Health Net

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Carl of Aptos, CA October 17, 2009

I am writing because I have exhausted all of the normal channels for receiving support from Health-Net. For the last seven months, I have been trying to help my 86 year old mother receive status and reimbursement on a claim made in February, 2009. At that time, my father was released from a skilled nursing facility and required medical equipment upon return to his home. The discharge coordinator at the skilled nursing facility (Manor Care in Walnut Creek, California) directed me to a specific medical supply company and advised that HealthNet would pay for the required equipment. The medical supply company told me that they would confirm clearance from Affinity Medical Group (the medical group for my father's primary physician).

A few days later the equipment arrived but we were required to make payment and were told we would be reimbursed after sending the receipts. I made initial contact with HealthNet in April and they advised me that they were working on the claim and asked me to allow additional time. This was not my initial understanding but since I was not at home when the equipment was received, it was necessary to just accept as it is.

I assumed that the process would take a few months but when no progress had been made by August (after my father's death in July), I made contact with HealthNet. At that time, they told me that they needed another month and that I would be contacted. I followed up in September and was told that "they need 'these' codes". Two months later, I have no idea what "these codes" are or who is supposed to provide them. The HealthNet representative (a supervisor named Carolina) promised to "fast track" my mother's claim and then I would hear something in a week. When that week passed, I had to initiate contact, and Carolina told me she needed 7 - 10 more days. Eight days had passed since that contact and I called to learn that HealthNet is "still working on it and Carolina will call me on Monday, October 19th (more than 20 days since Carolina committed to "fast track" the claim). With each call, I have spent nearly an hour or more on the phone.

My mother is a recent widow who is trying to get an understanding of her finances and make decisions for the rest of her life. She has not lived on her own since World War II. It is completely unreasonable that she should be held back by a claim sent to HealthNet almost 9 months ago and HealthNet's tactics are completely out of line. In reality, this is only creating stress which will only add to the depression that she is already facing. Frankly, I fear that this will go on so long that HealthNet will claim that too much time has passed for payment. If an error was made by someone else, HealthNet as gatekeeper should work with that provider. My mother should not be responsible if we followed the directions of our provider. At this point, I have not been provided with any information about the reason for the delay in processing this claim.

This claim is for around 700.00. By failing to respond as committed, it is likely that HealthNet is expending more that this amount in customer service and administrative time. That is not to mention the "good will" loss. I hope that there is something that you can do to move this item along. I am at my wits end with the hurdles and missed promises from HealthNet.

Stephen of San Diego, CA October 2, 2009

In approx 2000 I was diagnosed with a gastrointestinal problem. For over 9 years this problem was in check with a medication called Protonix 40MG . In July of 2009 , HealthNet informed me this drug was not on their formulary and I MUST change prescriptions to another drug. Aciphex was chosen. Very quickly I was starting to be ill with Diarrea, gas , dizzyness and loss of weight. I passed out one day and saw my doctor as quick as I could Oct22/09. I then began an ordeal trying to get the protonix reinstated. I also found that during this time I had also had a heart attack and now have a 100% blockage in my LAD artery to my heart. The Gastrointestinal problem associated with the chage in Medicine has caused internal bleeding to my GI track , and my heart problem can not be addressed until the GI Bleeding is stopped. I was otherwise prior to the change in medications in good health. It seems uncontionable to me that this was done to my medication.

Jaime of Redlands, CA August 6, 2009

We took our two year old son to the doctor as he was having a hard time shaking off a cold and had a fever. The doctor found that he had an ear infection and prescribed antibiotics and he was cured. We recently got a bill from the doctor's office for that visit and when we further inquired about why we were being billed and not the insurance company, we found out that Health Net had decided that the ear infection was a pre-existing condition. They refused to pay the bill. We contacted Health Net's customer service and found out that if you have a cold or any condition in the past and it repeats, (even if the causes are unrelated) they will deny coverage. We are stuck paying a bill for over 200 and are now afraid that they will not cover any treatments if they don't feel like it. Beware of HealthNet. They will not cover your medical expenses, but they'll gladly take your money every month.

april of swansboro, NC June 17, 2009

Have to say, I'm very happy with the way Healthnet has treated me. My husband had it through his employer and when he changed jobs, I ended up in the hospital with brain cancer. The insurance ended the day before my surgery. Thank God for COBRA! I've continued my insurance plan through Healthnet, while my husband has BCBS. Had I gone with his plan, I would be paying 20% of my radiation, chemo, and mris. That would have run me in the 1000's every month!

With healthnet, I pay 75 for each mri, radiation is covered and would chemo be at 100% if done through clinic. I pay a 25 copay for my chemo pills and they run almost 3000 a month. To the poster that said she shouldn't be paying a copay for medications because she's double insured is wrong. My kids are double insured and the pharmacy files on the insurance that has the cheaper copay, not nopay!

Florence of Peoria, AZ March 3, 2009

Florence of Peoria AZ (03/03/09)
I would like to rescind my complaint against Healthnet. I received prompt attention by the time my surgery was done. It was fully paid without any charge to me. I also received the reimbursement check for the batteries on my wheelchair. Healthnet is trying to accommodate everyone and I realize it takes time, so I am very grateful to them for all they did for me.

Mike of Barstow, CA February 7, 2009

Mike of Barstow CA (02/07/09)
as i approached 65 i was swamped with insurance companies trying to sell me supplemental insurance..than a representative from health net met with me and told me that health net had a supplemental program that they provided at no cost to me,as the government paid for it..i was told how more coverage i would have at no cost. never in his presentation did explain that they took the money that i was paying into medicare and that i would no longer have medicare.they also did not mention that they were an hmo.

this misrepresentation seemed like a good thing,so i signed up with them.as my moms care provider when they approached her i thought it was still a good idea and signed her.but the reality of the situation is that it was a big step in the wrong direction and the coverage is much less.my mom is getting billed for things that were paid in full before.she has been denied treatments that she had recieved before health net.now they say she cannot go to her regular heart doctor unless it goes through another dr and he gives authorization.

my mom is 86 yrs old and health nets misinformation is jeapordizing her health and welfare. if they had been honest in there presentation we would have never got involved.what we need is to get disconnected from healthnet and have the medicare reinstated.my mothers subscriber number to health net is ro6152434 and mine isro4551893

denial of medical proceedures,unable to see regular doctors,lrge increase in out of pocket payments.detrimental to moms health

Kimberly of Lemon Grove, CA January 22, 2009

Kimberly of Lemon Grove CA (01/22/09)
If anyone out there is even CONSIDERING retaining Healthnet for their medical coverage, thank very long and hard about this. I have never, in all the years I have been forced to deal with medical insurance carriers, come accross such blatent disregard for their insureds. Case in point.

Every other time I walk into a pharmacy to get a prescription filled, they tell me that Healthnet has denied the prescription because it needs pre-authorization. Forget the fact that your suffering and NEED THIS MEDICATION TO GET BETTER! I also have inside information from someone who actually works at Healthnet who has informed me that it is their policy to deny every medication. I have had to hire a lawyer to address their incompetence and their refusal to honor prescrptions that have been given to me by my doctors.

I have had to pay THOUSANDS AND THOUSANDS of dollars in prescriptions because they won't authorize them, because of their unethical practices. What really kills me is between my husband and I and his employer, we are going to pay Healthnet almost 14,000.00 per year to have a PPO, not an HMO, yet we are being treated like we are in an HMO.

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