San Diego woman claims Kaiser Permanente denied her the mental health care she was entitled to, and at least one Kaiser therapist and the American Psychological Association claim her story is similar to what they see with many others patients.
Emily Pacillo told NBC 7 that she was diagnosed with generalized anxiety disorder several years ago. She said she regularly saw a therapist, who helped her deal with her mental health issues.
But when Pacillo moved from Boston to San Diego and started a new job in early 2021, she had to find a new health insurance provider. She said she signed up for Kaiser Permanente coverage and started trying to find a new therapist as soon as possible.
As part of the selection process, Pacillo said he was asked to complete a short questionnaire about his mental state in the previous two weeks. She said on the basis of this screening, she was told that she was not eligible for therapy.
Pacillo said she spoke with at least three therapists as she continued to try to get approval for treatment. She said a therapist told her she could only seek services if she was going into a mental health crisis.
“So if we’re going to compare this to regular medicine, basically I don’t do checkups until I have stage four cancer,” Pacillo said. “And then what? Can I come in? Can I get treatment? Don’t you think it’s a little too late? Isn’t that a little counterintuitive? Mental health has to be preventative. “
Pacillo also said a Kaiser therapist told him it was unhealthy to go to a therapist once a week and that friends and family are supposed to be the support system for healthy mental health.
A spokesperson for Kaiser Permanente told NBC7 they could not comment on individual patients, but said the advice Pacillo “receives from reports from his therapist is not in line with our philosophy and approach to providing. mental health care services “.
Jim Clifford, a Kaiser therapist for 20 years, called Pacillo’s situation “a perfect example of the kind of concerns” he has.
Clifford has been battling his own business for at least a decade over what he calls gaps in mental health care. He told NBC7 he has not only seen Kaiser’s patients struggle to get the initial care they need, but also patients who have to wait too long for follow-up care.
“The wait between appointments is often a month to two months, and it’s just a very difficult way to operate,” Clifford said.
“We spend a lot of time apologizing,” Clifford said.
Clifford said he thinks Kaiser is more focused on finding ways to tell people they don’t need treatment or rush them, rather than simply addressing staff shortages.
In June, the Kaiser therapists sent a letter with their concerns, including this statement: “As providers, it is devastating for us to recognize that the ethical care and accessibility needed to better serve our patients is not what it is. that we are able to provide – far from that. “
In a statement to NBC7, Kaiser said meeting the mental health needs of its members is a priority and that they have hired nearly 600 therapists in California over the past five years, increasing their overall therapist base. by 35%.
Kaiser’s statement also said: “We know there is still a long way to go for Kaiser Permanente and all providers before they can truly meet the growing demands for mental health care. This is a national issue, a problem we all need to work on together to help solve.
“I would ask Kaiser and I would ask the California Department of Health Care Management to take this more seriously,” said Dr. Jared Skillings, head of professional practice for the American Psychological Association.
In January 2020, Dr. Skillings sent a letter to the California Department of Managed Health Care, which oversees HMOs, calling the delays in Kaiser’s mental health care services “serious.”
In a statement to NBC 7, the Department of Managed Health Care said, “The ministry continues to investigate the issues raised by the APA” and “continues to hold Kaiser accountable.”
The ministry told NBC 7 that it fined the plan $ 4 million in 2013 and reached a settlement agreement in 2017 that required Kaiser to make significant improvements to oversight of the behavioral health care plan. . The ministry did not specify what these improvements are.
Dr Skillings told NBC 7, with the growing need for mental health care amid the pandemic, getting mental health care right now is more important than ever.
“We have a mental health tsunami in this country and it is crucial that we take this seriously. It is crucial that we provide access to care and in particular to serious mental illnesses and to patients most at risk,” said said Dr Skillings.
After a month, Pacillo decided to enroll in the medical plan of another health insurer.
“Your health insurance plan is exactly for that – your health – and they don’t care about your health,” Pacillo said.
Read the full statements from Kaiser Permanente and the California Department of Managed Health Care below.