How do I game Kaiser (Northern California) to get a therapist?
February 8, 2017 9:56 AM Subscribe
Kaiser is notoriously lousy for mental health. They basically tell you that your only option is topic-specific classes. I'm sure these are fine, but I want weekly, one-on-one therapy. I'm pretty sure this is possible, right?
Some people (including the mental health intake person) will tell you that ongoing therapy is just not something Kaiser does, and that if you want it, you're just going to have to pay $150/wk out of pocket. I've talked to some people, however, who say they've gotten therapy, no problem.
Is there some trick I'm missing out on? I'm not going to exaggerate my problems or anything, but is there some thing I can say that will open the secret door? I'm not in crisis; I just have some garden variety discontents that could use an airing on the couch, and it strikes me as completely absurd that this otherwise good insurance is all ¯\_(ツ)_/¯ about it.
Some people (including the mental health intake person) will tell you that ongoing therapy is just not something Kaiser does, and that if you want it, you're just going to have to pay $150/wk out of pocket. I've talked to some people, however, who say they've gotten therapy, no problem.
Is there some trick I'm missing out on? I'm not going to exaggerate my problems or anything, but is there some thing I can say that will open the secret door? I'm not in crisis; I just have some garden variety discontents that could use an airing on the couch, and it strikes me as completely absurd that this otherwise good insurance is all ¯\_(ツ)_/¯ about it.
I have Kaiser Midatlantic out here in VA, so not quite the same animal but just as much a beast when it comes to neglecting mental health. I basically went with Kaiser because it was the cheapest option at my employer, by far, but most if not all regular treatment I have is mental health related. So I pay $90 oop every 3 months when I see my psych (he doesn't accept health insurance anyway but I insist on seeing him and paying oop because he's that good and Kaiser's option is abysmal), can't get a medically-necessary name brand drug unless I have a deductible/copay discount card (because KP won't pay for any name brand pharma), and have quit seeing a therapist because she's not in network and my Kaiser PCP informed me I could only see the one therapist onsite who, surprise, has a huge waiting list. Not to mention therapists are something you kind of have to shop around for til you find the right fit, and I had my therapist long before I had Kaiser. To see a new therapist would be to start from scratch which I am not interested in doing.
It sucks. I really considered switching to the other insurance carrier my employer offers, back during our open enrollment, but couldn't justify the difference in cost because it seemed like I would be paying out my nose in one form or the other.
I think next year I may just eat said costs and switch health insurance. I can't take it much longer. Good luck to you. (Sincerely!)
posted by nightrecordings at 10:45 AM on February 8, 2017 [2 favorites]
It sucks. I really considered switching to the other insurance carrier my employer offers, back during our open enrollment, but couldn't justify the difference in cost because it seemed like I would be paying out my nose in one form or the other.
I think next year I may just eat said costs and switch health insurance. I can't take it much longer. Good luck to you. (Sincerely!)
posted by nightrecordings at 10:45 AM on February 8, 2017 [2 favorites]
My solution to this was to drop Kaiser because they dropped the ball on a few other health issues. But I had a plan of attack to try and get them to pay for my out of network psychiatrist. (it was only a few sessions, so I only filed for reimbursement, but didn't appeal their denial)
California requires timely access to care. And their mental health department never meets it. They can do this if it doesn't impact your health. So you need to document that your mental health isn't responding to their suggested treatments. If they don't have enough therapists, the law requires them to pay for someone out of network. They try to say that only a crisis meets that definition. But the law requires 48 hours for a crisis and 15 business days for any medical issue (shorter if treatment plan requires greater frequency).
The appeal will take forever. It might hurt the pocket, but I think this is a feature. Once it goes through the appeal process, you'll hopefully have a solid therapeutic relationship. At that point you have an argument that it would be harmful to start over. Particularly given their longstanding history (lawsuits etc) with being unable to provide adequate care for mental health parity.
posted by politikitty at 10:46 AM on February 8, 2017 [2 favorites]
California requires timely access to care. And their mental health department never meets it. They can do this if it doesn't impact your health. So you need to document that your mental health isn't responding to their suggested treatments. If they don't have enough therapists, the law requires them to pay for someone out of network. They try to say that only a crisis meets that definition. But the law requires 48 hours for a crisis and 15 business days for any medical issue (shorter if treatment plan requires greater frequency).
