Kaiser Therapists, Patients Allege Long Waits for Mental Health Care

Kaiser Permanente’s newly opened medical center in Oakland. (Lisa Aliferis/KQED)

Kaiser Permanente’s newly opened medical center in Oakland. (Lisa Aliferis/KQED)

One month, three months, even five months.

That’s how long some Northern California Kaiser patients wait to see an individual therapist — according to many Kaiser patients and therapists.

KQED’s Jon Brooks has reported extensively on this issue over the last two months. He talked to close to two dozen therapists and patients who said that they were experiencing long wait times. One therapist whose specialty is geriatric care told him that she had written to her superiors saying, “I can’t tell a patient that has six months to live that I’ll see them in five months.” Continue reading

Long Way to Go Before State May Authorize Autism Therapy as Benefit

(Getty Images)

(Getty Images)

By David Gorn, California Healthline

State officials on Friday said they have not determined whether or not to offer applied behavior analysis (ABA therapy) as a Medi-Cal benefit to children with autism.

Federal officials earlier this month issued guidance on the subject, saying it is covered for Medicaid beneficiaries under age 21 as part of the Early and Periodic Screening, Diagnosis and Treatment program.

“Under the Medicaid state plan, services to address [autism spectrum disorder] may be covered under several different … benefit categories,” the CMS guidance said. For children, it said, “states must cover services that could otherwise be covered at state option under these categories consistent with the provisions … for Early and Periodic Screening, Diagnostic and Treatment services (EPSDT). Continue reading

Explaining the Health Insurance ‘Explanation of Benefits’

By Lynne Shallcross

We are wrapping up the first phase of our PriceCheck project. The goal is to shine a light on costs of common health care procedures in California. We’re starting with screening mammograms, and already we’ve found that the cash price (for people who are uninsured or have gone out of network) varies from a low of $60 at the H. Claude Hudson Comprehensive Health Center in Los Angeles, a county-run clinic, to $801 at U.C. San Francisco on the high end.

Together with KPCC in Los Angeles and ClearHealthCosts.com, we’re also asking you, the members of our community, to share what you’ve been charged — and what your provider has been paid — for common health procedures.

In order to do that, you need to get familiar with your insurance company’s “explanation of benefits” or EOB. That’s the form your insurer sends to explain what was paid, to whom, at what level and why.

Here’s a typical EOB, that we’ve marked with some explanations below:

An explanation of benefits from Anthem Blue Cross.

An explanation of benefits from Anthem Blue Cross.

Continue reading

Therapists, Patients Criticize Kaiser Over Long Delays for Therapy

Kaiser Permanente's newly opened medical center in Oakland. (Lisa Aliferis/KQED)

Kaiser Permanente’s newly opened medical center in Oakland. (Lisa Aliferis/KQED)

This is the second of two parts about mental health services at Northern California Kaiser.

In January 2013 a woman named “Nina” had a terrible falling out with her father. Soon after, she found out he had incurable cancer and was going to die. In the ensuing weeks, she tried to patch things up, but with the pressures inherent in the last months of a dying man, was unable to attain any form of closure. Some six months after their fight, he was gone.

“People are suffering, and I fear some of my patients will commit suicide for lack of ongoing treatment.”

“Nina,” who did not want us to use her real name for reasons of privacy, had been prone to depression. Zoloft had helped, but the now irreparable family rift left her severely depressed, with occasional thoughts of suicide. “I was in a state of constant emotional pain and confusion,” she says. “It was affecting all aspects of my life.”

She went for an intake appointment at the psychiatric department at Kaiser Permanente’s Oakland Medical Center, with the expectation she’d be able to see a therapist for individual appointments during this severe emotional crisis. She requested those sessions, but the intake therapist told her Kaiser only offered group therapy.

“I said I’m not comfortable talking about my situation with a bunch of strangers,” Nina says. “She very kindly tried to make me aware of the value of group therapy. But I knew in my heart it wasn’t where I wanted to be.” Continue reading

Sonoma County Has Highest Whooping Cough Rate in Statewide Epidemic

Napa has the second highest rate of the disease. (Esparrow1/Flickr)

Napa has the second highest rate of the disease. (Esparrow1/Flickr)

By Lynne Shallcross

It’s been a little over a month since California declared a whooping cough epidemic, and according to the most recent data from the state, three neighboring Bay Area counties have the highest rates of the disease statewide: Sonoma, Napa and Marin.

Sonoma County’s rate of whooping cough, also known as pertussis, is almost 120 cases per 100,000 people. Napa County’s rate is 90 per 100,000, and Marin’s rate is 65 per 100,000.

Sonoma County’s interim health officer, Karen Holbrook, says the number of cases reported each week has peaked and is now declining.

