Health Net

I had to change to Health Net in 6/2011. I needed to have my insulin refilled by July 2011 and the strips for my glucose meter. You should also know my doctor of 17 years suddenly was no longer on the plan for new patients. So I had a new doctor, who was okay but didn't have a history with me and didn't care to really fight for me. Health Net declined to cover my insulin and made me switch to another brand just because and they did that with my glucose meter/strips too. The new strips and meter are ** and I had problems with the quality of them within 48 hours of changing over. Apparently, if you don't close/seal the bottle of strips, they become inactive.

With my old strips, I never closed the bottle and just stored it safely away. But the real problem was the new insulin due to Health Net arbitrary games. Be aware that I have contacted Health Net directly. Yes Corbin, you have been contacted and it is two months after I called you everyday for help and I still haven't heard from you. I gave up. I tried to get them to fix the insulin issue because even before the oral problems, I knew it was affecting me "strangely". I tried to see what I could do to get back to my doctor, others in the plan that were with the company longer were grandfathered in so it wasn't a problem for them. I stopped calling daily in October.

I was a Health Net member with my kids for 10 years plus. I paid all my bills, even as the costs skyrocketed to ridiculous amounts over the years. (Major medical).

My husband got a new job with new insurance through work so I gave Health Net notice and cancelled our coverage. My young daughter has asthma and needs inhalers for her issues. I received a letter from Heath Net (case number **, stating that we owe the company $256.47 for an Advair inhaler that was paid for by the company after our coverage ended! I refused to pay this amount due to no fault of my own and always being a good customer.

When I called the 1-800 number they gave me, I cannot even speak to a person about this issue. They just say to take it up with my new insurance carrier. I refused to pay this bill and will take it to small claims if I must with family backing. I would appreciate a call in regards to this matter and thank whoever reads this in advance for any help.

I have a severe lower back pain that radiates to my legs. I went to my primary care doctor who was very nice, and he gave a shot of Toradol and put a PA to see a neurologist. After 2 weeks, I received a letter in mail stating that my PA is approved and I can call and make an appointment. The PA letter that I received has a blank space for phone number.

I called the Lake Side community health care. They gave me a number. I called the number. They said that this PA is for PT and MRI. How am I supposed to do a PT or MRI without the doctor's order? I called back Lake Side and they gave me different number. I called that office and they said "We can't make an appointment. This is a wrong PA. Call your primary." I called my primary and they said, "No, this is for neurologist." I called back the neurologist office. I am wandering around for 2 days, being on the phone from 8 am-5 pm with no answer yet.

I called at 8:15 and the manger (Chantel) was not in the office yet. I called the day before at 4:30 pm and she has left the office. In the paper that I have, it is stated that their office hours is between 8 to 5, so someone is leaving early and not showing up the next morning on time. That's why I have a letter with a wrong PA number and no phone number. I was on the phone for 16 hours. I spoke to the following people in Lake Side and neurologist and WNN office: Carla, Rebecca, Pari, Britney, Maria, Laura, Natalie, Ofelia, again different Carla, Edward, Lupea, and I am still wondering around in physical pain and emotional pain. I have been crying all day.

Why do I have health insurance? I could collect all my monthly payment and pay on my own to a doctor I can choose to go to.

In mid June, they increased my rates by 6% because my birthday is coming (happy birthday to you too, you've got my vote for socialized health care you rats!). Then at the end of July, they're increasing my premiums by 25.2%... because I'm getting older?

That's a 31% increase in less than a month. These guys are unchecked, and while I hate the government, I would love to see the full power of the military unloaded on these **.

My mother signed up for coverage with the HealthNet HMO Medicare plan. She has poor circulation and has had numerous problems with her legs. She has a primary care provider in Hemet Ca who has continually delayed treatment causing reoccurrance of painful venous stasis ulcers. These have been treated with antibiotics, home health and wound care at his direction. When I was visiting from out of state we were to meet the doctor at his office in Hemet. Instead we were called by a Dr. Win his partner. We drove to the office and she met us in the parking lot, looked at the wound with my mother in the car seat and her leg out the open door. She took the dressing off and put it on the ground, advised us to go home and mix table salt and water and use it to clean the wound everyday. She then picked up the dirty dressing and put it back on the wound. What a great example of HealthNet health care.

