Case Management

News: Kaiser Permanente ordered to halt denial of care

Case Management Weekly, March 7, 2012

Kaiser Foundation Health Plan is illegally denying some of its California enrollees physical, speech and occupational therapy services, according to a cease and desist order filed February 27 by the state.

According to the order, Kaiser "categorically denies coverage" for these services on the basis that certain enrollees do not have a physical condition or physical impairment that triggers the coverage, and does not provide these patients with a medical necessity review, according to the Department of Managed Health Care, which regulates managed care plans serving 21 million lives.

California's Knox-Keene Act specifies that speech therapy, physical therapy and/or occupational therapy "are required basic health services, and therefore Kaiser's denial of coverage for physical therapy, speech therapy, and/or occupational therapy based on a lack of physical impairment is illegal and contrary to the Act," according to the order.

Read more on the HealthLeaders Media website.

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