“It’s not what the state is experiencing as a whole, but we are coming down,” Holbrook says. “Will that hold indefinitely remains to be seen.”

Holbrook says California is seeing a whooping cough epidemic partly because the disease is cyclical, with cases spiking every three to five years. Continue reading

Latina Small Business Owner Enters the Insurance Marketplace

Under the Affordable Care Act Sandra Lopez, 41, owner of Las Fajitas in Newport Beach, obtained health insurance for the first time since arriving in the U.S. in 1990. (Heidi de Marco/Kaiser Health News).

Under the Affordable Care Act Sandra Lopez, 41, owner of Las Fajitas in Newport Beach, obtained health insurance for the first time since arriving in the U.S. in 1990. (Heidi de Marco/Kaiser Health News).

By Heidi de Marco, Kaiser Health News

Alongside one of Newport Beach’s canals, blocks from the beach, Sandra Lopez is finally living her idea of the American dream.

For years Lopez took home remedies or asked friends to bring her medicine from Mexico.
In 1996, six years after crossing the border from Mexico without papers, she began working at Las Fajitas, a popular Mexican restaurant as a cashier and cook. With the help of her boss, she received a work visa in 2001.

Eleven years after that, she bought the business – a bustling establishment where Lopez knows most customers by name. Mexican lanterns hang from the ceiling, and cheers from a soccer match on TV fill the room.

Lopez, now a legal resident, said the income from her small business fluctuates monthly. “People think that because you own a business, you have lots of money…that life is easy,” she said. “But it’s hard work and I have so many bills to pay.” Continue reading

Work as Refuge? Working Mothers Report Better Health

Life at the office can look really appealing sometimes. (Getty Images)

Life at the office can look really appealing sometimes. (Getty Images)

I love it when my job intersects with the rest of my life.

NPR is reporting Tuesday about a fascinating survey that found that women who work full time “reported significantly better physical and mental health than moms who part time.” They heard from more than 2,500 mothers in the 2012 survey.

In addition, people appear to be more stressed at home than they are at work.

Oh, and mothers who worked part time said they enjoyed better health than their counterparts who didn’t work at all.

Really? As the mother of two children who worked part time for several years before taking this job, I was all-in on this story. Could I really be enjoying peak health while working full time and — yes — still raising those kids. (Disclosure that my husband does help: Thanks, dear!) Continue reading

Kaiser, Nurses Union Brace for Upcoming Contract Battle

(April Dembosky/KQED)

Members of the California Nurses Association rallied in Sacramento in May to raise awareness around what they say are patient care concerns in California hospitals. (April Dembosky/KQED)

Going to a nurses union meeting is a little bit like going to an evangelical church service.

Contract talks begin next week on new four-year contract.
“We all have to stand up, and it’s a struggle,” says nurse Veronica Cambra, reporting a grievance at Kaiser Hospital in Fremont as though she’s giving testimony. “And we will overcome this, okay?”

The rest of the nurses respond with the passion of a devout congregation, humming “Mmm hmmm,” and “That’s right,” through the series of speeches.

The union heads at the front of the room interject now and then to rally the group around a unifying message.

Continue reading

PriceCheck: What Insurance Companies Are Paying for Mammograms

(Illustration: Andy Warner)

(Illustration: Andy Warner)

It’s been almost three weeks since we launched our PriceCheck project, and women statewide are continuing to share what they — or their insurance companies — have paid for a mammogram.

Is your insurer paying $134 or $1,200?    

I talked about PriceCheck and our most recent data with Rachael Myrow on The California Report Thursday morning.

It’s been fun to see people’s mouths fall open when I tell them the range we’re seeing that insurers pay for mammograms across California:  $134 on the low end to $1,200 on the high end. Continue reading

Feds Want California to Clear Medi-Cal Backlog

State officials have until Monday to submit plan. (Justin Sullivan/Getty Images)

State officials must submit plan by Monday. (Justin Sullivan/Getty Images)

By Phil Galewitz, Kaiser Health News

Tired of waiting for states to reduce their backlogs of Medicaid applications, the Obama administration has given California and five other states until Monday to submit plans to resolve issues that have prevented more than 1 million low-income or disabled people from getting health coverage.

600,000 people signed up, but not yet enrolled, in Medi-Cal.

“CMS is asking several state Medicaid agencies to provide updated mitigation plans to address gaps that exist in their eligibility and enrollment systems to ensure timely processing of applications and access to coverage for eligible people,” said Aaron Albright, a spokesman for the Centers for Medicare & Medicaid Services. He said the agency will monitor states’ progress in solving the problems getting people enrolled in the state-federal insurance program for the poor.

In addition to California, the other states are Alaska, Kansas, Michigan, Missouri and Tennessee. Continue reading