Know Your Rights
in California
As a California resident, you have the legal right to:
Receive Timely
Access to Care
In California, HMOs like Kaiser Permanente are required to offer you an initial non-urgent mental health appointment within 10 business days of when you request one and, starting July 1, 2022, a follow-up mental health appointment within 10 business days unless the treating therapist determines that a longer wait will not have a detrimental impact on your health.
Timely Access Regulations — California Code of Regulations 1300.67.2.2(c)(5)
| Provider Type | Appointment Type | Elapsed Time Standard |
|---|---|---|
|
Non-MD Mental Health Provider |
Routine |
10 Business Days |
|
MD Mental Health Provider |
Routine |
15 Business Days |
|
Non-MD Mental Health Provider |
Urgent |
2 Days |
|
Non-MD Mental Health Provider |
Follow-up*
*Section 1300.67.2.2(c)(1) |
10 business days unless the treating therapist determines that a longer wait will not be detrimental to your health |
Receive Timely
Access to Care
In California, HMOs like Kaiser Permanente are required to offer you an initial non-urgent mental health appointment within 10 business days of when you request one and, starting July 1, 2022, a follow-up mental health appointment within 10 business days unless the treating therapist determines that a longer wait will not have a detrimental impact on your health.
Timely Access Regulations — California Code of Regulations 1300.67.2.2(c)(5)
| Provider Type | Appointment Type | Elapsed Time Standard |
|---|---|---|
|
Non-MD Mental Health Provider |
Routine |
10 Business Days |
|
MD Mental Health Provider |
Routine |
15 Business Days |
|
Non-MD Mental Health Provider |
Urgent |
2 Days |
|
Non-MD Mental Health Provider |
Follow-up*
*Section 1300.67.2.2(c)(1) |
10 business days unless the treating therapist determines that a longer wait will not be detrimental to your health |
Equal Coverage for Mental and Physical Health Conditions
Consumers have the right to receive benefits for mental health and substance use treatment on the same basis as they do for other illnesses. For example, if your health plan doesn’t put limits on the number of appointments you can have with your primary care doctor each year, it cannot place annual limits or caps on appointments with a mental health clinician.
Medically Necessary Mental Health and Addiction Care
California law requires commercial health insurers (outside of Medi-Cal) to cover all medically necessary treatment for mental health and substance use disorders including outpatient services, hospital services, residential treatment, partial hospitalization, and intensive outpatient treatment. There are no annual visit limits or limits on the duration of time you can be in ongoing therapy as long as it’s determined to be medically necessary.
Out-of-Network Care
If your health plan cannot provide you with timely and geographically accessible care from its contracted network of mental health providers, then it must arrange for you to get care from an out-of-network provider at no extra cost to you (for example, you would pay the same office-visit copays).
Receive Timely
Access to Care
In California, HMOs like Kaiser Permanente are required to offer you an initial non-urgent mental health appointment within 10 business days of when you request one and, starting July 1, 2022, a follow-up mental health appointment within 10 business days unless the treating therapist determines that a longer wait will not have a detrimental impact on your health.
Timely Access Regulations — California Code of Regulations 1300.67.2.2(c)(5)
| Provider Type | Appointment Type | Elapsed Time Standard |
|---|---|---|
|
Non-MD Mental Health Provider |
Routine |
10 Business Days |
|
MD Mental Health Provider |
Routine |
15 Business Days |
|
Non-MD Mental Health Provider |
Urgent |
2 Days |
|
Non-MD Mental Health Provider |
Follow-up*
*Section 1300.67.2.2(c)(1) |
10 business days unless the treating therapist determines that a longer wait will not be detrimental to your health |
Receive Timely
Access to Care
In California, HMOs like Kaiser Permanente are required to offer you an initial non-urgent mental health appointment within 10 business days of when you request one and, starting July 1, 2022, a follow-up mental health appointment within 10 business days unless the treating therapist determines that a longer wait will not have a detrimental impact on your health.
Timely Access Regulations — California Code of Regulations 1300.67.2.2(c)(5)
| Provider Type | Appointment Type | Elapsed Time Standard |
|---|---|---|
|
Non-MD Mental Health Provider |
Routine |
10 Business Days |
|
MD Mental Health Provider |
Routine |
15 Business Days |
|
Non-MD Mental Health Provider |
Urgent |
2 Days |
|
Non-MD Mental Health Provider |
Follow-up*
*Section 1300.67.2.2(c)(1) |
10 business days unless the treating therapist determines that a longer wait will not be detrimental to your health |
Equal Coverage for Mental and Physical Health Conditions
Consumers have the right to receive benefits for mental health and substance use treatment on the same basis as they do for other illnesses. For example, if your health plan doesn’t put limits on the number of appointments you can have with your primary care doctor each year, it cannot place annual limits or caps on appointments with a mental health clinician.
Medically Necessary Mental Health and Addiction Care
California law requires commercial health insurers (outside of Medi-Cal) to cover all medically necessary treatment for mental health and substance use disorders including outpatient services, hospital services, residential treatment, partial hospitalization, and intensive outpatient treatment. There are no annual visit limits or limits on the duration of time you can be in ongoing therapy as long as it’s determined to be medically necessary.
Out-of-Network Care
If your health plan cannot provide you with timely and geographically accessible care from its contracted network of mental health providers, then it must arrange for you to get care from an out-of-network provider at no extra cost to you (for example, you would pay the same office-visit copays).
Mental Healthcare That Meets Your Clinical Needs
Under California law, health plans are required to maintain an internal “grievance” process in order to handle patient complaints. Through this process, you can voice your concerns about quality of care, financial issues, and decisions by your health plan to delay or deny appointments, referrals, or other types of care.
Click here to learn more about how to file a complaint.
Receive Care in the Emergency Room
Federal law, through the Emergency Medical Treatment and Active Labor Act, requires anyone coming into an emergency department to be stabilized and treated, regardless of their insurance status or ability to pay.
File a Complaint with your Health Plan
You have the right to file complaints with your health plan if you feel you’re not receiving timely and appropriate care or are experiencing other problems. See “Filing Complaints” for more information.
File an External Complaint With a State or Federal Oversight Agency
If filing an internal grievance with your health plan does not resolve your concern, you have the right to file a consumer complaint with consumer-protection agencies or to request an Independent Medical Review. Also, if you have an issue that involves an immediate threat to your health, you can file a complaint with government agencies without first filing a member grievance with your health plan. (See our separate page on “Filing Complaints”).
Has Kaiser Permanente delayed or denied your mental health care? Have you or a loved one been forced to endure long waits for appointments?
In an emergency or in need of immediate help, dial 911 or go to your nearest emergency room.
NATIONAL SUICIDE PREVENTION LIFELINE
1-800-273-8255