We have asked for vascular referals and were seen by "In Network" doctors who were unable to help or were coached in the need for denials. She had a wound on her achilles tendon which is 3X4 cm and deeper than the tendon. She was seen by an in network doctor for this on July 1. They made an appointment for 5 weeks later for a recheck. No prescription for antibiotics or wound care at home. She lives alone, has poor vision and this causes her great pain. I brought her to Arizona on July 4th to spend a couple of weeks with our family. On the morning of the 4th of July I asked if she wanted me to help change the dressing. Her wound was infected, with cellulitis up to her knee, and yellow and green exudate from the wound. I took her to the emergency room and they admitted her for antibiotic therapy and she was seen by a vascular surgeon who did an angiogram and found the leg could be saved by opening the arteries with a balloon.

They also found an area in the right groin that needed repaired. She was in the hospital for several days trying to get the infection under control. She came home and was to return to have the balloon done to open the arteries to save her legs. HEALTHNET DENIED THE PROCEDURE BECAUSE SHE IS OUT OF HER AREA OF COVERAGE!

I am a teacher, I teach second grade, and began losing my voice in December 2010. I came down with bronchitis, but the doctors began to have mixed thoughts as to just what I really had. I have asthma, so the complication is that stress, viruses, etc. can trigger coughing and wheezing in me. I did feel that my problem was upper bronchial, but couldn't talk above a whisper. This has gone on for five months now. I have seen numerous doctors including three specialists. The pulmonary specialist finally sent me to the UCLA Voice Center to get an evaluation of my vocal cords. I had seen an ENT in January who said that everything looked fine at that point. The UCLA ENT said that I have a paralyzed vocal cord on the right side. This causes coughing, choking and difficulty swallowing which I have experienced.

When I finally got in to see Dr. Dinesh ** at the UCLA Voice Center in West Los Angeles, he told me that he was going to give me an injection of collagen into my paralyzed vocal cord so that my vocal cords will meet mid line and help me to talk, prevent things aspirating into my trachea, and stop the coughing as well as continual throat clearing. He was just about to give me the shot when he took another look at my chart and said, "Oh, you need another referral in order to have this procedure done." You can imagine how I must have felt--completely discouraged!

Even though the nurse, Angelica, put an "urgent" note on the request, it has now been a full week and I am still suffering. I have chronic pains in my back, rib cage, chest, and under my arms from coughing spasms. Nothing helps! I have to live on cough drops to keep my throat moist, but I still cough. My complaint is, that if I get a referral to a specialist, why should I need yet another referral for what the specialist decides that I need for my treatment? That seems like the Insurance Company is overstepping the wisdom and expertise of the doctor! It causes a lot of grief and hardship for the patient. I am very depressed, discouraged and upset over this. If I could have had the injection when I was there on April 25th, I could be talking in time for CST testing. As it stands, I will probably be coughing and chocking through the entire test with a whisper voice. Please do something to correct such a poor policy!

My family has had health insurance coverage with Health Net for approximately five years. I can no longer afford their rising premiums. I received a letter informing me that if they did not receive payment by a specific date, they would terminate our coverage. I did not pay. I filed no additional claims. Four months later, they called me telling me that I owed them for the previous four months of coverage. I reiterated that their letter informed me that I was being terminated. Their response was that because so many small businesses were having problems paying, that they had extended my coverage as a favor (one which I had not asked for). When I told them that I couldn't afford their coverage, they demanded $5000 in back payments. They never asked for my request of termination, just a notification that I was being terminated. Now they are stalking my husband and I for the $5000 that we cannot afford (or we would be paying for medical insurance). Please help!