The appeal will take forever. It might hurt the pocket, but I think this is a feature. Once it goes through the appeal process, you'll hopefully have a solid therapeutic relationship. At that point you have an argument that it would be harmful to start over. Particularly given their longstanding history (lawsuits etc) with being unable to provide adequate care for mental health parity.
posted by politikitty at 10:46 AM on February 8, 2017 [2 favorites]
I have a friend in northern CA who had great luck seeing a grief counselor at Kaiser. She got in right away, loved the counselor, and ended up seeing her for a long time and just doing general therapy with her (rather than specific to grief). She recently decided she wanted to see her again (for general life reasons, not a specific loss), and by telling the intake person that she was having trouble processing the loss of her brother (from years earlier), she was able to get back in right away. Not sure if this would work the same way for you, but could be worth a try! If you can in some way frame your reason for seeing a therapist as something to do with grief/loss, even if it's a stretch, maybe that will give you access?
posted by scalar_implicature at 10:55 AM on February 8, 2017 [3 favorites]
posted by scalar_implicature at 10:55 AM on February 8, 2017 [3 favorites]
That was a contributing factor to us dropping Kaiser in Georgia. When the ONE therapist who saw children was in an accident, they just kept rescheduling us...and rescheduling us...until 6 months had passed. (This was not the fault of the therapist! She was severely injured.)
KP _sucks_ for mental health care.
posted by heathrowga at 11:53 AM on February 8, 2017 [1 favorite]
KP _sucks_ for mental health care.
posted by heathrowga at 11:53 AM on February 8, 2017 [1 favorite]
I'm not clear on exactly what you have tried. But not too long after one of the lawsuits lit a fire under Kaiser, I managed to get good counseling via Kaiser Oakland (is that the same as Kaiser NorCal?) for a garden-variety situational thing that was going on. This was in maybe 2014. It was a bit of an annoying multi-step process to get referrals, but not hard at all. If you use the approach I describe below, plan on it taking about fifteen 5- to 10-minute phone calls and three in-person appointments before you're dialed in with a great new therapist. If someone was in crisis-level depression, I'd recommend that they get support in navigating the process, but if you can maintain a to do list and calendar, it should be no problem.
You asked for something specific to say. I would not exaggerate your symptoms, but I'd describe how they impact your life functioning. Work was so stressful that I had stayed home sick on the day that I first called Kaiser and was considering quitting my job (for pretty good reasons, actually!). Maybe that threat to being able to maintain normal life functioning helped me qualify? The therapy did help me manage the stress, get through the stressful period, and keep my job, so in my case, Kaiser came through.
Here's how the process went for me, in perhaps more detail than you need. I called Kaiser's adult mental health number and had to leave a message. They called me back, and I explained what stressful thing was happening. On the spot, they said I was approved for ten sessions and referred me to some external source with a horrible name (like CheapoCounseling or BuyRiteTherapy or something; I can't remember). CheapoCounseling was basically a referral service to a bunch of therapists in the area. They called me back, or I called them, I can't remember. They asked me what I was looking for to filter down a list of providers using my zip code, any specialized knowledge needed, and questions like "do you need weekend times?" They tried to just give me one name. This was where things got annoying, because that person (who took 48 hours to call me back) had no availability. So I had to call back and get another therapist's name, leave a message with them, and then after another day or two, learn that they had no availability. Ultimately, the best approach was to take a lunch break, repeat-call CheapoCounseling to get about 9 therapists' names, leave messages with all of them, chat with whoever called me back and had availability, meet with the top two or three, and then decide. In between those trial sessions, I had to call Cheapo to get my authorization switched from Dr. X to Dr. Y. I did ultimately have trial sessions with two people, then clicked with the third. This process of doing several trial sessions turned out to be important because Kaiser's list -- probably like any list of therapists -- has some real amateurs on it. The first person was amateur to the point of being unprofessional; he barraged me with advice right out the gate. Especially if you've never done therapy before, I'd plan on the need to try a few people so you can get a sense of which one has their act together the most. After after all of that, the third therapist I tried was a fantastic person with decades of experience who helped me a lot! And she managed to get my authorization extended from ten to twenty sessions, by which point I didn't need to keep going. One last thing to keep in mind -- Kaiser will bill you for your co-pay for these sessions, whatever it is. That bill will come after a number of sessions, so do set the money aside -- don't be like me and think "oh, hmm, guess there's no co-pay after all." If you don't receive the bill, try to find it; in my experience, they are not good at billing. Anyway, I hope all that detail helps.
