Health Plan Coverage Claims in 2001 Account For Less Than 1% of All Arbitration Claims at Kaiser Permanente

Apr 13, 2001, 01:00 ET from Office of the Independent Administrator

    LOS ANGELES, April 13 /PRNewswire/ -- Despite concerns that coverage
 claims are on the rise, results of the second annual report from the Office of
 the Independent Administrator show that benefit and coverage claims at Kaiser
 Permanente made up less than 1% -- 11 cases total in 2001. The second annual
 report from the Office of the Independent Administrator covers the period
 between March 29, 2000 to December 31, 2000.
     Improvements in the speed and efficiency in Kaiser Permanente's
 arbitration system also were reported: a 41-day average to appoint a neutral
 arbitrator, and an average of 278 days to the last day of the actual
 arbitration hearing. Out of a total of 349 arbitrators, 216 have been selected
 to serve as neutral arbitrators.  "We have taken our mandate to speed up and
 improve the arbitration process at Kaiser Permanente very, very seriously,"
 said Sharon Lybeck Hartmann, the independent administrator.  "We want to
 ensure that Kaiser Permanente members get the fairest and the quickest hearing
 possible.  We think we have done that."
     Since its inception two years ago a total of 1,716 demands for arbitration
 have been forwarded to the Office of the Independent Administrator. Fifty
 percent of those claims have been resolved in arbitration hearings or through
 settlement.  On average it now takes about eight months to resolve a case from
 beginning to end, a significant improvement.
     Other changes include a new oversight board headed by David Werdegar, MD,
 MPH, professor, Community Medicine, emeritus, UCSF School of Medicine. "The
 Office of the Independent Administrator has made significant progress in
 improving the arbitration system and the new board looks forward to working
 with the independent administrator to make further improvements," said Dr.
 Werdegar.  New additions to the oversight board include Cornelius Hopper, MD,
 vice president for Health Affairs, emeritus, University of California, and
 Cruz Reynoso, professor of law, UCLA School of Law.
     The Law Offices of Sharon Lybeck Hartmann began independently
 administering Kaiser Permanente's arbitration system following the state
 Supreme Court's criticism of the health plan's self-administered system in
 1997 decision, Engalla v. Permanente Medical Group.  In response to this court
 decision, Kaiser Permanente convened a Blue Ribbon Advisory Panel to evaluate
 its arbitration process and recommend improvements.  The panel recommended
 Kaiser Permanente turn over administration of its arbitration system to an
 independent firm.  The Law Offices of Sharon Lybeck Hartmann, a Los Angeles-
 based civil rights firm which specializes in monitoring civil rights consent
 decrees and alternative dispute resolution, was selected in November 1998.
     The new arbitration system was designed to ensure that Kaiser Permanente
 members have access to an arbitration process that is fair, timely, less
 costly, and protects the privacy interests of all parties.  "This report is
 intended to take the mystery out of the arbitration process," according to
 Hartmann.  "The record is public so consumers can compare court cases to
 arbitration cases."
     The full report is available on the OIA's web site at
 www.slhartmann.com/oia or call 213-637-9847.  Copies of the report also can be
 obtained by calling the Kaiser Permanente Member Service Customer Center at
 1-800-464-4000.
 
 

SOURCE Office of the Independent Administrator
    LOS ANGELES, April 13 /PRNewswire/ -- Despite concerns that coverage
 claims are on the rise, results of the second annual report from the Office of
 the Independent Administrator show that benefit and coverage claims at Kaiser
 Permanente made up less than 1% -- 11 cases total in 2001. The second annual
 report from the Office of the Independent Administrator covers the period
 between March 29, 2000 to December 31, 2000.
     Improvements in the speed and efficiency in Kaiser Permanente's
 arbitration system also were reported: a 41-day average to appoint a neutral
 arbitrator, and an average of 278 days to the last day of the actual
 arbitration hearing. Out of a total of 349 arbitrators, 216 have been selected
 to serve as neutral arbitrators.  "We have taken our mandate to speed up and
 improve the arbitration process at Kaiser Permanente very, very seriously,"
 said Sharon Lybeck Hartmann, the independent administrator.  "We want to
 ensure that Kaiser Permanente members get the fairest and the quickest hearing
 possible.  We think we have done that."
     Since its inception two years ago a total of 1,716 demands for arbitration
 have been forwarded to the Office of the Independent Administrator. Fifty
 percent of those claims have been resolved in arbitration hearings or through
 settlement.  On average it now takes about eight months to resolve a case from
 beginning to end, a significant improvement.
     Other changes include a new oversight board headed by David Werdegar, MD,
 MPH, professor, Community Medicine, emeritus, UCSF School of Medicine. "The
 Office of the Independent Administrator has made significant progress in
 improving the arbitration system and the new board looks forward to working
 with the independent administrator to make further improvements," said Dr.
 Werdegar.  New additions to the oversight board include Cornelius Hopper, MD,
 vice president for Health Affairs, emeritus, University of California, and
 Cruz Reynoso, professor of law, UCLA School of Law.
     The Law Offices of Sharon Lybeck Hartmann began independently
 administering Kaiser Permanente's arbitration system following the state
 Supreme Court's criticism of the health plan's self-administered system in
 1997 decision, Engalla v. Permanente Medical Group.  In response to this court
 decision, Kaiser Permanente convened a Blue Ribbon Advisory Panel to evaluate
 its arbitration process and recommend improvements.  The panel recommended
 Kaiser Permanente turn over administration of its arbitration system to an
 independent firm.  The Law Offices of Sharon Lybeck Hartmann, a Los Angeles-
 based civil rights firm which specializes in monitoring civil rights consent
 decrees and alternative dispute resolution, was selected in November 1998.
     The new arbitration system was designed to ensure that Kaiser Permanente
 members have access to an arbitration process that is fair, timely, less
 costly, and protects the privacy interests of all parties.  "This report is
 intended to take the mystery out of the arbitration process," according to
 Hartmann.  "The record is public so consumers can compare court cases to
 arbitration cases."
     The full report is available on the OIA's web site at
 www.slhartmann.com/oia or call 213-637-9847.  Copies of the report also can be
 obtained by calling the Kaiser Permanente Member Service Customer Center at
 1-800-464-4000.
 
 SOURCE  Office of the Independent Administrator