I received Health Net medical benefits until August 2009 when I changed jobs. I purchased COBRA benefits (also through Health Net) which took effect immediately. During the covered period, my son had to be hospitalized, generating bills from three entities. Health Net denied all claims, saying that we were not eligible when, in fact, we were. My former employer has re-sent the eligibility information to Health Net on at least three occasions over the past 1.5 years and for some reason, Health Net will not process the letters. I have spent untold hours back and forth on the issue and have been sent to collection agencies by the hospital and laboratory. It is now 2011 and still no progress on this case due to apparent incompetence at Health Net. Consumers, think twice before signing up with Health Net. I never will again.

I have had uncontrolled Type 2 diabetes for 20 years along with eye and kidney failure, heart failure and a stroke 18 months ago and a prior knee and back injury. My average fasting glucose reading is between 400 and 490 mg/dl. Two of my primary care doctors wrote prescriptions for a diabetes drug that has been on the market for about a year. I was also given 3 sample cartridges as it is an injectable medication. The doctors submitted the required pre-authorization requests which were denied.

The samples brought my glucose levels down to an acceptable range of 100-150. I appealed the denial and attended 2 Diabetic Classed that were requested by the doctors and medical group with no recommended changes to my diet or limited exercise procedures. When the sample medications ran out, my glucose level elevated back again and possibly higher than what it was originally.

I then received a packet on Tuesday this week regarding the denial of appeal. I read through the report and it said that this drug cannot be used for Type 1 Diabetes. It went on to say I had until the next day to add anything to the report. The next morning, I called the number given and spoke with Dana **, the Health Nets Appeals Case Coordinator. I explained to her that I would like to have two days extension to complete my glucose history log and to correct the errors within the report. She informed me that she had already closed my case and that she didn't have time to allow me any rebuttal. I pointed out the error with the denial being based on me having type 1 diabetes instead of having type 2.

She informed me that my doctors would have to correct this since Health Net got this information from them, and then hung up on me. I read every doctors report submitted in the packet from both doctors and not one of them had listed me as type 1. I wrote out a rebuttal and faxed it to the number listed on the cover letter even though Ms.Haydel had told me that my case was closed. I have not heard from them since. I believe this is nothing more than a stall tactic to see if I will die and they will not have to pay the cost of this medication.

I woke up and discovered my normal $240 (currently annually increased rate) had suddenly been increased to $390 without any prior notification. The reason? I updated my address in mid-September. According to them (three phone calls later), they sent a letter to my new address and that letter was returned to them. By whom? I live in a house. We have one mailbox with no other nearby mailboxes. I always open my mail. So who returned this "supposed" letter of notification? I then asked John at health net if they had any actual physical evidence of the letter -- a Xerox, a postage receipt -- nope. His computer database just states, "Letter sent. Letter returned. "So then I called official Department Of Insurance, thinking that might actually help.

I mean if an insurance company holds your health in their hands, then surely they have to be accountable for evidence of just systems, correct? Nope. Turns out according to Deborah at the Department of Insurance, there is no insurance law that hold these companies accountable for holding real evidence and proof of their actions. They just have to have some poor pawn in their company type, "Letter sent. Letter returned," and that's enough for the Department of Insurance and America. I then asked Deborah, "What if 100,000 people like me called today and said, 'hey this company didn't tell me of my rate increase and just took an extra $150 of my money without warning me ahead of time -- money I was going to eat with. '"Deborah's response, "Well then if we notice a trend (Ex. 100 - 100,000 claims of this), we do a Market Conduct Exam.

Meanwhile, the robbers have already spent your money and your happiness while you wait to see of the other people like you speak up. And if enough do, then they file a Market Conduct Exam. Which, as a pointed out to Deborah would probably be invalid for action considering her statement that there is currently no insurance law to outlaw such processes. What is there to stop insurance companies from this kind of fraud? Because I must say, if they can factor our ages, liability factors and all the other numbers to deny people their rights, what makes us really think they may not just use mathematical equations to figure out what number of people they can safely ** over within a given span of time? Got a story of your own? Tell it now. The more people who speak up, the sooner this kind of behavior will be stopped.

