point Richmond resident Susan Futterman, said her husband, Fred Paroutaud, killed himself after "desperate" requests for an urgent mental health appointment were delayed until his psychiatrist returned from vacation.

Los Angeles area plaintiff Megan Mortensen wound up seeking an urgent mental health appointment outside the system after Kaiser allegedly "refused" her request for a timely appointment after the loss of her brother. The third plaintiff, Acianita Lucero of Oakland, allegedly "made repeated requests for Kaiser to provide her with an urgent mental health appointment but Kaiser refused to see her within the 48 hours required by law," according to the suit.

The suit follows a report from earlier this year by the California Department of Managed Health Care which suggested Kaiser needed to reduce mental health appointment wait times. Kaiser was fined $ 4 million -- the second largest fine issued by the Department -- and issued a Cease and Desist Order to correct the problems, Siegel said.

Kaiser officials say the report did not fault Kaiser's mental health care quality or member's ability to obtain urgent or emergency mental health care.

"What was identified in the DMHC survey were some areas where our non-urgent appointment wait times and data tracking needed improvement," officials said. "We took the findings seriously, have submitted a corrective action plan to the DMHC, and have worked to correct the issues identified in the survey."

The class action lawsuit seeks compensatory and statutory damages for class members as well as an injunction requiring Kaiser to comply with the law, Siegel said.

"We're suing for Kaiser to clean up there act and provide mental health services to their clients that complies with the law," he said. "And we want damage compensation for the tens of thousands of Kaiser members who have been victimized by this."

Wednesday, October 23, 2013

Kaiser wants the public to know the truth about Kaiser quality. So do I.

Here it is straight from the horse's mouth: Kaiser wants the public to have more information about the quality of medical care provided by Kaiser.

I'm happy to help with this blog. Of course, I agree that Covered California should post ratings of insurers. I'd also like to suggest that the California exchange public Kaiser's treatment guidelines and those of other insurers.

The desire for openness is a big change in attitude for Kaiser, a company that usually wants to keep secrets.

Kaiser faults California’s exchange for lack of quality ratings
Chad Terhune
Los Angeles Times
Oct. 22, 2013

Healthcare giant Kaiser Permanente and two other insurers say California’s insurance exchange is withholding crucial information from consumers by not posting quality ratings alongside health plan rates.

The insurance companies said “there has never been a compelling reason to deny this information to consumers…. On this issue, Covered California has surrendered its ‘pace car’ status.”

Sharp Health Plan in San Diego and Western Health Advantage in Sacramento joined Kaiser in criticizing the state’s position in a letter sent Monday to Covered California, the state health exchange. Some consumer advocates have also urged the state to reconsider, saying any delay rewards lower-performing insurers.

Thousands of people have been shopping for coverage at the state’s website at since enrollment opened Oct. 1 under the Affordable Care Act, also known as Obamacare.

Covered California ignited this debate in August when it backed off earlier plans to include insurance company ratings in its online enrollment system.

This came as a surprise because state officials had touted the idea of consumers choosing coverage based on the overall value, combining price and quality measures.

At the time, the exchange said it reversed course because the latest state rankings examine performance from 2011, and they don’t reflect many of the new health plans and provider networks being offered for the first time under the federal healthcare law.

Major insurers such as Blue Shield of California and Health Net Inc. have offered narrower networks for some exchange policies to help lower premiums. In contrast, Kaiser and its full provider network are often more expensive.

State officials have discussed including ratings for some health plans, such as Kaiser, that are using their current network and labeling newer products as “not yet rated.” Covered California’s five-member board is expected to consider the matter at a regularly scheduled meeting Thursday.

In their letter, the three insurers also point out that other state-run exchanges, such as those in Colorado, Maryland and Oregon, are displaying quality data prominently on their websites. Colorado’s website even sorts a consumer’s options by quality, rather than just price.

“The leadership of these three state exchanges faced a choice, as California’s does now – and they chose to put consumers first,” the insurers said.

