Healthnet of CA - Advice Needed

[pipedream]

Contact the CA DOI and lodge a formal complaint. HN is already on their "list" due to some past transgressions. One more won't hurt.

Already done and awaiting their response.

With your permission, I will post your story in InsureBlog. This blog get's a lot of traffic and sometimes pressure from the blogosphere helps.

You have my permission and my brother's to post his story anywhere. I might have posted on InsureBlog myself if I had known about it. I came to this forum because the folks here were helpful to me about a year ago when Assurant Health discontinued our family HSA health insurance plan and offered us a completely unaffordable substitute in the guise of providing us with a better plan. (It was better....for them.)

You might also look for patient advocates. They may or may not help but a few hundred dollars to have them review the details is cheaper than a lawyer.

The news media is another resource. The MSM is nutso about claim issues right now, and especially in CA. You can probably get someone to take up your cause without too much trouble.

We will check out both options.

Carriers record all phone calls involving patient matters. If need be, those records can be subpoenaed to support your case.

John has been trying to get copies of the recordings and all records. So far without success...it probably will require subpoenas.

Contact me direct if you want to discuss in more detail.

Will do. Thanks.
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I don't know about the "industry" but they have had a multitude of issues with the CA regulators over the past number of years. You might check this one out. I will sound somewhat familiar to your own case.

Well, I guess HN learned their lesson....(excerpt) "...Health Net also said it would review its practices and the way its brokers and agents are trained."

Now instead of canceling policies unjustly, HN can concentrate on perfecting ways to deny benefits while the policy remains in place.

 

[stormtracker]

I don't wish to divert from the context of this thread, but how would single-payor insurance take the agent out of the system? Wouldn't the system then employ agents in-house? For what it's worth, if such a system would end this type of hypocrisy, I'm all for it. I used to sell an HMO in central Texas and I had to leave because I could not work for them in good conscience.

 

[djs]

Single-payor fixes some problems but creates as many new ones. Heck, it might even work well for a few years, but it doesn't take much of a crystal ball to see problems in the future, in a very big way!

Even the president believes its not the way to go. Medicare, which arguably is a test case for single payor, is on the path to insolvency. According to the president, this threatens the economic stability of the US.

Given the Presidents views, why would we want to make the problem larger? Yes, it might defer it for a few years, but it doesn't solve the problem on a larger scale.

Dan

 

[somarco]

Medicare, which arguably is a test case for single payor, is on the path to insolvency.

Not on the way. Already there.

In FY 2008 Medicare took in $194 billion in taxes and paid out $391 billion in claims. They have been running in the red for years. The folks in Obamington are pulling the wool over our eyes by claiming they need to take over the entire health care system to save Medicare and the economy.

 

[pipedream]

Well, well, well....look at what I found today. This press release was put out by the CA Nurses Association earlier this month - looks like John might not have had any better luck if he had returned to CA and stayed in-network for treatment.

California's Real Death Panels -

More than one of every five requests for medical claims for insured patients, even when recommended by a patient's physician, are rejected by California's largest private insurers, amounting to very real death panels in practice daily in the nation's biggest state, according to data released Wednesday by the California Nurses Association/National Nurses Organizing Committee....

...."With all the dishonest claims made by some politicians about alleged 'death panels' in proposed national legislation, the reality for patients today is a daily, cold-hearted rejection of desperately needed medical care by the nation's biggest and wealthiest insurance companies simply because they don't want to pay for it," said Deborah Burger, RN, CNA/NNOC co-president.

For the first half of 2009, as the national debate over healthcare reform was escalating, the rejection rates are even more striking. Claims denial rates by leading California insurers, first six months of 2009:

• PacifiCare -- 39.6 percent
• Cigna -- 32.7 percent
• HealthNet -- 30 percent
• Kaiser Permanente -- 28.3 percent
• Blue Cross -- 27.9 percent
• Aetna -- 6.4 percent

"Every claim that is denied represents a real patient enduring pain and suffering. Every denial has real, sometimes fatal consequences," said Burger....