As a member of the California Farm Bureau Federation, a group insurance plan is provided by HealthNet Insurance to the membership of CFBF. After 11 months of membership, I have been advised 8 days prior to my renewal date, that my annual insurance cost will be increased by 21%. I believe this increase to be excessive and unreasonable given the fact that the deductibles are so high for many plans that the insurer has effectively shielded themselves from all medical costs short of a catastrophic event. In the current economic climate, this increase is very hard on small business in particular.

In April 2010, I had an MRI with Dr. **** as my orthopedic surgeon. The result showed a large posterior labrum hip tear. It was so severe that there is almost a complete detachment and also, a small anterior tear. Dr. **** does not do this surgery and referred me to Dr. **** on May 26, 2010. Dr. **** informed me that the tear was so extensive he was not comfortable doing the surgery and told me to get a second opinion. I was referred to Dr. ****, from an out of network and the referral was denied. I appealed the denial and was denied again on July 28, 2010.

My case worker Queenie **** has been ineffective in helping me. Meanwhile, I searched for a doctor within network. I located a Dr. **** from UC Davis Health Net provider who looked at my MRI. He informed me that he could do the surgery. He is in Sacramento. I called Health Net and they said they would approve a 2nd opinion and then denied the referral on April 30, 2010. I am paying myself for the consultation until August 10, 2010. I am asking Health Net to pay for this consultation and they initially said they would.

I am a 63-year old single woman living on a budget and HealthNet continues to increase my monthly premiums. I am now paying $1185.00 monthly and covering myself only. I cannot get other coverage due to a heart attack I had three years ago. This monthly premium is more than I pay for my mortgage. I understand that they are being investigated for increasing premiums way too high. I am not able to pay my mortgage and my premium, too. I believe that HealthNet is defrauding its customers with the premiums they charge and the continual increases. I constantly worry about how to pay these premiums every month. Can you investigate this company and help bring down the cost of my premiums?

My wife was diagnosed with a small lump in her breast during a routine exam and referred to a radiologist for an ultrasound and mammogram. The ultrasound showed that the small lump is a tumor and she was referred to a physician for a biopsy. Health Net has spent three weeks trying to find ways to deny the claim and prolong the process. My wife still has not had the biopsy done and Health Net has sent her case to a review board!

I am filing a complaint against Advance Cleanse and Acai Berry Pure ticket for unauthorized debits from my banking account, overcharge of postage, and failure to comply with their own Terms and Conditions. I am requesting a total refund of $412.77. I have attempted to resolve these matters several times but have been declined.On 1/15/10, I attempted to purchase a 30-day free trial of Advance Cleanse and a 30-day free trial of Acai Berry Pure via the website. Not once did I receive a Check Out Page. In fact, the site said our website is not able to process your order, please try again later.

Problem 1. Overcharge of Postage. I called to inform them of the 5 postage charges and requested my order be cancelled. The agent said it would be taken care of and that I was no longer subscribed.

I then called Ace. She confirmed the Cleanse order was cancelled but that the agent from 1/15/10 left no notes concerning my call. She said she was unable to identify the man but gave me a cancellation number dated on the 15th. I then emailed the refund dept.

Problem 3. Failure to comply with their own Terms and Conditions. My comments are in parenthesis.1. When you enroll on the order checkout page (never received) 2. We refund all cases unauthorized transactions (their stand is to deny refund) 3.If you cancel before the end of the fourteen day trial period, you will not be charged the one time Membership Fee. (I was charged 2 fees ofF $169.95, 2 fees of $54.95 and I cancelled on Day 1).

In trying to set up a new doctor for my daughter. I could hardly understand the person who was taking information. This happens more and more, and it is very difficult to communicate with these people who have such strong accents. Maybe they are qualified on paper, but talking on the phone is another story. It is very distressing to deal with people who cannot communicate well with the public. I get frustration from this insurance company.

Wife in severe pain. Doctor requested an MRI to determine cause. Healthnet denied. Appeal sent (urgent) on 1/8/10. As of 2/1/10 no response and no one responsible.

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).

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.

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.

Beware of HealthNet. They will not cover your medical expenses, but they'll gladly take your money every month.

