Kaiser Permanente - Out-of-Network Claims (California) Class Action Settlement

Insurance · Mental Health Reimbursement · Claims Open

What Is This Settlement About?

Kaiser Foundation Health Plan, Inc. ("Kaiser Permanente") has agreed to reimburse certain California members who paid out of pocket for out-of-network mental health and substance use disorder care. The reimbursement program grows out of settlements Kaiser reached with government regulators — the U.S. Department of Labor's Employee Benefits Security Administration (EBSA) and the California Department of Managed Health Care (DMHC) — over the plan's delivery of behavioral health services. It is a regulatory settlement and reimbursement process, not a class action lawsuit, so there is no court-approved class.

Regulators alleged that Kaiser members in California could not always access timely in-network mental health or substance use disorder treatment, and that some members had to seek and pay for out-of-network care as a result. Under its February 2026 settlement with the U.S. Department of Labor, Kaiser agreed to pay at least $28.3 million to reimburse members for out-of-pocket costs they incurred obtaining out-of-network mental health and substance use disorder services on or after January 1, 2021. Separately, in an October 2023 settlement with the California DMHC, Kaiser agreed to a $50 million fine — the largest in that agency's history — and pledged $150 million over five years toward improving behavioral health care, while agreeing to corrective action. Kaiser resolved these matters without an admission of liability.

Who Qualifies?

You may be eligible to submit a claim if all of the following are true:

• You received out-of-network mental health or substance use disorder care after January 1, 2021;
• You were a Kaiser Permanente member in California (Northern or Southern California region) at the time you received that out-of-network care; and
• Before going out of network, you attempted to obtain in-network mental health or substance use disorder services from Kaiser Permanente but were unable to access timely care, and you paid (or are currently obligated to pay) out of pocket for the out-of-network care.

Claims may also be submitted on behalf of an eligible member who is deceased, was a minor at the time of service, or is an incapacitated adult, by an authorized representative who completes the form's addendum and encloses documentation of their authority.

How Much Can You Get?

There is no fixed, per-person payment. Eligible members may be reimbursed for some or all of their out-of-pocket costs for the qualifying out-of-network mental health or substance use disorder care, based on the documentation submitted and Kaiser's review of each claim. The out-of-network reimbursement program is funded by at least $28.3 million under Kaiser's settlement with the U.S. Department of Labor.

On the claim form, you list each out-of-network provider, the dates of service, the total amount you paid out of pocket, and any amount you still owe. Kaiser may contact your provider to confirm amounts owed. If your claim is approved and you accept the reimbursement, you give up the right to seek additional reimbursement for the same services.

How to File a Claim

You can file online or download, print, complete, and mail the claim form to the Kaiser Permanente Notice Administrator. To file online, you log in to the secure portal using the Notice ID Code and Confirmation Code from the notice you received, then upload your information. To file, you will:

• Log in with the Notice ID Code and Confirmation Code from your notice (online portal);
• Provide the patient's name, contact information, date of birth, membership record number, and region (NorCal/SoCal);
• Confirm that you paid out of pocket for out-of-network mental health or substance use disorder services and that you first tried to get in-network care;
• Describe your attempts to obtain in-network care (when you requested services, how, and to whom);