Marilyn's complaint:
April 25, 2015

Insurance Company: Kaiser Permanente
Coverage Type: Health Insurance

• Claim Handling - Denial of Claim

This story is very hard to get across in words how tragic and desperate we felt but I will try. Two years ago my son was in his 2nd year of college. He developed a drug problem. We had no idea how bad it was and what to do about it. We expected to get guidance from our health care professionals at Kaiser. After all, that is what we have insurance for.

When our son came home after the second year was over, thru various and horrible ways we found out he was abusing drugs. He agreed he had a problem and wanted help. We turned to Kaiser Addiction medicine. They put him in outpatient rehab. We felt that maybe he needed more but we had never dealt with this and did not question their “knowledge”. He attended most meetings, he did miss a few, but he drove himself to and from the meetings on his own. He wanted to be sober. After a couple of weeks, my husband and I found him unconscious and barely breathing. It was latterly the worst moment of our life. My husband performed CPR until the 911 responders arrived. They shot him in the heart with something to make his heart beat again and start breathing. He was taken to the closest hospital, not a Kaiser hospital. He was there for about 8 hours. The doctor there told us that he needed more treatment then he was getting and he has a serious problem. When he was stable enough, they moved him to a Kaiser hospital where he stayed for about another 24 hours. We were told he was ok to go home with us. A big red flag went off in both our heads and we knew this was not right. We asked if any psychiatrist had seen him and they said no. We insisted he talk to someone before he left. They called someone in and she had about a 2 minute conversation with him and said ok he is free to go. Just make an appointment with the addiction doctor. Once again, we did. The next day my husband took him to the “addiction specialist” (HAHA and told him what happened and how close to death my son was. The doctor then said something that to this day is unbelievable, he said to my husband AND my son in the same room that death was nothing to him, they deal with it every day and that my son should quit smoking cigarettes. Then he said to our son that he should attend Kaiser’s outpatient rehab that meets every day for two weeks. My husband tried to get him into in patient but the doctor said no. My son at this point was frustrated because he knew what he was doing was not working but we really did not have a choice.

He attended the meetings; again, he did miss some. He was a 19 year old drug addict. But he did attend classes and had us go to classes as well. He was trying. Then, about a week and a half into the everyday rehab, the second overdose happened. Again 911 responders came and gave him something to wake him up. This time he was taken to a Kaiser hospital where he stayed for about 3 or 4 hours then was released. At this point his father and I were begging the doctor to put him into an in-patient rehab. The emergency doctor told us is was not that easy and sent us on our way. My son was still showing effects of being on drugs. It was horrible.

We knew something had to be done and it was up to us. We immediately made plans for my husband to take our son out of state to clean up and get away from the bad habits he had fallen into. They were leaving the next day and it was my job while they were gone to work things out with Kaiser and get him into an in-patient facility that he needed. Our son agreed. He knew he needed help and he felt he was not getting it. He was very discouraged. They left and the next three days were spent on the phone with Kaiser talking to anyone who would listen and could make the decision to get him into inpatient facility. I kept hearing No and no approval never came. They said the reason was he lacked motivation and missed some outpatient meetings. Well, he is a 19 year old boy addicted to heroin. But the kid CLEARLY is crying out for help. I had some really amazing conversations with the Kaiser doctors. They are completely incompetent when it came to addiction and mental health issues. We were on our own. We are not rich and that leads to a whole different story… Please see gofundme.com campaign number spwjv4m

I was blessed enough to find a wonderful place where he attended in patient rehab for 3 months. He had to learn a lot of things to live a clean and sober life. He got the treatment he needed. He needed daily follow up care for 9 months. At this young age, they do not have the skills or wisdom to stay on the right track without help. So we did what we had to do to get our son healthy and on his way to a happy, healthy life. I am proud to say he is sober today and has earned himself his personal trainer certification and has a job he likes. We are so happy to have our son back. No thanks to Kaiser. We submitted all our bills to them and they declined to reimburse us. They said it was because we did not use a Kaiser facility. Well it does not make sense. We tried to go to a Kaiser facility, they said no NUMEROUS times. They gave a different reason. But now, they give us a different reason again. There were so many rude comments and inconsistencies from Kaiser. They just did not care. When the doctor told my husband and son his little death explanation, I immediately filed a complaint against him. I feel that from then on out he truly did not care what happened to my son and went out of his way to make treating him as difficult as possible. The only thing I could find on this guy was that before Kaiser, he was a family practitioner. Normally, addiction specialists are trained in mental health issues. He was a family practice doctor. He exacted his retribution on us to the tune of the cost of rehab for about a year. Kaiser never paid. We tried to get a lawyer but nobody would take our piddly little case.
It is my opinion that Kaiser does not have it's own facility and they would have to pay someone else to treat my son. That is why he was not treated by Kaiser.
My son is happy and healthy today and I thank God and pray to him to keep him that way.

Thank you for reading my story.

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