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!

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.

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

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.

They increased my out of pocket premium from $100 to $201. per month and blamed the physician group and hospital, they lied.

I had an application with them on the 27 of October, they requested medical records, that I sent them on November 3rd they told me that it would take 24 to 48 hrs. My medical record show that I am a very healthy person. They never called me back so on Friday the 7th I called them an they said I was denied coverage. I was insured by them once before with no problems. So why now?

I wasted my time and money (medical records) for them to decline me for no reason.

Health net insured me for catastrophic health insurance. I had a double mastectomy for breast cancer. They refuse to pay the $70,000 due my hospital. They have been in many law suits over this.

Gender Descrimination... taking advantage of woman when they are sick with chemo and radiation and taking advantage of them. Woman have to fight Breast Cancer and Health Net

I am still waiting a premium refund of $500 for policies cancelled in February. Repeated communications, in the form of email, have reassured me that the refund will occur in less than 3 weeks. My premiums were automatically drafted and the refund was to be drafted back into my checking account. The ironic part of this is that I STILL receive monthly premium notice reminds with a premium amount owed of -$500 - clearly part of their system recognizes that the policy has been cancelled.

I have requested my refund once again and this time asked for interest - probably won't see it.

Purchased ppo supplement to Medicare on Feb. 1, 2008 (65 0n 2/7/2008). I sent application with credit card # to charge first month (119.00 + 80.00 farm bureau membership. I paid March, April & May @119.00 per month. The company continued to bill me 451.00 each month and never corrected their mistakes. Monthly calls did not get results.

All claims have been denied because of non payment by me even though the mistakes are theirs. So basically, I have paid for 4 months of supplement and are actually uninsured by them. All calls ended in dead ends with the company as they will not correct the accounting and their mistakes.

I have been a subscriber to HealthNet insurance plan for 5 years. The insurance covers myself and my three year old and I am employed part time so my premiums are fully out of pocket at the rate of almost 13,000 per annum.

My son was diagnosed with speech and sensory problems (Aphasia and Spensory Porcessing Disorder)at age two. My state mandates that children receive early intervention from Birth to Three and that insurance also pay for those services. We paid on a sliding scale and Healthnet paid for the services my son received for speech and occupational therapy.

Healthnet paid this until the day my son turned three (when the state mandate expires) and refused all speech claims from the point he turned three. My son was seen by a Yale pediatric neurologist and diagnosed with Aphasia and was given a prescription for intensive speech therapy

Healthnet has refused to pay for any speech, using a fallout that my son would have had to acquire and then lose speech (for instance by having a stroke) in order to get speech therapy. My son never got the chance to acquire proper speech, hence the speech delay and the need for therapy.

I initiated an internal and an external appeal. I made numerous calls and was told everything from they only paid it when he was two because they had to by law, to just keep submitting claims and see what happens - a veritible dice roll with my son's claims.

My appeals were denied for the same clause that he had to have a stoke or accident in order to get the 30 promised speech therapy sessions in my handbook from Healthnet.

I started an appeal with the State Insurance Commissioner and was told that Healthnet was not consistent in their reasoning for the denial but that the Insurance commissioner was not optimistic about Healthnet coming through for my three year old.

Healthnet discriminates against children with disabilites - how else could we explain the fact they paid the claims for the year they had to as governed by the State and now refuses to honor their policy of paying for 30 speech sessions per year.

We are forced to pay 13k for insurance and 150 per hour for private speech. We are unable to do this. We are unable to help our child get the help he needs and we are completely let down by our insurance company who has no caring or concern what their loose interpretation of their policy does to the health and well being of a three year old child who needs speech therapy and occupational therapy as a medical necessity.

We are considering moving, refinancing or anything in order to get our child what the doctors say that he needs.

