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Friday, May 25, 2012

 

DMHC Secures Agreement with Kaiser Health Plan to Provide Medically Necessary Physical, Occupational and Speech Therapy

(Sacramento) - The California Department of Managed Health Care (DMHC) announced today the settlement of its enforcement action against Kaiser Foundation Health Plan, Inc. (Kaiser) for categorically denying the coverage of certain physical, occupational, and speech therapies regardless of medical necessity. Under the terms of the agreement, Kaiser must provide coverage for these services moving forward and reimburse members who paid outof-pocket for medically necessary therapies.

“The agreement ensures that Kaiser members will get the care they are entitled to under the law,” said Brent Barnhart, Director of the DMHC.

The settlement requires that, within 60 days, Kaiser must contact members who have filed complaints since January 2009 regarding denial of speech, physical, or occupational therapy. The notice will inform them that they may be able to receive reimbursement for past out-of-pocket expenses and it will include instructions for requesting reimbursement. A similar notice will be included in Kaiser’s Partners in Health bulletin distributed in July. Members must seek reimbursement prior to January 31, 2013.

The full settlement agreement can be found here:
http://www.dmhc.ca.gov/library/reports/news/settlement052512.pdf

To learn more about health care options, consumer rights, or to receive assistance filing complaints and appeals, Californians can contact the DMHC Help Center at 1-888-466- 2219 or visit www.HealthHelp.ca.gov.

The DMHC regulates managed care health plans in California, protects the rights of approximately 20 million health plan enrollees, educates consumers on their health care rights and responsibilities, and preserves the financial stability of the managed health care system. Since 2000, the department has helped more than 1 million Californians resolve health plan problems through its Help Center.


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