If you are a California Kaiser member who paid out of pocket for out-of-network therapy or addiction treatment after January 1, 2021 because you could not get timely in-network care, you may be able to get that money back.
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.
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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);
- List each out-of-network provider and the dates and amounts of service; and
- Enclose your supporting documents (see below) and sign the attestation.
All claim details and the online filing tool are available at the official settlement website, OutOfNetworkHealthClaims.com.
What Documentation Do You Need?
This claim requires documentation. You must enclose:- Invoices or itemized bills for the services you are seeking reimbursement for, showing the dates of service, the services provided, and the amounts billed; and
- Proof of payment — documents showing you paid for the services, such as receipts, acknowledgements of payment, or cancelled checks.
If you do not have these documents, you may be able to obtain them from your provider. If you are obligated to pay but have not yet paid for some or all of the services, the form has an option to indicate that. Because the program reimburses documented out-of-pocket costs, keeping your bills and payment records is important. To file online, you also need the Notice ID Code and Confirmation Code printed on the notice you received in order to log in to the secure portal.
What Is the Deadline?
Your claim must be submitted within 180 days of the date you received notice of the opportunity to file. Notices are sent on a rolling basis, so your personal deadline depends on when you were notified. If you believe you qualify but are unsure whether the window is still open, check the official settlement website for current details.Related Mental Health & Privacy Settlements
If you are reviewing mental health and consumer-health cases, you may also want to read about the BetterHelp FTC settlement over the alleged sharing of online therapy users' information, and the Flo period-tracker privacy settlement. These are separate matters with their own deadlines and eligibility rules.Frequently Asked Questions
Who is eligible for the Kaiser out-of-network mental health reimbursement?
You may be eligible if you were a California Kaiser Permanente member who, after January 1, 2021, attempted but was unable to obtain timely in-network mental health or substance use disorder care and, as a result, paid (or are obligated to pay) out of pocket for out-of-network care.
What is the claim deadline?
Your claim must be submitted within 180 days of the date you received notice of the opportunity to file. Because notices are sent on a rolling basis, your personal deadline depends on when you were notified.
Is proof or documentation required to file a claim?
Yes. To file online you log in with the Notice ID Code and Confirmation Code from your notice, and you must enclose copies of the invoices or itemized bills showing the dates of service, services provided, and amounts billed, plus documents showing you paid for the services (such as receipts, acknowledgements of payment, or cancelled checks). If you do not have these documents, you may be able to obtain them from your provider.
How much money can I get back?
There is no fixed per-person amount. Eligible members may be reimbursed for some or all of their out-of-pocket costs for the qualifying out-of-network care, based on the documentation submitted. 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.
How do I file a claim?
To file online, log in to the secure portal with the Notice ID Code and Confirmation Code from your notice. You can also download, complete, and mail the claim form. Complete the member and claim information, describe your attempts to obtain in-network care, list each out-of-network provider and the amounts paid, and enclose your invoices and proof of payment. Details are at OutOfNetworkHealthClaims.com.
Sources
- Official settlement website — OutOfNetworkHealthClaims.com
- U.S. Department of Labor — EBSA settlement news release (Feb. 2026)
- California DMHC — Kaiser behavioral health settlement (Oct. 2023)
