Kaiser Foundation Health Plan is illegally denying some of its California enrollees physical, speech and occupational therapy services, says a cease and desist order filed Monday by the state.
According to the order, Kaiser "categorically denies coverage" for these services on the basis that certain enrolleess do not have a physical condition or physical impairment that triggers the coverage, and does not provide these patients with a medical necessity review, says the Department of Managed Health Care, which regulates managed care plans serving 21 million lives.
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California's Knox-Keene Act specifies that speech therapy, physical therapy and/or occupational therapy "are required basic health services, and therefore Kaiser's denial of coverage for physical therapy, speech therapy, and/or occupational therapy based on a lack of physical impairment is illegal and contrary to the Act," the order says.