My husband and I have had double coverage through our respective jobs working for separate organizations for the past seven years. My husband had Blue Shield insurance for 5 years then Health Net for the past two years. I have been a Health Net Health insurance recipient for the past seven years. I found out last year from another Health net representative that because of our double coverage that we should not have had to pay any pharmacy co-payment even though we have been for at least the past six years. I was told that the benefits should be coordinated through the health plan and for the most part should not have any co-payment. My husband went to our local pharmacy (Lucky Pharmacy in Pinole, CA.) for me last week and came back with my medication and told me that he had to pay a $30 co-pay. I had to once again call Health Net and Miguel once again had to set up the account so that I would not be charged a co-payment. But I am concerned that for all of this time that (almost seven years) that I have had to pay hundreds of dollars in copays that I should not have had to pay.

$445.00 in the hole

I received a letter from above on August 16, 2007, stating that I would receive a refund for the batteries I had purchased for my electric wheel chair, when I followed the directions of Health Net and called Preferred Home Care for this service. Because I was told that they would take my chair for 4-6 weeks and no loaner, it was impossible for me to use their service, eventhough my policy covers replacement batteries.

I sent a complaint to Kay Smith stating my disappointment with Preferred Home Care to supply me with a loaner chair while they took my chair to replace these batteries. The response letter from Kay Smith apologized for the misinformation I received from Preferred Home Care and stated that a reimbursement check in the amount of $247.00 would be issued in 4-6 weeks. It is now over 10 weeks and I still haven't received this check after numerous phone calls to Kay Smith, I was told to expect it by the end of October, 2007. This is the end of October now and the check still isn't here.

Health Net, also does not have any specialists or primary care doctors in Peoria and I must depend on AAA to take me to my doctor's appointments. They have caused me to miss at least 3 of these appointments by showing up long after my appointment time, eventhough they schedule my pick up time at least 2 hours prior to when they arrive. I have asked for an out of network specialist, since the first one they sent me to was extremely offensive and I didnt want to see him again. I was denied. I, then, called the appeal board to get a 72 hour decision, since my illness is life threatening and I needed a specialist (endocrinologist) immediately for a mass (thyroid) that is grossly large and causing breathing and swallowing problems. Rosie told me that I had to write to the appeals board, even though I explained the urgency of having an over the phone appeal. I received a letter from this appeals board which stated that they would respond within 30 days. Health Net's endocrinologist specialists are all in the same group or clinic, therefore, when I called to see another specialist at that group I was told, their policy is that if I don't want to see the original specialist I had seen, they would not allow me to see another specialist in their group. I reported this to Health Net and was told, perhaps, you should find another health plan. I plan on doing this, but, unfortunately, I cannot change my plan until November 15th, which is the date anyone can change their plans. So, I am left with this life threatening illness until then.

The very real possibility of choking to death.

My place of employment changed health insurance companies back in January of this year and due to my previous medical history I had to switch from HMO to PPO so I could keep my same doctor's that I was being treated by. I go in for PET Scans and CT Scans about every 6 months because I had stage 3 Melanoma and could not do chemotherapy. On July 25, 2007 I went for my 6 month visit to my Oncologist and they ordered me to have a PET Scan.

I was told that even though I have PPO insurance I still had to wait for an authorization. I received a letter in the mail on August 6th stating that they were denying the authorization because they feel that it is not necessary for me to have this scan done because my cancer has not come back in 4 years. I called Health Net on August 7th to file an appeal and I stated to this woman who didn't tell me her name that this was part of my treatments even though my cancer is currently gone. She stated to me that she would give the appeals department my information and it could take up to 30 days to get any response.

In the meantime I contacted my Oncologist and he called my insurance company to get it appealed also. My Oncologist was told Health Net will not cover this test because it is just for surveillance it is not for a reason which is absolutely untrue. Just because my cancer is currently gone does not mean these tests are unnecessary at this time.

If I have to pay for this PET Scan out of my pocket completely it will be at least $2,000.00 if not more and me being a single woman living on my own that is not financially possible.

This has caused me unneeded stress and grief and it is totally and completely wrong. How dare an insurance company that I am paying out the nose for tell me that my life or health does not matter just because cancer is not present at this time. I assumed that because I pay for PPO insurance that I woul dbe treated a little better, I guess not.