BAD KAISER!!!

GOOD MORNING PEOPLE! It is kind of funny that Kaiser approved my WLS in no time, but has refused to provide medical treatment for my son Andrew who suffers from Autism.  They keep saying that all the treatments for Autism are experimental, not medically necessary, educational, not effective, well tired insurance parlance! Currently, I am going through two Independent Medical Reviews, dozens of grievances for denying access to care for my son, including the "alteration" of records to reflect treatments, assessments and procedures that never happened.  There is arbitration pending, I had to hire a lawyer to sue the F*CK out of them for fraud, negligent infliction of emotional distress, breach of contract and bad faith among other things. These people think that I don't know what I am talking about.  They don't want to pay because treatment for Autist is very expensive and long term, not short like WLS.  I can tell you that the have saved, with me alone, thousands in medical care as a result of my WLS, but my poor baby is going through a lot and they don't want to help.  However, they don't know that I am a litigator and know my way around the law, but these people think that I am bluffing, NOT! I find it extremely difficult to reconcile the law mandate, under AB88 that provides in part that Autism is a parity diagnosis that should be treated like any other illness, but the only treatments there are to ameliorate the behaviors associated with Autism Kaiser is always trying to find an excuse not to cover them.  I am praying that my IMRs will be successful.  I can tell you that as result of my barage of complaints to the Department of Managed Health Care Kaiser is facings over $100,000.00 in administrative fines, plus the fact that I am going to, you know, sue the F*CK out them.  The DMHC complaints are currently under Counsel review to assess these fines.  I hope they get hit big time.  What they have done to my baby is criminal! You need to know that Kaiser cannot always hide behind arbitration clauses.  If Kaiser denies you for  medically necessary care and they refuse to provide it and your condition gets worst, you can probably get a jury trial which will get you much more than the maximum $250,000 limit on compensatory damages provided  in their arbitration rules. The only thing that I can tell you is,  KEEP GOOD RECORDS and write down the who, when, where and what.  I did and it is paying off, but the amount of paperwork is monumental, in my case already two 5" binders and now getting ready for a third one. Just venting, I am so  that Kaiser can do this to a 2 year-old child!  Pray for us. Regards, Guillermo

Well over 30 years ago, Kaiser was negligent with my mother ultimately causing her death at the young age of 54. I will never forget that and my father thinking they did everything they could for her How about ignorning lumps and saying they were okay....like hello????

My point is Gullermo is bravo to you for fighting for the proper medical treatment your son deserves!!!! I wish you the best!

Never give up the fight Waarce........I know it is very consuming and it boggles your thoughts to why Kaiser does the things they do.  They just paid UC Davis to do my surgery when they could have done it themselves.  I will say a prayer for your child and your family. Hang in there, Annabelle

Just wanted to wish you luck with your case and let you know that I will be thinking of you and your son!


Shells

Bless you for having the strength to fight! Its people like you who make a difference in the world. Your son is so blessed to have a Mother who is willing to fight for him. I wish you both the best!