Kaiser, Don't Deny

As a patient, you have rights under state and federal laws. These rights include:

1. Right to Timely Access to Care

Hawai’i law requires HMOs like Kaiser to deliver access to care “without unreasonable delay” and without forcing patients to travel unreasonable distances. Additionally, Kaiser is required to have sufficient numbers of therapists and psychiatrists on hand to meet patients’ needs in a timely way. (Hawai’i Revised Statutes § 431:26-103)

What’s “timely” care? Kaiser has committed to meet the standards set by the National Committee for Quality Assurance (NCQA).

NCQA’s Timely Access Standards for Behavioral Health Appointments

Provider	Appointment Type	Elapsed Time Standard
Licensed Therapist (non-MD)	Non-urgent	10 business days
Psychiatrist (MD)	Non-urgent	15 business days
Licensed Therapist (non-MD)	Urgent	2 days

If a patient’s clinical needs require more rapid access than the timeframes noted above, then Kaiser must deliver such care. If Kaiser cannot provide reasonable access to care, it must inform you about your right to receive timely care from an out-of-network therapist or psychiatrist at Kaiser’s expense. Kaiser must address these requests “in a timely fashion appropriate to the covered person’s condition.” (Haw. Rev. Stat. § 431:26-103(c))

2. Right to an Effective, Individualized Treatment Plan

Hawai’i law says:

“All mental health services shall be provided under an individualized treatment plan approved by a physician, psychologist, licensed clinical social worker, licensed marriage and family therapist, licensed mental health counselor, advanced practice registered nurse, or licensed dietitian treating eating disorders, and must be reasonably expected to improve the patient’s condition.” (Haw. Rev. Stat. § 431M-4(b)(1))

3. Right to Mental Health Parity

Consumers have the right to receive benefits for mental health and substance use treatment on the same basis as they do for other illnesses. These rights are protected by both federal law (the Mental Health Parity and Addiction Equity Act) and state law (Haw. Rev. Stat. § 431M-2(b) and § 432D-28). For example, if your health plan doesn’t put limits on the number of appointments you can have with your primary care doctor each year, it cannot place annual limits or caps on appointments with a mental health clinician. Similarly, you cannot be charged a higher copay for an office visit with a mental health clinician than for an office visit with a primary care provider.

4. Right to File a Complaint with Your Health Plan

You have the right to file complaints with your health plan if you feel you’re not receiving timely and appropriate care or are experiencing other problems. See “Filing Complaints” for more information.

5. Right to File a Complaint with State or Federal Oversight Agencies

You have the right to file complaints with state and federal agencies responsible for protecting the rights of healthcare consumers. See “Filing Complaints” for more information.