Private Practice Therapist Speaks Out on Behalf of her Northern California Kaiser Client

“Several months ago I met with a new client in my private practice who told me she had Medicare, which was contracted through Kaiser. This client had been speaking with a Kaiser psychiatrist for years, but only by phone. During our initial assessment, I discovered that my client had been unable to leave her home for years during daytime hours due to severe agoraphobia caused by lifelong sexual trauma. She was also actively suicidal, had been hospitalized twice during the past year, and was struggling to remain sober. She assumed her Medicare would cover her therapy with me, and was finally willing to try individual therapy because my office was two blocks from her home, a distance that was extremely anxiety-provoking, but worth it to her to receive treatment.

“Of course I soon found out that Kaiser would only cover her therapy if it was approved as medically necessary. Her psychiatrist at the Richmond facility said this could only be approved by her supervisor.  It was not approved.  I pressed with more details of the client’s situation and was finally told that perhaps a social worker could be sent.  This never happened.  I consulted with a managed care regulatory board that worked with Medicare patients and was told to submit a complaint to them, and then a formal complaint to Kaiser. They also told me that most likely nothing would happen.  I have not yet submitted a formal complaint to Kaiser.

“I have continued to see this client pro bono because of her suicidality and because I plan to continue to fight with Kaiser to approve my services.   And, of course, because I don’t want to be part of a system that refuses service to people in need.”

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