• jbiedajr6

Working with Kaiser as Your Insurance Part 1 of 3

When Clients have kaiser and need to see a therapist weekly, they must establish for the company that they meet Medical Necessity. According to kaiser utilization review documents, "The determination of whether a service is medically necessary is based upon criteria that are consistent with sound clinical principles and processes, which are reviewed and approved annually by the Plan."

So what does this mean to you as the client, who is having depression, anxiety, fear of leaving your house, or many other symptoms that may be affecting you. It means that if your diagnosis is one that fits into a Parity diagnosis, you automatically meet medical necessity.

What are Parity diagnosis? They are moderate to severe mental health diagnosis that the federal and california governments have designated as needing to meet the same level of care as medical diagnosis. So if a cancer diagnosis would get you residential care and rehabilitation, an eating disorders diagnosis might get the same level of care.

The determination of level of care necessity is made by your provider, the insurance company may disagree, but your providers job is to back up their diagnosis and recommendations with clinical knowledge and evidence.

The parity diagnosis are as follows

  1. Dementia

  2. Psychosis

  3. Bipolar disorder

  4. Schizophrenia

  5. Major Depression

  6. Panic Disorder

  7. Agoraphobia

Under california Parity the diagnosis below is also covered.

  1. ADHD

If you have these diagnosis, then you have the right, under federal and state law to have your treatment be equal to your medical treatment,

As all things with insurance there are exclusions.

  1. Your policy is not full coverage, ie it excludes mental health coverage

  2. Your Policy is with a company that has fewer then 50 employees

This is a basic primer on Parity, Remember that using this language with Insurance companies is powerful. Informed consumers are better at advocating for themselves.

We want all of our clients to have the knowledge to get what they need and deserve from their insurance.

11 views0 comments

Recent Posts

See All

So, you have determined you need therapy, and gone to kaiser, they have referred you to their groups for depression and anxiety, and then switched you to a in house therapist who saw you for 4 session