Filing a complaint to demand timely access to Kaiser mental health care
FILE AN URGENT COMPLAINT WITH THE CALIFORNIA DEPARTMENT OF MANAGED HEALTH CARE (DMHC)
The DMHC is a consumer protection agency that regulates Kaiser in California.
Filing an urgent complaint with the DMHC could increase the likelihood that you’ll receive your prescribed course of treatment sooner.
You should file an urgent complaint with the DMHC, if:
- Your Kaiser mental health clinician has determined that you should receive therapy sessions sooner or more frequently than Kaiser can provide, and
- The delay in prescribed care could jeopardize your life, health, ability to regain maximum function, and/or cause severe pain.
- Filing a complaint with the Department of Managed Health Care should only take about 5 minutes.
- The state agency is required to promptly investigate complaints and contact Kaiser to address them.
- Kaiser must promptly adhere to the agency’s findings. This could include providing timely or more frequent therapy appointments or authorizing therapy sessions outside of the Kaiser network.
ATTACHING TREATMENT NOTES TO COMPLAINT:
- At the bottom of the complaint form it will ask to attach supporting documents. The document you want to attach are your treatment notes from your most recent visit.
- To access the treatment notes:
- Go to kp.org and log in to your account.
- Click on the medical record tab.
- Choose past visit information.
- If the treatment notes are not yet available:
- File the DMHC complaint.
- Check kp.org within 2-3 days to retrieve your therapist’s treatment notes.
- If your therapist’s treatment notes are not yet available on kp.org after 2-3 days, you may wish to contact your therapist to request they send the treatment plan directly to you through Kaiser’s secure messaging system.
- Supplement the treatment notes to your complaint by emailing them to email@example.com or faxing them to 916-255-5241. You can reference your name and the date you filed your complaint.
For the last question on the complaint form — “Briefly describe the problem you are having with your health plan” — you can copy and paste the sample response below. Customize the highlighted text to reflect your unique situation.
URGENT GRIEVANCE: Kaiser is unable to provide me with timely access to prescribed mental health care. On [date], I met with Kaiser mental health clinician, [name], who prescribed individual psychotherapy for me at a dose of [45, 60, or 90]-minute sessions, frequency of [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. 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 provider, including on an out-of-network basis.
You can find answers to other Frequently Asked Questions on dmhc.ca.gov.
For Medicare Enrollees
If you’re insured through Medicare, you may NOT be eligible to file a complaint with the DMHC. The DMHC does not regulate Standard Medicare plans and has limited jurisdiction over Medicare Advantage plans. Instead, you are encouraged to:
- Submit a complaint to Kaiser Member Services on kaiserpermanente.org, if you have not done so already — see info below.
- Contact the Medicare Rights Center National Helpline online at medicarerights.org/counseling-and-advocacy or call 1-800-333-4114.
- 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/.
The DMHC does regulate Medi-Cal plans, so you can file a DMHC complaint if you are a Medi-cal enrollee.
FILING AN INTERNAL COMPLAINT WITH KAISER MEMBER SERVICES
It’s your right as a patient to file a complaint with Kaiser which is required to have an internal process for member complaints and responses within 30 days.
FILE A COMPLAINT WITH KAISER MEMBER SERVICES:
- BY PHONE: Call Kaiser’s “Member Services Department” at 1-800-464-4000.
- BY WEB: File a complaint though your Kaiser member account on kaiserpermanente.org or visit healthy.kaiserpermanente.org/support and follow the steps to select your region and then scroll down to the bottom to click on “File a complaint.”
Sample text to consider for filling out the complaint form:
You may wish to use this sample text to assist you in completing the complaint form. The highlighted text is to be customized.
Describe the nature of the issue:
This grievance is filed due to Kaiser’s network inadequacy. As explained to me by Kaiser mental health clinician [name], I require individual psychotherapy at a dose of [45, 60, or 90]-minute sessions, frequency of [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 [date of meeting with Kaiser mental health clinician].
Explain how the issue was resolved:
On [date], the Kaiser mental health clinician escalated this matter to their supervisor.
Outline a proper solution to this issue:
Under SB855, Kaiser must identify a suitable and available provider who will be able to accommodate the prescribed treatment plan, including on an out-of-network basis.
Select your region, click the appropriate form to fill out and mail.
- Northern California: View Medicare form or Non-Medicare form on kp.org
- Southern California: View Medicare form or Non-Medicare form on kp.org
It can take Kaiser up to 30 days to review a complaint. If you, or your Kaiser behavioral health clinician/therapist, feel that waiting 30 days for Kaiser’s review could jeopardize your life, health, ability to regain maximum function, and/or cause severe pain, you have the right to submit an expedited grievance to Kaiser Member Services.
To submit an expedited grievance, call Kaiser’s Expedited Review department at 1-888-987-7247 (toll free) or 711 (toll-free TTY for the hearing/speech impaired), 8 a.m. to 5:30 p.m., 7 days a week. You may need to leave a message if the expedited review unit is unavailable and doesn’t answer. Once you contact the Expedited Review department, a case manager will have to respond within 48 hours.
For help with Consumer Independent Medical Review/Complaint Requests, contact the Department of Managed Health Care:
- 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
If you need help filing a grievance with the the Department of Managed Health Care about your health plan, or with filing a Member Services complaint:
- Call the Health Consumer Alliance’s Consumer Assistance Program at 1-888-804-3536 for one-on-one support
- The Health Consumer Alliance (HCA) offers free assistance over-the-phone or in-person to help people who are struggling to get or maintain health coverage and resolve problems with their health plans