The U.S. Department of Labor has reached a major settlement with Kaiser Foundation Health Plan Inc. after federal investigators found the insurer failed to provide timely, adequate access to mental health and substance use disorder treatment.
The agreement—stemming from multiple investigations by the Employee Benefits Security Administration into the Oakland, Calif.-based health insurer—requires Kaiser to reimburse members at least $28.3 million for out-of-network mental health and substance use disorder services they were forced to seek when in-network options weren’t available. Kaiser will also pay a $2.8 million penalty to the federal government.
The settlement resolves allegations that Kaiser did not maintain adequate provider networks for mental health and substance use disorder care and used patient responses to questionnaires to improperly prevent patients from receiving care. As a result, many members were unable to access in-network mental health or substance use disorder care and were forced to seek care outside Kaiser’s network, often at higher out-of-pocket costs.
As part of the settlement, Kaiser agreed to overhaul its policies to reduce appointment wait times, strengthen care review processes to ensure members receive medically necessary care, and monitor network adequacy to ensure its network includes enough qualified providers.
In a statement to Reuters, Kaiser said “We have made many enhancements to our mental health care delivery system and acknowledge there is still work to be done to ensure our interventions and therapies are aligned with our members' expectations and to ensure we achieve the best patient outcomes.”
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