Kaiser Permanente Ordered to Halt Denial of Care
"The Department appears to have misunderstood or mischaracterized Kaiser Permanente's approach to providing speech, physical, and occupational therapy to our members. Kaiser Permanente provides these clinical and medical therapies to our patients. These therapies are not limited only to patients with "physical conditions."
"We remain committed to discussing DMHC's position with them and reaching a shared understanding. In the interim, we will continue to cover medically necessary health care services."
In California, consumers have the right to appeal a health plan's refusal to provide medically necessary health care services. They also have the right to receive an independent medical review if they disagree with the plan's decision.
The order says that the state's code of regulations provides that the DMHC may impose administrative penalties on a plan when it finds the plan "engages in a practice of mischaracterizing determinations substantially based on medical necessity coverage decisions, or otherwise interferes with the rights of an enrollee to obtain independent medical review."
Cheryl Clark is senior quality editor and California correspondent for HealthLeaders Media. She is a member of the Association of Health Care Journalists.
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