Kaiser Don't Deny

Know Your Rights

in Hawai'i

As a Hawai’i resident, you have the legal right to:

Receive Timely
Access to Care

Hawai’i law requires HMOs like Kaiser to deliver care “without unreasonable delay” and without forcing patients to travel unreasonable distances. Additionally, Kaiser is required to have sufficient numbers of therapists and psychiatrists on hand to meet patients’ needs in a timely way.
(Hawai’i Revised Statutes § 431:26-103)
Provider Type Appointment Type Elapsed Time Standard
Licensed Therapist (non-MD)
Non-urgent
10 Business Days
Psychiatrist (MD)
Non-urgent
15 Business Days
Licensed Therapist (non-MD)
Urgent
2 Days

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
Licensed Therapist (non-MD)
Non-urgent
10 Business Days
Psychiatrist (MD)
Non-urgent
15 Business Days
Licensed Therapist (non-MD)
Urgent
2 Days

Out-of-Network Care if Kaiser Can’t Provide Timely Care

If a patient’s clinical needs require more rapid access than the timeframes noted above, then Kaiser must deliver such care. If Kaiser cannot provide reasonable access to care, it must inform you about your right to receive timely care from an out-of-network therapist or psychiatrist at Kaiser’s expense. Kaiser must address these requests “in a timely fashion appropriate to the covered person’s condition.” (Haw. Rev. Stat. § 431:26-103(c))

An Effective, Individualized Treatment Plan

Hawai’i law says:

“All mental health services shall be provided under an individualized treatment plan approved by a physician, psychologist, licensed clinical social worker, licensed marriage and family therapist, licensed mental health counselor, advanced practice registered nurse, or licensed dietitian treating eating disorders, and must be reasonably expected to improve the patient’s condition.” (Haw. Rev. Stat. § 431M-4(b)(1))

Mental Health Parity

Consumers have the right to receive benefits for mental health and substance use treatment on the same basis as they do for other illnesses. These rights are protected by both federal law (the Mental Health Parity and Addiction Equity Act) and state law. (Haw. Rev. Stat. § 431M-2(b) and § 432D-28)

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.

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.

Click here to learn more about how to file a complaint.

Let's Go

File a Complaint with State or Federal Oversight Agencies

You have the right to file complaints with state and federal agencies responsible for protecting the rights of healthcare consumers. See “Filing Complaints” for more information.

Click here to learn more about how to file a complaint.

Let's Go

Receive Timely
Access to Care

Hawai’i law requires HMOs like Kaiser to deliver care “without unreasonable delay” and without forcing patients to travel unreasonable distances. Additionally, Kaiser is required to have sufficient numbers of therapists and psychiatrists on hand to meet patients’ needs in a timely way.
(Hawai’i Revised Statutes § 431:26-103)
Provider Type Appointment Type Elapsed Time Standard
Licensed Therapist (non-MD)
Non-urgent
10 Business Days
Psychiatrist (MD)
Non-urgent
15 Business Days
Licensed Therapist (non-MD)
Urgent
2 Days

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
Licensed Therapist (non-MD)
Non-urgent
10 Business Days
Psychiatrist (MD)
Non-urgent
15 Business Days
Licensed Therapist (non-MD)
Urgent
2 Days

Out-of-Network Care if Kaiser Can’t Provide Timely Care

If a patient’s clinical needs require more rapid access than the timeframes noted above, then Kaiser must deliver such care. If Kaiser cannot provide reasonable access to care, it must inform you about your right to receive timely care from an out-of-network therapist or psychiatrist at Kaiser’s expense. Kaiser must address these requests “in a timely fashion appropriate to the covered person’s condition.” (Haw. Rev. Stat. § 431:26-103(c))

An Effective, Individualized Treatment Plan

Hawai’i law says:

“All mental health services shall be provided under an individualized treatment plan approved by a physician, psychologist, licensed clinical social worker, licensed marriage and family therapist, licensed mental health counselor, advanced practice registered nurse, or licensed dietitian treating eating disorders, and must be reasonably expected to improve the patient’s condition.” (Haw. Rev. Stat. § 431M-4(b)(1))

Mental Health Parity

Consumers have the right to receive benefits for mental health and substance use treatment on the same basis as they do for other illnesses. These rights are protected by both federal law (the Mental Health Parity and Addiction Equity Act) and state law. (Haw. Rev. Stat. § 431M-2(b) and § 432D-28)

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.

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.

Click here to learn more about how to file a complaint.

Let's Go

File a Complaint with State or Federal Oversight Agencies

You have the right to file complaints with state and federal agencies responsible for protecting the rights of healthcare consumers. See “Filing Complaints” for more information.

Click here to learn more about how to file a complaint.

Let's Go

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.

Let's Go

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?

Share Your Story

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

Kaiser Is Failing Mental Health Patients — You Deserve The Best Care