Southern California Kaiser Client Tells Her Story

The day after I opened up this forum, I immediately got a response. Makes me think we’re on to something…

“In 2010 I was laid off from my job. I had been working as a San Diego area teacher for over 30 years. My husband and I sold our house and downsized to a smaller home. Just six months later the new car dealership my husband had worked at for the last 12 years closed its doors. We were 53 and 57 and both unemployed now. I was quickly spiraling downwards emotionally.

“I contacted Kaiser Permanente to obtain a Zoloft prescription, a drug I had used once before but no longer was taking. They had the Shadowridge mental health facility in Vista contact me, and they did a quick over the phone interview. I was set up with an appointment to see a psychiatrist in six weeks — a long wait. The day before my appointment they called me and said the doctor had the flu, but if I came in they would find someone else to see me. I declined, as I was nervous about seeing “someone” without knowing anything about who that person was. I asked if a doctor could just prescribe me the Zoloft over the phone, and the nurse refused. I then asked for another appointment with the psychiatrist I had originally been scheduled with. The nurse set me up with a new appointment – in ANOTHER six weeks.

“Even though my husband and I were paying $1,200 in insurance premiums each month to Kaiser, I eventually became so depressed that I made an appointment with an out-of-network psychiatrist who had once prescribed the Zoloft to me years earlier.  By this time I was feeling suicidal and was also having panic attacks. The out-of-network doctor diagnosed me with severe panic disorder and depression. He recommended marriage counseling, but we couldn’t afford it and our Kaiser insurance wouldn’t cover it. We ended up going to our church, which had a licensed psychologist and MFT doing marriage counseling at a reduced rate of $50 per session. We attended 10 times. By now I was paying out-of-pocket for the every-2-months psychiatrist visit, the Zoloft, the marriage counseling AND paying $600 each month to Kaiser for my insurance. And my husband and I were both still unemployed.

“Eventually I heard about the DMHC fine and the cease and desist letter to Kaiser regarding the violations in their mental health care. I contacted the company by e-mail and asked what they knew about it. They claimed that they were “formulating a response” and would be sending letters out very soon. ( I still have a copy of the e-mail Kaiser sent me  in response to my inquiries) They never did send a letter as they promised. In the meantime I was discovering details on my own about the DMHC violations.

“I decided to make a formal complaint to Kaiser asking for compensation for the 5 psychiatric visits, the cost of the Zoloft, and the 10 visits to the marriage counselor. Even though I sent a detailed letter, and letters from these out-of-network mental health professionals documenting my expenses, Kaiser refused to reimburse me. Kaiser claimed that I had no claim to reimbursement since I went out of network.

“If I had NOT gone out-of-network to get help when I finally did, I believe I might have committed suicide. I was having suicidal ideation nearly every day by then. After Kaiser denied my claim, I sent a letter to the DMHC detailing all of my circumstances and asked them to investigate Kaiser and also to let me know if there would be any class action lawsuits against Kaiser in the future. In truth, I don’t care about compensation — it totaled $1,000. (I have since received a large inheritance and I do not need the money.) I am more interested in being an advocate for other California health care consumers.”

We’re on the Road to Somewhere

Featured

Welcome to 90 Days to Change, the website developed in 2014 by a (now former) Kaiser Permanente psychotherapist to promote improvements in mental health services at California’s largest HMO. The First 90 Days (Reader’s Edition) provides an account of my last three months at Kaiser, as I promoted positive change from within. After being relieved of duty prematurely, I spent another three months reaching out to consumer protection agencies and politicians. You can read about this search for allies in The Second 90 Days (Reader’s Edition).

With the February 24, 2015 release of the Department of Managed Health Care’s stunning follow-up report,  I’m encouraged to stay involved, to write about the next phase in the transformation, and to advocate for as rapid a change as possible.

Now that a California State agency has corroborated the testimony of Kaiser’s 2600 mental health practitioners, the pressure is really on the Feds to address the widespread and appalling treatment of people with mental illness, Americans under the legal protection of the Mental Health Parity and Addiction Equity Act (2008) and the Mental Health Parity Act (1996). The randomized audit of services, detailed in the State agency’s report, creates a precedent for a similar investigation to be led by the Centers for Medicare and Medicaid Services, concerning the subset of Kaiser mental health patients being treated by the Kaiser Advantage Medicare program.

So much has been accomplished already — by the psychotherapists at Kaiser, their patients, and their patients’ families and friends. As a result of years of perseverance, the State has started to do its part. It’s time for the Feds to do theirs.