posted by salvia at 12:39 PM on February 8, 2017 [2 favorites]
You asked for something specific to say. I would not exaggerate your symptoms, but I'd describe how they impact your life functioning. Work was so stressful that I had stayed home sick on the day that I first called Kaiser and was considering quitting my job (for pretty good reasons, actually!). Maybe that threat to being able to maintain normal life functioning helped me qualify? The therapy did help me manage the stress, get through the stressful period, and keep my job, so in my case, Kaiser came through.
Here's how the process went for me, in perhaps more detail than you need. I called Kaiser's adult mental health number and had to leave a message. They called me back, and I explained what stressful thing was happening. On the spot, they said I was approved for ten sessions and referred me to some external source with a horrible name (like CheapoCounseling or BuyRiteTherapy or something; I can't remember). CheapoCounseling was basically a referral service to a bunch of therapists in the area. They called me back, or I called them, I can't remember. They asked me what I was looking for to filter down a list of providers using my zip code, any specialized knowledge needed, and questions like "do you need weekend times?" They tried to just give me one name. This was where things got annoying, because that person (who took 48 hours to call me back) had no availability. So I had to call back and get another therapist's name, leave a message with them, and then after another day or two, learn that they had no availability. Ultimately, the best approach was to take a lunch break, repeat-call CheapoCounseling to get about 9 therapists' names, leave messages with all of them, chat with whoever called me back and had availability, meet with the top two or three, and then decide. In between those trial sessions, I had to call Cheapo to get my authorization switched from Dr. X to Dr. Y. I did ultimately have trial sessions with two people, then clicked with the third. This process of doing several trial sessions turned out to be important because Kaiser's list -- probably like any list of therapists -- has some real amateurs on it. The first person was amateur to the point of being unprofessional; he barraged me with advice right out the gate. Especially if you've never done therapy before, I'd plan on the need to try a few people so you can get a sense of which one has their act together the most. After after all of that, the third therapist I tried was a fantastic person with decades of experience who helped me a lot! And she managed to get my authorization extended from ten to twenty sessions, by which point I didn't need to keep going. One last thing to keep in mind -- Kaiser will bill you for your co-pay for these sessions, whatever it is. That bill will come after a number of sessions, so do set the money aside -- don't be like me and think "oh, hmm, guess there's no co-pay after all." If you don't receive the bill, try to find it; in my experience, they are not good at billing. Anyway, I hope all that detail helps.
posted by salvia at 12:39 PM on February 8, 2017 [2 favorites]
I broke down in sobs over the poor gyn care I was getting at D.C.'s North Capitol Street center in 1998 or so. The gyn then directed that before pursuing the diagnostic laparoscopy I wanted (needed!) that I must see a KP psychiatrist.
A few years later (happily KP-free), I was talking with my endocrinologist about never getting a returned call from my gastro's office about a post-cholecystectomy problem.
The endo said you pretty much have to go into hysterics for people to take you seriously.
It stinks, but there you go.
posted by jgirl at 12:39 PM on February 8, 2017 [1 favorite]
A few years later (happily KP-free), I was talking with my endocrinologist about never getting a returned call from my gastro's office about a post-cholecystectomy problem.
The endo said you pretty much have to go into hysterics for people to take you seriously.
It stinks, but there you go.
posted by jgirl at 12:39 PM on February 8, 2017 [1 favorite]
I ended up sobbing in my car outside of Kaiser after explaining my lifelong, severe mental illnesses to a psychologist who then handed me old xeroxes called 'what is depression' and 'ten tips for busting stress.' She stated that, realistically, I would only be able to see a therapist once a month, and that was by booking several sessions in advance at each appointment.
posted by missmary6 at 1:03 PM on February 8, 2017 [1 favorite]
posted by missmary6 at 1:03 PM on February 8, 2017 [1 favorite]
Best answer: FWIW, I have Kaiser, and have seen therapists through them, off and on over decades. I've always had my psychiatrist make the referral for individual therapy, though — maybe my request is given a higher priority because of that?
