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I am pregnant and therefore need to find an OBGYN and hospital close by so that I can have prenatal care and plan for labor and delivery but Health Net is putting me through hell and back before they can figure out what is in network for my plan. Using my Health Net online account I found an "in-network" doctor and confirmed with Health Net on the phone that they were in network. After visiting the doctor I came to find out I am out of network. The discrepancy seemed to be because the enhanced care PPO is a smaller network, but whoever I spoke to didn't confirm that and the website search that I have access to through my account is inaccurate. Since then (5/10/19), I've been trying to figure out how to get that doctor contracted or find which doctors and hospitals are in-network through customer service, but it's been non-stop trouble and a waste of time for me.
I try calling but end up getting transferred several times because employees seem to have problems having access to my type of plan. When I finally get through to someone they are out of the country and don't give me the same customer service I would if they were in country. Just today I spent an hour and a half, got transferred 6 different times! Once even on to an animal hospital, in the end someone was supposed to email me a list of in-network doctors and hospitals and I never got it.
What's worse is of all the times I've called and tried to get help from customer services located in the U.S. they say they can't access my account to write notes that they looked things up for me. Those notes would show all of the contradicting information I've gotten, all of the times I've called, all the false hope I've received and little things like telling me that they're sorry that the wrong customer service # is on my card. Again I'm pregnant and need to find in-network care or set up the doctor I already have to be in contract; it shouldn't be this hard!!!
Having problem with this insurance. I did let them know that my plan had been terminated since March 31 2019 through Covered California, but my desperate effort to inform this insurance that I have another insurance, they keep sending me bills and pressuring me.
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This is by far the worst health insurance I've ever gotten. The networks are TINY, it's impossible to find a doctor nearby who can get you in for appointment in less than a month, and in my current medical group there are ZERO gynecologists. How is that possible or even legal? The website is useless, the communication is horrible, the customer service is completely useless. I've never been so upset with an insurance provider before in my life, and I've had some bad insurance before. But never have I been compelled to write a review about how bad it was until Health Net.
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My husband has been dealing with one problem after another with Health Net. We see a specialist and then they send in an authorization for referral to another specialis or procedure and we hear nothing for a while then we are told the authorization was denied. This has happened over and over again. The Health Net patient portal is useless. Half the autnorizations listed are not active links so you are left guessing what is going on. Every time we call we have to push our concerns to a Supervisor because most of the general staff that answer the phones have no clue.
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More expensive each year with less coverage and outrageous prescription coverage. Ambulance bill I had I paid 350.00 and ins paid 77 dollars. The RX Gold card gets about the same discount as insurance and it costs nothing. We had better coverage at no additional charge before Obamacare but that was cancelled when Obamacare came out and we were forced to only one option. It should not even be called insurance anymore. I no longer trust any insurance co. When you have paid into something all your life and you get to an age where it would be helpful it is not much help. I live in a County where the options do not exist and because I had a hospital visit last year I no longer qualify for anything better. HUH!!??
We are sorry for the difficulties you experienced Charles. We want to help. Please check your private messages.
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Incredibly unprofessional and shady insurance company, called for coverage twice for a program and they said we are covered but when the bill came they retracted what they said and I'm stuck with the bill. Never had any one that could actually help me. Even no apology for lying.
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Unfortunately, it seems my experience is similar to many others. My daughter received services through an Urgent Care in February 2018. After many hours on the phone and filing two grievances, I am still having to call every few weeks and have still spent hours of my time trying to get the matter resolved. Even after finally receiving a letter from appeals in January stating my case was reviewed and approved to be In Network, it is still pending. Every time I call I receive the same information... it is still pending. This is absolutely ridiculous that this has to occur in order for anything to be resolved. We decided to switch our daughter's insurance this year because of this. Health Net is no longer getting our money and not surprisingly, our insurance broker said that many others felt the same way about the terrible service and unresolved claims, etc.
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I've had a few major accidents. Had to file claims with the the California Dept. of Insurance continuously in order to force them to pay claims that were rightfully their obligation. Including ambulance charges. I was told" she no longer works here" when I requested to speak with the one person who was willing to do her job correctly. 100's of hours wasted while simultaneously fighting for my life battling with Health Net's team of demons during the 8-9 years I was under their "care." The fact that Health Net still exists baffles me.
