The U.S. Department of Labor’s Employee Benefits Security Administration has reached a settlement with Kaiser Foundation Health Plan Inc. to address systemic failures in providing timely access to mental health and substance use disorder services for millions of California members covered through employer plans.
Scope of Violations
The settlement resolves investigations into Kaiser’s practice of maintaining inadequate provider networks for mental health and substance use disorder care and using patient questionnaire responses to improperly deny care access. According to the Department of Labor, these failures forced many members to seek treatment outside Kaiser’s network at significantly higher out-of-pocket costs.
Financial Remedies
Under the agreement, Kaiser will pay at least $28,323,219 to reimburse covered members for out-of-network mental health and substance use disorder expenses. The company will also pay a $2,832,321 penalty to the federal government. The settlement establishes a claims process allowing eligible members who received out-of-network care after attempting to access in-network services to seek reimbursement.
Operational Reforms
Kaiser has committed to multiple practice reforms designed to improve access to behavioral health care. These include reducing appointment wait times, improving care review processes to ensure members receive medically necessary treatment, and implementing enhanced network adequacy monitoring to guarantee sufficient access to mental health and substance use disorder providers and facilities.
Members in California who participated in Kaiser plans after January 1, 2021, and paid for out-of-network mental health or substance use disorder services after attempting to use in-network care have been notified of their potential eligibility for reimbursement. Those seeking information about the settlement or filing claims can visit www.outofnetworkhealthclaims.com or call Kaiser at 1-877-684-4129. The Department of Labor’s EBSA also provides toll-free support at 866-444-3272 or through askebsa.dol.gov for individuals experiencing difficulty locating available mental health providers within their network.
This article is an AI-assisted summary. All facts and figures are drawn from the original report: https://www.dol.gov/newsroom/releases/ebsa/ebsa20260210