I'd ask your primary care doctor to refer you to a psychiatrist, and then get the psychiatrist to refer you to individual therapy.
posted by culfinglin at 1:11 PM on February 8, 2017 [2 favorites]
I'd ask your primary care doctor to refer you to a psychiatrist, and then get the psychiatrist to refer you to individual therapy.
posted by culfinglin at 1:11 PM on February 8, 2017 [2 favorites]
i ended up going through my EAP and got someone great immediately, and have been seeing her for almost 6 months now. that might be an option for you - they are completely confidential and try to work with whatever insurance you have. i don't have kaiser, but they asked if i did since it's an option at my company.
posted by koroshiya at 2:52 PM on February 8, 2017 [1 favorite]
posted by koroshiya at 2:52 PM on February 8, 2017 [1 favorite]
From a Mefite who wishes to remain anonymous:
Unfortunately I don't remember the triage/set-up process since it was a few years ago, but I was able to secure recurring individual therapy appointments through Northern California Kaiser. It's not weekly, though -- I see my therapist, my psychiatrist (medication management), and (until recently) a sex therapist on a monthly basis. I schedule the next appointment at the end of each session. I also have access to a weekly OCD group with a very helpful facilitator, and have participated in other groups as well. Copays for my plan are $15 for group therapy, and $30 for individual.posted by LobsterMitten at 3:36 PM on February 8, 2017 [1 favorite]
If you haven't yet, perhaps try requesting monthly meetings with an individual therapist. If there is a specific issue (like sex) that comes up in your sessions, maybe your therapist can refer you to a special provider who can talk to you about that topic on a monthly basis as well. In that scenario, you would have two therapy appointments a month instead of one, with two different providers.
Response by poster: I should mention that I did drop Kaiser for a year, and Blue Shield was not markedly better. They had a semifunctional online lookup system that gave few details about the therapists, and when I asked my therapist (who was unsurprisingly not a great match--I had found someone online I wanted to go to who took Blue Shield, but for arcane reasons, she wasn't on their list) if I could go to a psychiatrist to look into medication, he kind of threw his hands in the air after naming one person he knew who was nowhere near me. Then when I called for some referrals, several of those places weren't open yet or weren't accepting patients. I eventually gave up on it. At times one does suspect that this is all by design.
All of this (ok, except for "maybe your expectation of therapy is unreasonable") is super helpful. I guess I'll mark one thing best answer because I'm supposed to.
posted by Smearcase at 6:34 PM on February 8, 2017
All of this (ok, except for "maybe your expectation of therapy is unreasonable") is super helpful. I guess I'll mark one thing best answer because I'm supposed to.
posted by Smearcase at 6:34 PM on February 8, 2017
Salvia is pretty close to what I've seen. You call your doctor (psychiatrist if you have one, otherwise primary care) and get a referral for mental health services. You get referred to a triage person and convince then that your symptoms interfere with your daily life to point that it justifies a referral to a weekly therapist (not an in-house therapist who will only see you once a month.) Outside referral are handled via either Magellan or BeaconOptions - two insurance companies with their own networks. You then call them and tell them what you need. In San Jose area at least, they will call down the list of therapists for you to find someone who actually has an opening. May not be the perfect match but it does save you from having to call dozens just to get one therapist to return the call.
posted by metahawk at 8:51 PM on February 8, 2017 [1 favorite]
posted by metahawk at 8:51 PM on February 8, 2017 [1 favorite]
I have done this dance with KP. The first time I tried to get care through them they offered me the couple individual sessions thing, then one of the classes, which almost explicitly forbade personal sharing. I was pissed off and felt pretty hopeless.
Flash to a couple years later: I scheduled an appointment for a meds check-in with a psychiatrist and she quickly got me in to see a therapist, whom I've been seeing pretty regularly. I'm also now in a group that does honest to god group therapy. I'm much happier with my situation now, though they're still not able to do weekly individual sessions. More like every other or even every three. But the group therapy is a great help for filling in those gaps, and is a wonderful part of my care on its own.