...Rejection of care is a very lucrative business for the insurance giants. The top 18 insurance giants racked up $15.9 billion in profits last year.


"The routine denial of care by private insurers is like the elephant in the room no one in the present national healthcare debate seems to want to talk about," Burger said. "Nothing in any of the major bills advancing in the Senate or House or proposed by the administration would challenge this practice."


“The United States remains the only country in the industrialized world where human lives are sacrificed for private profit, a national disgrace that seems on the verge of perpetuation," she said.

(Bolded Emphasis is mine.) See entire press release with heartbreaking examples of denials here:

California's Real Death Panels: Insurers Deny 21% of Claims

 

[pipedream]

From my brother's blog post today -

"The Ca. Dept. of Insurance has informed me that they are very happy that I contacted them, and they encourage me to stay in touch, but are unable to help with this particular problem. They say that my dispute with Health Net is a “he said, he said”...... Nothing that they can do, and that litigation is my next step. Disappointing, but I have to agree. I am still seeking a lawyer to take this on spec. If I am unsuccessful, I guess that I will do it myself...... a bit of David and Goliath drama....."

Since the phone calls between customers calling in and Health Net are taped, I wonder why the CA Insurance Commission would not dig a little deeper into this situation. Assuming there are tapes, how does that make it a "he said, he said" situation?

Health Net could more accurately be termed "Health Nyet".

 

[Guest]

From my brother's blog post today -

"The Ca. Dept. of Insurance has informed me that they are very happy that I contacted them, and they encourage me to stay in touch, but are unable to help with this particular problem. They say that my dispute with Health Net is a “he said, he said”...... Nothing that they can do, and that litigation is my next step. Disappointing, but I have to agree. I am still seeking a lawyer to take this on spec. If I am unsuccessful, I guess that I will do it myself...... a bit of David and Goliath drama....."

Since the phone calls between customers calling in and Health Net are taped, I wonder why the CA Insurance Commission would not dig a little deeper into this situation. Assuming there are tapes, how does that make it a "he said, he said" situation?

Health Net could more accurately be termed "Health Nyet".

Did you take your case to the Dept. of Managed Health Care? See if you can locate Cindy Ennis who is the director or Ellen Badley (if she still works there.) Ellen will remember me. I don't think Cindy will.

The DOI is the wrong venue. You want to take this to the DMHC. Let us know what they say. If they say they won't help, you need to take that to the media along with the rest of it. I believe the only thing Healthnet is really afraid of is the media because bad publicity can/will result in less business written.

Al
InsuranceSolutions123 Agency

 

[pipedream]

Thanks, al3 - Will do so post haste. Surgery is scheduled for next Monday to remove my brother's bladder....so he will be out of commission for several weeks after that. I will make sure he sees your recommendation and hopefully he will be able to get his complaint to the Dept. of Managed Health Care before then.
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I believe the only thing Healthnet is really afraid of is the media because bad publicity can/will result in less business written.

Al
InsuranceSolutions123 Agency

I believe your statement has more than a little substance - excerpt from an article which popped up on my Google News Alert for California Health Net

"...Only one PPO, Anthem Blue Cross, had a double-digit membership percentage gain. Anthem said its OC PPO enrollment grew 10% to 298,072 members.

Blue Shield of California said its local PPO membership rose 8% to 130,578.

Aetna Health of California's PPO membership fell 3% to 128,099 enrollees.

Health Net Life Insurance Co.'s OC PPO membership fell 14% to 23,000 enrollees, something that spokesman Brad Kieffer said was "a factor of the current economy."

Health Net has seen its customers go from higher-cost plans, such as PPOs, to lower-cost ones, Kieffer said...."

Excerpt from - Local HMOs On a Rebound, Saw 5.6% Gain in Members - 10/5/2009 - insurancenewsnet.com


Brad should consider that maybe more than the current economy is at work here....perhaps Health Net's 30% denial rate and lousy customer service should be factored in the equation as well.