Tuesday, October 8, 2013

California health insurance exchange opens October 1, 2013

Shop at the new health exchange,

In San Diego County, six insurance companies will offer plans in the exchange: Sharp Health Plan, Kaiser Permanente, Anthem Blue Cross, Blue Shield, Molina Healthcare and Health Net.

State health exchange opens Tuesday
By Paul Sisson
Sept. 30, 2013

Outreach worker Ghaith Al Obaidi of the Borrego Community Health Foundation, chats about the new Covered California health insurance exchange with two unidentified men at the El Cajon Farmer's Market Thursday. The exchange has spent millions on outreach to spread the word about he new exchange at community events, health clinics and other locations across the state.

Despite the political battles being fought over the new federal health care law in Washington, Covered California, the state’s new insurance exchange, is set to open as scheduled on Tuesday.

Californians will be able to sign up for health insurance either on the new marketplace’s website or over the phone. Consumers also can apply for income-based tax credits designed to keep premium costs affordable for families.

Peter Lee, Covered California’s executive director, said Thursday that he is confident the new marketplace will be fully functional in two days, as promised.

“We’re good to go on Oct. 1,” Lee said.

Covered California is a key component of the Affordable Care Act, the sweeping federal health reform law approved in 2010. At the core of health reform, often called Obamacare, is the tenet that most Americans have health insurance by Jan. 1, 2014, or pay a small penalty. Enrollment in exchange plans must occur by Dec. 15 for coverage to start at the first of the year.

While the budget brinkmanship in Washington, D.C., continues, states and the federal government are moving forward with implementation of health exchanges required by the Affordable Care Act.

California is one of 17 states, and the District of Columbia, to create its own exchange while seven more are operating in partnership with the federal government. The federal government will also run exchanges in the remaining 27 states where leadership has generally opposed health reform.

A place to shop Covered California takes an Internet commerce approach to selling health insurance. Uninsured residents can go online, specify their locations, and see the plans offered in their area.

Much of what consumers will see is already visible on the website. Those who visit today can enter their family size, household income and ZIP code and receive a list of plans displayed side-by-side, with the premium they would pay and whether they would qualify for a tax credit from the federal government.

Lee said that, on Tuesday, a new button will appear on the website allowing visitors to enroll for policies effective Jan. 1. A consolidated physician directory will also be posted Tuesday, which will allow applicants to search for doctors across plans, Lee said.

“We think it’s a big deal to have a consolidated directory,” he said.

For people without computers, the exchange has created two call centers staffed by 442 operators who can guide applicants through the process.

In San Diego County, six insurance companies will offer plans in the exchange: Sharp Health Plan, Kaiser Permanente, Anthem Blue Cross, Blue Shield, Molina Healthcare and Health Net.

On the exchange, each carrier is required to clearly list the premiums and copays it charges, as well as the out-of-pocket maximums, for each policy sold.

Health reform also requires all exchange plans to cover the same 10 categories of “essential health benefits,” which range from emergency services to prescription drugs.

Because the health reform law is so strict about which benefits must be included, consumers will largely be deciding on premiums, coverage levels and doctor networks when making a decision about which plan to purchase.

Sunday, October 6, 2013

Patients who were harmed can join class action suit against Kaiser Permanente

Chance to participate:

On October 2, 2013 a class action suit was filed in Alameda County, California - alleging denial of timely and/or appropriate care.

Filed by Siegel, Lewitter, Malkani of Oakland, California
Contact Information: Latika Malkani
Phone Number: 510-452-5000
1939 Harrison Street, Suite 307
Oakland, California 94612

California Class Action Case RG13697775
Filing found here for your viewing:

[The complaint is interesting reading, discussing the investigation of the California Department of Managed Health Care (DMHC).]

This suit consists of all current and former Kaiser members who have either been denied access to mental health services, dissuaded from pursuing mental health services, provided with delayed access to mental health services and/or provided with inaccurate and confusing information from Kaiser regarding mental health services available to them from October 2, 2009 to the present.

(Violations of Business and Professions Code, Section 17200 et seq., Violations of the Unruh Civil Rights Act, Breach of the Covenant of Good Faith and Fair Dealing, Breach of Contract)

--Vickie Travis