Kaiser, Don't Deny

THE PROBLEM

For too long, a loophole in California law required HMOs and health insurers to provide initial mental health assessments within two weeks, but didn’t require them to also provide return therapy appointments within 10 business days.

As a result, many Californians, including members of Kaiser Permanente, have been forced to wait months to see their therapist.

THE SOLUTION

Starting July 1, 2022, a new law, California Senate Bill 221, went into effect requiring HMOs and health insurers to provide individual follow-up mental health and substance use disorder therapy appointments within 10 business days of the prior appointment unless the treating therapist determines that a longer wait will not have a detrimental impact on the patient’s health.

THE FACTS

• What is Senate Bill 221?

  Sponsored by the National Union of Healthcare Workers and authored by State Sen. Scott Wiener, SB 221 is a landmark mental health law that guarantees Californians the right to timely mental health and substance use disorder therapy sessions.

• When does the bill go into effect?

  SB 221 went into effect on July 1, 2022. It was signed into law in 2021 after passing the legislature with nearly unanimous bi-partisan support.

• What does the bill do?

  The bill requires HMOs and health insurance companies to provide individual mental health and substance use disorder therapy appointments within ten business days of a prior appointment unless the treating therapist determines that a longer wait will not have a detrimental impact on the patient’s health.

• What if your insurer or HMO is unable to provide an appointment within 10 business days?

  If unable to provide an in-network therapy session, an HMO or health insurer must arrange coverage outside the plan’s contracted network at no additional cost to the patient.

• You should file a complaint with the consumer-protection agency that oversees your type of insurance. For example, HMO members should file a complaint with the California Department of Managed Care. Go to nuhw.org/kaiser-dont-deny/patient-resources/filing-complaints/ for telephone numbers, links, and instructions for each consumer-protection agency.