Kaiser Settlement and Mental Illness
Legally reviewed By Scott Glovsky in Class Action, Insurance and Healthcare Denials, Insurance Bad Faith, Mental Health
Kaiser Settlement and Mental Illness
On January 16, 2020, the California Superior Court for the County of Alameda granted final approval of a class action settlement in the case Charles Dion v. Kaiser Foundation Health Plan, Inc., Case No. RG1718903. Mr. Dion, acting as the class representative, and The Law Offices of Scott Glovsky brought suit against Kaiser to address allegations that Kaiser categorically denied coverage and access to all residential treatment for severe mental illness, other than short term acute treatment, without regard to medical necessity. The information below addresses the Kaiser Settlement and Mental Illness.
In Kaiser plans, members do not have access to outside mental health providers unless that provider is contracted with Kaiser and Kaiser refers that member to the outside provider. This means that if a member could not get an appointment in a timely manner, then they could not get timely treatment.
The settlement followed the Court’s order certifying a class to address the propriety of Kaiser’s residential treatment criteria. The class action settlement requires Kaiser to provide 105,201 California members living with severe mental illness access to medically necessary residential treatment. Under the terms of the court-approved settlement, Kaiser has agreed to make systemic reforms addressing these issues. Specifically, Kaiser will implement new residential treatment guidelines which include coverage for non-crisis residential treatment. As a result of this settlement, over 100,000 Kaiser members will now have access to necessary residential mental health treatment.