Southern California Kaiser Client Tells Her Story

The day after I opened up this forum, I immediately got a response. Makes me think we’re on to something…

“In 2010 I was laid off from my job. I had been working as a San Diego area teacher for over 30 years. My husband and I sold our house and downsized to a smaller home. Just six months later the new car dealership my husband had worked at for the last 12 years closed its doors. We were 53 and 57 and both unemployed now. I was quickly spiraling downwards emotionally.

“I contacted Kaiser Permanente to obtain a Zoloft prescription, a drug I had used once before but no longer was taking. They had the Shadowridge mental health facility in Vista contact me, and they did a quick over the phone interview. I was set up with an appointment to see a psychiatrist in six weeks — a long wait. The day before my appointment they called me and said the doctor had the flu, but if I came in they would find someone else to see me. I declined, as I was nervous about seeing “someone” without knowing anything about who that person was. I asked if a doctor could just prescribe me the Zoloft over the phone, and the nurse refused. I then asked for another appointment with the psychiatrist I had originally been scheduled with. The nurse set me up with a new appointment – in ANOTHER six weeks.

“Even though my husband and I were paying $1,200 in insurance premiums each month to Kaiser, I eventually became so depressed that I made an appointment with an out-of-network psychiatrist who had once prescribed the Zoloft to me years earlier.  By this time I was feeling suicidal and was also having panic attacks. The out-of-network doctor diagnosed me with severe panic disorder and depression. He recommended marriage counseling, but we couldn’t afford it and our Kaiser insurance wouldn’t cover it. We ended up going to our church, which had a licensed psychologist and MFT doing marriage counseling at a reduced rate of $50 per session. We attended 10 times. By now I was paying out-of-pocket for the every-2-months psychiatrist visit, the Zoloft, the marriage counseling AND paying $600 each month to Kaiser for my insurance. And my husband and I were both still unemployed.

“Eventually I heard about the DMHC fine and the cease and desist letter to Kaiser regarding the violations in their mental health care. I contacted the company by e-mail and asked what they knew about it. They claimed that they were “formulating a response” and would be sending letters out very soon. ( I still have a copy of the e-mail Kaiser sent me  in response to my inquiries) They never did send a letter as they promised. In the meantime I was discovering details on my own about the DMHC violations.

“I decided to make a formal complaint to Kaiser asking for compensation for the 5 psychiatric visits, the cost of the Zoloft, and the 10 visits to the marriage counselor. Even though I sent a detailed letter, and letters from these out-of-network mental health professionals documenting my expenses, Kaiser refused to reimburse me. Kaiser claimed that I had no claim to reimbursement since I went out of network.

“If I had NOT gone out-of-network to get help when I finally did, I believe I might have committed suicide. I was having suicidal ideation nearly every day by then. After Kaiser denied my claim, I sent a letter to the DMHC detailing all of my circumstances and asked them to investigate Kaiser and also to let me know if there would be any class action lawsuits against Kaiser in the future. In truth, I don’t care about compensation — it totaled $1,000. (I have since received a large inheritance and I do not need the money.) I am more interested in being an advocate for other California health care consumers.”

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