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Kaiser Foundation Health Plan & Bad Faith Claims

Kaiser Foundation Health Plan is the nation’s largest managed care organization. Kaiser Foundation Health Plan, a non-profit, is one of three related entities that makes up Kaiser Permanente, which provides healthcare to nearly 12 million customers across the country. While Kaiser claims a stellar reputation for providing preventive care to its policyholders, the insurer often falls short in providing the treatments to which its patients are entitled under their policies and under state law. If you need help regarding Kaiser Foundation bad faith claims, contact one of our attorneys today.

Non-profit, but still quick to deny patient claims

HMO policyholders are forced to trust that their insurers will provide the care they need—and that they pay for—when they need it. Insurers who deny these critical services to their customers are both betraying their customers’ trust and falling short of their contractual obligation to provide necessary treatment, all in the name of saving money. Insurers will often claim that a sought-after service is not covered by the patient’s policy, relying on the fact that customers who are overwhelmed by a health crisis will be too intimidated by the use of complex legal or medical jargon to fight back.

Kaiser claims that its status as a non-profit makes it immune to concerns over profits or shareholders, and that it solely focuses on providing high-quality care. The fact is that many divisions of Kaiser operate on a for-profit basis, and even the non-profit divisions have been repeatedly criticized for holding onto large cash reserves, not reinvesting that cash in its facilities or patient care.

Seasoned and dedicated help after a wrongfully-denied claim

You don’t have to fight back against a bad faith denial of care alone. Let the experienced and aggressive bad faith insurance lawyers at Gianelli & Morris help. Our seasoned insurance claim denial lawyers have established themselves as leaders in the field of bad faith insurance claims, having won hundreds of millions of dollars in damages for victims of wrongfully-denied claims. Contact us today and learn about your legal options if you’ve had a claim wrongly denied by Kaiser.

Attorneys with experience fighting against Kaiser for wrongly-denied claims

Our attorneys have gone to battle on behalf of large classes of Kaiser policyholders and emerged victorious, resulting not only in money damages for our clients, but also in changes to corporate policy that will help patients for years to come. In a recent case filed on behalf of thousands of Kaiser patients, Gallimore v. Kaiser Foundation Health Plan, Inc., we argued that patients who had undergone bariatric weight loss surgery were entitled to receive reconstructive surgery to have excess skin removed. Kaiser had denied patients coverage for this surgery, despite California laws that require coverage of reconstructive surgery when it would improve function or create a normal appearance. Gianelli & Morris partner Robert Gianelli, the lead attorney on the case, succeeded in persuading a judge that excess skin removal should be covered under Kaiser’s policy, a change that will result in a predicted $150 million in benefits for Kaiser patients in need of reconstructive surgery.


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Denial of claims for mental and occupational therapy criticized

Perhaps most notably, Kaiser has been the subject of repeated criticism for failing to provide its patients with necessary treatment and therapy for their mental and emotional well-being. In 2013, Kaiser incurred a $4 million fine for its failure to provide timely mental health treatment for its patients. Kaiser was again forced to settle claims with the California Department of Managed Health Care regarding similar complaints in 2015 and 2017. Additionally, our team of California insurance bad faith attorneys has personally led the charge against Kaiser’s denial of critical therapy for young policyholders with autism. Robert Gianelli’s leadership in the case titled Arce v. Kaiser Foundation Health Plan, Inc., which sought coverage of Applied Behavior Analysis therapy for children with autism, earned him the distinction of being named an Attorney of the Year by California Lawyer magazine, as well as a finalist for the award of Consumer Attorney of the Year by the Consumer Attorneys of California.

If you’re facing a bad faith denial of a claim under your Kaiser health insurance policy, get the help you need fighting for the care you deserve by contacting the Los Angeles insurance bad faith attorneys at Gianelli & Morris for a consultation on your case at 213-489-1600.

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