Kaiser to pay at least $28.3 million for members' out-of-network mental health and SUD costs

The U.S. Department of Labor’s Employee Benefits Security Administration reached a settlement with Kaiser Foundation Health Plan Inc. after investigations found Kaiser’s inadequate provider networks and improper use of patient questionnaire responses limited access to in-network mental health and substance use disorder care. Kaiser will pay at least $28,323,219 to reimburse members’ out-of-network costs and a $2,832,321 federal penalty, and has agreed to policy reforms to reduce wait times, improve care review, and monitor network adequacy. Notices have been sent to potentially eligible California members who participated in the plan after Jan. 1, 2021, and a claims website and phone number are available.