How to file a complaint regarding Kaiser’s mental health care delays
Option 1: Filing a complaint with the Department of Managed Healthcare (DMHC)
You can file an urgent complaint utilizing the Independent Medical Review (IMR)/Complaint form available online through the Department of Managed Health Care (DMHC), a consumer protection agency that regulates Kaiser in California. If you are a Medicare enrollee, please scroll down to see alternate resources.
The initial complaint process will take you about 5 minutes, and the DMHC will then be required to promptly reach out to Kaiser to address your concerns. Filing a complaint could increase the likelihood that you will receive your prescribed course of treatment sooner.
Urgent complaints to the DMHC should be resolved expeditiously. Health plans must promptly follow the DMHC’s orders. Non-urgent complaints should be resolved within 30 days, although the DMHC has been known to take longer to resolve non-urgent complaints.
Although the DMHC website indicates that you should complete Kaiser’s internal, 30-day grievance process before filing a complaint, you may bypass this process if your complaint is “urgent.” Your complaint is “urgent” if: (1) you or a Kaiser behavioral health clinician (i.e., therapist) determined that you must receive behavioral health care sooner or with greater frequency than what Kaiser can provide AND (2) there is: (a) substantial jeopardy to your life, health, or ability to regain maximum function, or (b) a risk of experiencing severe pain while waiting for Kaiser to evaluate your internal grievance. The DMHC is required to promptly investigate and respond to urgent complaints. Your complaint should facilitate timely access to care, including the potential for the DMHC to require Kaiser to authorize out of network accommodations** to meet its legal obligations to enrollees.
Below is an example of the Independent Medical Review (IMR)/Complaint form with guidance on how to complete the important questions:
For the last question on the online complaint form, “Briefly describe the problem you are having with your health plan,” you can also paste this information into the answer section. The highlighted fields are to be customized for each patient.
URGENT GRIEVANCE: Kaiser is unable to provide me with timely access to prescribed mental health care. On (ENTER DATE), I met with Kaiser mental health clinician, (ENTER NAME), who prescribed individual psychotherapy for me at a dose of (ENTER 45, 60, or 90)-minute sessions, frequency of (ENTER NUMBER) session(s) per week, for an extended duration. I was told that my individual treatment needs to begin urgently so that my life, health, and/or ability to regain maximum function are not jeopardized and/or so that I do not experience severe pain. However, I was also informed that timely access to mental health care for my condition is unavailable at Kaiser. The clinician escalated this issue at Kaiser but the matter remains unresolved. Under SB855, Kaiser is obligated to immediately arrange for the prescribed care by a suitable and immediately available out-of-network provider.
This explanation will provide the information necessary for the DMHC to recognize your problem as urgent.
You can find answers to other Frequently Asked Questions on dmhc.ca.gov.
For Medicare Advantage Enrollees
Please note that if your insurance is through Medicare, you do not need to file a complaint with the Department of Managed Health Care. The DMHC does not regulate Medicare Advantage plans.
Instead, you are encouraged to:
- Submit a complaint to Kaiser Member Services if you have not done so already (info below).
- Call the Health Insurance Counseling & Advocacy Program (HICAP) which is run through the California Department on Aging at 1-800-434-0222. You can also see cahealthadvocates.org/hicap/.
- Contact the Medicare Rights Center National Helpline online at medicarerights.org/counseling-and-advocacy or call 1-800-333-4114.
Option 2: Obtaining your Medical Records from Kaiser
As part of your complaint process, you will be asked to submit written documentation that your health problem is urgent. You can do this by submitting the treatment notes from your therapist, which includes a section documenting that you could not be scheduled for an initial assessment, secondary assessment, and/or follow-up therapy appointments as clinically indicated. You can find and download these notes by:
- Going to kp.org and logging in to your account.
- Clicking on the medical record tab.
- Choosing past visit information.
- Clicking on the note from today’s session. Unless there are extenuating circumstances, the note should be available within 2-3 business days.
Option 3: Filing an Internal Complaint with Kaiser
All health plans are required to have an internal process for health plan members to file complaints and receive a response within 30 days.
Call Kaiser’s “Member Services Department” at 1-800-464-4000 to file a complaint. You can also contact Member Services and file a complaint though your member account on kaiserpermanente.org or by visiting healthy.kaiserpermanente.org/support (follow the steps to select your region and then scroll down to the bottom to click on “File a complaint”).
You have the right to file a complaint with Kaiser’s Member Services. This will require Kaiser to review the treatment that has been prescribed and respond to you in writing within 30 days.
Here is information to file a complaint. The highlighted fields are to be customized.
- Northern California
- Southern California
For describing the nature of the issue:
This grievance is filed due to Kaiser’s network inadequacy. As explained to me by Kaiser mental health clinician (ENTER NAME), I require individual psychotherapy at a dose of (ENTER 45, 60, or 90)-minute sessions, frequency of (ENTER NUMBER) session(s) per week, for an extended duration. These services are unavailable in a timely manner for my condition(s). Please refer to the supporting progress notes in my patient chart entered on (ENTER DATE OF MEETING WITH KAISER MENTAL HEALTH CLINICIAN).
For explaining how you resolved this issue:
On (ENTER DATE), the Kaiser mental health clinician escalated this matter to their supervisor.
For what you’d consider a proper solution to this issue:
Under SB855, Kaiser must identify a suitable and immediately available provider who will be able to accommodate the prescribed treatment plan, including on an out-of-network basis.
The Department of Managed Health Care contracts with the Health Consumer Alliance, a group of local, community-based organizations that will provide you with assistance filing a grievance with your health plan. If you need one-on-one assistance, please contact the Health Consumer Alliance’s Consumer Assistance Program at 1-888-804-3536.
For Help with Consumer Independent Medical Review/Complaint Requests, you can contact the DMHC:
- Voice: 1-888-466-2219
- FAX: 916-255-5241
- TDD: 1-877-688-9891
- Mailing Address:
California Department of Managed Health Care
980 9th Street, Suite 500
Sacramento, CA 95814-2725