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I had Health Net insurance coverage in 2017, it has been the worst ongoing experience. PCP visits were paid as specialty, the doctors office would then bill us twice the copay stating it was the health insurance, stating it was the coding at the doctors office, error were never corrected and we were expected to pay. Many times they deny claims due to network issues and they have to be called and shown where the provider can be found in-network on their website, be prepared.
I had a procedure done after checking benefits and need for auth and reviewing my benefits clearly knowing my coverage. The procedure to date is being denied stating "non covered". I can specifically point to my benefits booklet where it states that I had a covered procedure and they refuse to pay it, even after an appeal. This is ongoing. Most recently I spent 2 hours on the phone with a supervisor reviewing this denial and came to no conclusion, no answer, unable to specify the problem. I get a different response every call. We have since switched insurance (UHC) and have had a much better experience.
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Benefits - eyewear. I had been with Health Net for five years. I received email from Health Net On April 18, 2018 about a reimbursement (you pay the money and mail us the reimbursement form). I did and mail it but they are denied. There is no documentation that was wrote. Health Net will NOT PAY if go out Network in this matter, I already switched to Aetna. I already told my relatives, friends and any person I knew about this and I advise them choose Aetna, Cigna or Blue Cross Blue Shield. NEVER CHOOSE HEALTH NET.
I was covered for the entirety of 2018, and had paid every month, but when a sudden bill for $460 appeared in October that year, I was perplexed. Multiple calls later with a host of different representatives, and nobody was any wiser, and every single person I spoke to kept referring it to the auditing dept, and promised to call me back within a couple of days. Those calls never materialized. When my plan was terminated in January, I made several calls with Health Net and on their advice also to Covered CA. It was there that someone spotted that I had moved homes in August, which would have changed my premium, had I moved out of district -accruing the $460- except my zip code hadn't changed. Apparently, when I updated my information with them on the phone, someone at Health Net had made a typo from 92036 to 92037.
More calls with Health Net to inform them of the error and with the potential to reinstate my plan, were a complete waste of time, with one representative transferring me directly back to Covered CA. They also informed me that they had reimbursed me for my payment in January and February this year, but no such reimbursement has ever shown on my account. At the time of writing I am seeking legal consultation.
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Today is April 8th, 2019 and I called Ambetter twice and their system was down. I have written six complaint letters to Ambetter concerning their terrible services and none have been answered. I have been denied services and prescriptions after having paid my premiums. I have had to call a total of nine times to establish a primary care physician. Each time I call the representative it is always an incompetent human being who is unable to remember the reason I called or that I had already established a primary care provider on a previous call weeks ago. A supervisor whom I escalated the issues to was rude and nasty to me.
After having paid for my insurance, my provider ran my insurance through Availity and is was showing me as inactive. Ambetter charged me twice for one month of service and still showed me as inactive in their system. I have requested my ID card three times and it has been over a month, I still do not have an insurance card. These are just some of the few issues that make this the worst insurance ever.
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I have called 4 to 5 times and the story is really long. This insurance is the worst I have ever had the displeasure to come across. After having an allergic reaction while at work in Sacramento (I commute from San Joaquin County) I dropped by the urgent Care to make sure I was ok and to get some allergy medication... WOOPS! Even when I called Health Net and asked at the counter (they said my insurance covered the bill) lo and behold I get a bill for over 200 for my 10 minute visit and prescription. I talk with Health Net. They say they fixed it. I get another bill. My mom calls Health Net and is positive they have fixed it... She gets the reference number of the urgent Care and Health Net. Lo and behold another 2 months later we get another bill (this time with a late fee on it)... We call Health Net!
What in the royal heck is going on here?? Turns out.. Hill Physicians of San Joaquin don't believe in emergencies where you might have to be seen by a hospital OUTSIDE of San Joaquin County (GOD FORBID!)... So they are refusing to cover the amount. This vicious circle has been going on between them and Health Net for over 6 months now!!! And I'm still getting billed.. I get a reference number from Hill Physicians and a reference number from Health Net. I make sure I have the names of employees, times I have talked to them and the date I called all written down as well as their assurances that they will resolve it and I don't have to worry anymore. Fast forward.... Last month (a year after the incident) guess what. I just got billed again.
I have called yet again and have another reference number under my belt and another vote of "reassurance that Health Net will resolve this"... Like ** hell they will. Pardon my French. I expect another bill in about 6 months from now because this company is so incompetent they probably don't have the manpower to resolve any issue that comes their way... I am so glad I left this company. Avoid it like the plague. I might actually have to seek legal action at this point to avoid my credit score dropping or paying over 200 (probably 300 at this point)...
