Kaiser Ordered To Cover Developmental Therapy for Certain Patients

On Monday, the Department of Managed Health Care ordered Kaiser Permanente Foundation Health Plan to stop denying coverage to certain patients seeking occupational, physical and speech therapy, the Contra Costa Times reports.

Background

Since 2009, DMHC has received complaints from more than 100 Kaiser policyholders who were denied coverage for the therapies because they lack a physical or mental health condition, according to agency documents.

Anthony Manzanetti -- chief of enforcement for DMHC -- cited an example of the difficulties stemming from Kaiser's coverage policies, saying that people who stutter or have a lisp cannot receive coverage for speech therapy under the insurer's current rules.

Kaiser's Response

John Nelson -- senior vice president for Kaiser Foundation Health Plan -- said that DMHC has "misunderstood or mischaracterized" Kaiser's policies.

He said, "These therapies are not limited only to patients with physical conditions."
Nelson added that Kaiser will continue discussions with DMHC and keep offering coverage for "medically necessary health care services" (Kleffman, Contra Costa Times, 2/27).

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