Show
Emergency? Federal law, through the Emergency Medical Treatment and Active Labor Act, requires anyone coming into an emergency department to be stabilized and treated, regardless of their insurance status or ability to pay. For more information about California’s Timely Access Regulations, go to the FAQs section below.
For example, if your health plan policy covers hospitalization of unlimited duration, then your policy should not limit treatment in a mental health facility to a specific number of days. For more information about mental health parity laws go to the FAQs section.
According to Kaiser, a grievance can be related to any dissatisfaction pertaining to a “referral, provision of or reimbursement for services or supplies, or other financial resolution.” Kaiser states that complaints about the standard of practice or quality of care are “generally treated as a grievance.” For more information about the Kaiser grievance process, go to the FAQs section.
•If Kaiser denies, modifies, or delays a covered health care service. For more information about obtaining Independent Medical Review (IMR), go to the FAQs section below. Click here to view a downloadable PDF of your above Kaiser mental health rights. • • • • • • • • • • • • • • • • • • • • • FREQUENTLY ASKED QUESTIONSTimely mental health appointments Obtaining appropriate mental health care A grievance versus a complaint Filing a
grievance within Kaiser Filing a complaint with the State of
California Filing a complaint with the Federal Government • • • • • • • • • • • • • • • • • • • • • – TIMELY MENTAL HEALTH APPOINTMENTS –What should I do if Kaiser offers me an initial appointment that would make me wait more than 10 business days before I’m seen? Return to the top of the FAQs section
Return to the top of the FAQs section – OBTAINING APPROPRIATE MENTAL HEALTH CARE –What do the Mental Health Parity laws require? Return to the top of the FAQs section
•Individual & group therapy visits for diagnostic evaluation & psychiatric treatment There are no visit limits on the above covered services on plans with Federal Mental Health Parity. Couples counseling may be covered if you are being treated for a mental health disorder and it’s determined that it’s medically necessary to bring your spouse or significant other into therapy as part of your treatment plan. Kaiser states that couples counseling is “not covered for the purpose of relational problems.” California Mental Health Parity requires HMOs to provide care and treatment for Serious Emotional Disturbances (SED) of children plus the following severe mental health diagnoses: •Schizophrenia There are no annual visit limits for these “parity” conditions. Return to the top of the FAQs section
Return to the top of the FAQs section
Return to the top of the FAQs section – A GRIEVANCE VERSUS A COMPLAINT –What is the difference between a grievance and a complaint? Complaint: Within
the grievance process, an expression of dissatisfaction. Return to the top of the FAQs section – FILING A GRIEVANCE WITHIN KAISER –Return to the top of the FAQs section How do I file a grievance with Kaiser? Filing a grievance online: Go to kp.org. You will have the option to submit a complaint (i.e., grievance) after clicking on the “Member Services” tab. You do not have to be signed into the Kaiser website to submit a complaint.The below slideshow provides a step-by-step overview of how to submit an online complaint (Click on each slide to progress through the slideshow. There are eight slides in all): Filing a grievance by phone: Call Kaiser Member Services at 1-800-464-4000 to file a grievance over the phone. Filing a grievance in-person: You can visit a Member Services Representative at any Kaiser facility that has a Member Services Department and file a grievance. All members are able to file a verbal grievance. However, this method is not recommended because it produces a less robust “paper” trail (as compared to filing an online grievance). Return to the top of the FAQs section
Grievance decisions: If your problem is urgent, Kaiser must give you a decision within 72 hours. If your problem is not urgent, Kaiser must give you a decision within 30 days. Return to the top of the FAQs section
Assistance with filing an appeal or challenging a denial is also available for those eligible for Medicare through the California Department of Aging through its Health Insurance Counseling and Advocacy Program (HICAP). Return to the top of the FAQs section
In order to file a grievance on behalf of someone else, an authorization form must be completed. These forms are available by calling Kaiser Member Services at 1-800-464-4000. These forms are also available at Kaiser facilities with a Member Services Department. Make sure to include this authorization form when filing a grievance on behalf of someone else. You may also, as a Kaiser member, appoint an authorized representative in writing by including your representative’s name, address, and telephone contact information with your grievance. Return to the top of the FAQs section English isn’t my first language. Can I get help and assistance when filing a grievance? Return to the top of the FAQs section – FILING A COMPLAINT WITH THE STATE OF CALIFORNIA –What are the steps required to file a complaint with the state? To request an Independent Medical Review by the Department of Managed Health Care you can submit an online request at http://www.dmhc.ca.gov/FileaComplaint/IndependentMedicalReviewComplaintForms.aspx The DMHC’s mailing address is:California Department of Managed Health Care To request an Independent Medical Review by the California Department of Insurance you can submit an online request at https://cdiapps.insurance.ca.gov/CP/create-complaint-page/. Alternatively, you can submit a request via mail to:California Department of Insurance Return to the top of the FAQs section
Return to the top of the FAQs section Where can I get more information about how to file a complaint with the state? DMHC – http://www.dmhc.ca.gov/FileaComplaint.aspx CDI – https://www.insurance.ca.gov/01-consumers/110-health/50-h-rfa/index.cfm (If this page is unresponsive you can also directly download a PDF version of the CDI health insurance complaint form here and a PDF version of the CDI application for Independent Medical Review here.) Return to the top of the FAQs section – FILING A COMPLAINT WITH THE FEDERAL GOVERNMENT –How can I file a complaint with the Federal Government? Return to the top of the FAQs section
Is Kaiser Mental Health on strike?Psychologists, social workers, therapists, and chemical dependency counselors are in the ninth week of an open-ended strike at Kaiser Permanente in Northern and Central California. The 2,000 mental health care workers walked out August 15; their contract has been expired since September 2021.
How do I get a Kaiser number in Southern California?To connect with the care you need, talk to your doctor or call us 24/7 at 1-833-574-2273 (TTY 711).
How do I make an appointment at Kaiser Southern California?Call 1-833-KP4CARE (1-833-574-2273) for medical advice at any time, 24 hours a day, every day.
Does Medi Cal cover mental health?Services covered by Medi-Cal include outpatient mental health services such as individual or group counseling, outpatient specialty mental health services, inpatient mental health services, outpatient substance use disorder services, residential treatment services, and voluntary inpatient detoxification.
|