Kaiser Permanente Ordered to Halt Denial of Care

Cheryl Clark, February 29, 2012

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.

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