My situation may be a bit different, though, because I have an eating disorder. It's not an especially raging case, but they may prioritize ED patients for this level of care.
What I would recommend is that you set an appointment with a psychiatrist. You don't need a referral for that. Maybe try a couple psychs to find one who'll really go to bat for you - you are able to get a 'second opinion' within KP. The psych I saw gave me a referral to the outside coverage system, and when I called they were happy to give me a long list of providers in my area.
Also, I am in the NorCal system (memail me if you'd like specifics - happy to share), and I know that my area, anyway, is working on bulking up its mental health care options. I've noticed a difference in just a couple years. Hopefully it will continue to improve.
posted by imalaowai at 1:24 PM on February 9, 2017 [1 favorite]
Flash to a couple years later: I scheduled an appointment for a meds check-in with a psychiatrist and she quickly got me in to see a therapist, whom I've been seeing pretty regularly. I'm also now in a group that does honest to god group therapy. I'm much happier with my situation now, though they're still not able to do weekly individual sessions. More like every other or even every three. But the group therapy is a great help for filling in those gaps, and is a wonderful part of my care on its own.
My situation may be a bit different, though, because I have an eating disorder. It's not an especially raging case, but they may prioritize ED patients for this level of care.
What I would recommend is that you set an appointment with a psychiatrist. You don't need a referral for that. Maybe try a couple psychs to find one who'll really go to bat for you - you are able to get a 'second opinion' within KP. The psych I saw gave me a referral to the outside coverage system, and when I called they were happy to give me a long list of providers in my area.
Also, I am in the NorCal system (memail me if you'd like specifics - happy to share), and I know that my area, anyway, is working on bulking up its mental health care options. I've noticed a difference in just a couple years. Hopefully it will continue to improve.
posted by imalaowai at 1:24 PM on February 9, 2017 [1 favorite]
YMMV but some of those classes are ok. I wanted one-on-one therapy at Kaiser Oakland a couple years ago and very begrudgingly did the anxiety class instead. It turned out to be pretty good. And an unexpected bonus was that it helped me pinpoint what I wanted from a therapist.
posted by not_the_water at 2:35 PM on February 9, 2017 [1 favorite]
posted by not_the_water at 2:35 PM on February 9, 2017 [1 favorite]
My experience is almost identical to Salvia's: I called the Northern California Kaiser psychiatry department back in December to request a referral to a therapist. I told them I'd been struggling with depression for the past six months, and while I was in no way a danger to myself, it was seriously interfering with my ability to get through ordinary life. I'd been expecting the depression to "resolve itself" (as if depression were a separate animal than its human host, i.e. me), but it hadn't by the time I called. They gave me a referral through Beacon Health Services, who called me back and provided me, no fuss, with a list of about fifteen therapists near me. I think over the phone I set some geographic limits on the list, so it could've been longer. At any rate, perhaps my advice would be to make a thorough set of notes for yourself to refer to during the intake, which bolster the case that your garden variety discontents are truly affecting your emotional well-being on a day-to-day basis. Don't be flippant or make light of your problems (even if that's your personality, or if you're trying to brush them off out of discomfort).
posted by tapir-whorf at 4:47 PM on February 9, 2017 [1 favorite]
posted by tapir-whorf at 4:47 PM on February 9, 2017 [1 favorite]
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Kaiser does contract with outside mental health agencies, but getting a referral is really difficult (ie, you probably need to be in crisis). You'll need to call (their website is useless for MH stuff) the member services line and ask for an appointment with a MH counselor. They will give you some insane wait time. Let them know that won't work for you, and ask for an outside referral. You will receive pushback on this.
The mental health services that kaiser contacts out with, are typically very hit or miss with quality too. Despite their reputation for evidence based practice, I was personally sent to someone who only engaged in "energy healing" and self hypnosis and shit. There's a wide spread.
I dealt with their system for 6 months, and honestly unless you really can't afford it at all, I would just pay out of pocket to see someone. That what I ended up doing until I could switch insurance. Working in the Kaiser system for MH stuff is straight abysmal (and ironically, can lead to more stress and dysfunction in one's life).
posted by furnace.heart at 10:15 AM on February 8, 2017 [4 favorites]