Class Accuses Kaiser of Patient Dumping
By Reni Anguelova
LOS ANGELES (CN) - Kaiser forces patients who suffer from mental illness to cancel their insurance and then shifts the cost of treatment onto taxpayers through a patient dumping scheme, a family claims in a class action lawsuit.
The 1999 California Mental Health Parity Act requires health insurers to provide all medically necessary treatment of patients suffering from a severe mental illness on the same financial terms and conditions as for physical illnesses.
The law states that mental illness is real, can be reliably diagnosed, is treatable, and the treatment is cost-effective.
Mental illness covered by the Parity Act include pervasive developmental disorder of children such as autism, obsessive-compulsive disorder, bulimia, anorexia nervosa, panic disorder, major depressive disorders, schizophrenia, and bipolar disorder, according to the complaint.
Kaiser claims to provide health plans for all medically necessary treatment and defines "medically necessary" as a service required to prevent, diagnose, or treat a condition in accord with the generally accepted professional standards of practice that are consistent with a standard of care in the medical community.
It claims that its medical health services include inpatient psychiatric hospitalization and intensive psychiatric treatment programs. In the mental/behavorial health service disclosures a section titled "Limitations & Exceptions," 'the summary states, "none," according to the complaint.
Plaintiff Matthew Szitkar-Kerr, 21, suffers from schizophrenia and bipolar disorders, he says in the complaint.
Szitkar-Kerr claims he was hospitalized for his condition at a Kaiser Permanent facility and then placed in a conservatorship the following month.
Conservatorship, otherwise known as "LPS Conservatorship," is a short-term (one year) service for people suffering from a mental disorder who are gravely disabled and require psychiatric treatment in a locked facility, according to the complaint. The yearlong conservatorship can be renewed annually if necessary.
Once placed on conservatorship, Szitkar-Kerr, says he was instructed to "disenroll" from the Kaiser health plan.
He claims that Kaiser telephoned him and said that "it was time" to terminate his status as a dependent insured so that he could be provided more treatment in a residential program at a Los Angeles County facility known as "La Casa."
Szitkar-Kerr says his treatment is now funded by the county, the state (through Medi-Cal), and the federal government (through Social Security and Medicare).
Despite its obligation to provide medically necessary services, including treatment for mental health, Kaiser systematically denies coverage, ensures a mandatory disenrollment to LPS conservatorships, and then dumps the costs of psychiatric treatment onto the government and taxpayers, Szitkar-Kerr says the complaint.
He seeks class certification and damages for civil rights violations, unfair competition, fraud and bad faith.
He is represented by Kathryn Trepenski, of Beverly Hills.