Honestly I feel more sorry for the doctor who isn't getting her paycheck for taking care of me. This group doesn't care for people or for doctors. They should be ashamed of themselves and I hope they get sued to oblivion... Who knows, maybe once I lawyer up with the urgent Care I will get a good paycheck and sue for my time wasted as well as the doctor's time wasted. I want to drive this company bankrupt.
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There is no vision coverage for Tricare Select Retired that is frustrating. I have attempted to get my eyes checked several times and found out there was no coverage. Also, if you are retired you are obviously on a fixed income or lower income than when we were active duty so why would the copay be higher for retired members and their families.
I have been with Health Net for three years and can't say one good thing about them. I was pregnant in 2017/2018 and had to fill a continuity of care form to deliver at an out of network hospital since I was already far into my pregnancy. It was approved but after 15 months, I am still battling claims that were denied that are a covered benefit. I have filed appeals, which were approved but still have not had resolution. I pay my premium and do my due diligence with reviewing my policy. And then I am told that the forms we receive that explains our coverage and covered benefits, don't mean anything and that the provider doesn't have to accept the contracted rate of payment when the claim in processed... WHAT?! I would never recommend Ambetter to anyone. It has been a nightmare and I don't see an end in sight.
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I was insured all of 2017 and was due to have my second child in February 2018. I was informed my coverage would change and my OB and hospital I chose to deliver at were no longer going to be covered as of 2018. I was offered the opportunity to fill out a continuity of care form so that I could finish out my pregnancy and deliver at the hospital of my choice. My care manager informed me that I was approved and granted a prior authorization for these services. It has been OVER a year and my claims have still not been paid.
When the denials started pouring in I contacted Health Net to discuss issues with claims and I have been promised that they would fix errors and resubmit. I have even spoken to managers and was informed my claims were escalated. Just spoke with someone yesterday who has basically stated that it is the hospital and OBs responsibility to correct issues and resubmit and none of my requests were processed. So I have a serious problem with the insurance and the hospital.
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Updated on 04/02/2019: I previously posted a review on this website about dealing with the Claims Dept for over a year about getting a claim resolved. They sent me a private message saying they wanted to help and to contact them via email. I did and was told the name of the person handling my issue as well as her contact number. I called because nobody had reached out to me, and not only did she have no idea what I was talking about, she just told me to contact their main line as a solution. Again, such a complete scam. They don't want to help you, they want you to GIVE UP.
The only explanation I can think of is that, in the long run, this how they avoid paying for the bills they promised they would pay so long as you chose them as your health insurance provider. Please DO NOT choose this company if you have ongoing medical problems that require claim reimbursements. They won't help. They don't care about you. They just want to save as much money as possible by continuously sending you to dead ends until you just throw your hands in the air and give up.
Original Review: I've been battling to get reimbursed for a claim for over a year now. I have submitted (and even resubmitted) all of the proper paperwork, and every time I call to check the status it's a new excuse as to why it's denied (they have even started to re-use old excuses, like "you didn't provide proof of payment", which is a total lie).
I'm beyond frustrated, and at this point I feel like they're giving me the runaround until I just give up. Nobody is accountable at the claims department, and they're trained to NEVER transfer you to a manager. They'll just transfer you around to other people and say "we will call you back", but they never do. It's such a scam, and I feel so mad at myself for even having chosen them as my provider in the first place. A company founded on complete disregard for its customers, with zero accountability, and the worst part is that they make you feel like you're powerless. Who is responsible? What do I do when nobody will help me? How do I get what's owed to me? I wouldn't be surprised if there were several others in my position, and if there are then you're not alone. I'm sorry anyone has to deal with this bureaucratic nonsense.
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I have no doctors in my area, call then and always refer me to the outdated list. Finally a representative took her time to find me a Nurse Practitioner as my primary Dr. She told me she was going to send me the new card. She never did, the N.P. is billing me because she is out of the network. I call and I call. Sign a grieving and they never call me... No solution...
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I paid for the month of January 2019. I did not get insurance cover and they didn’t refund my money. It has been over 2 months and no one will take the time and help me to fix the problem. They just keep transferring me from one to other or hanging up on me. No one know their job over there.
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Claims from 2018 show as paid per EOB but nobody can show proof of payment to doctor who continues to bill me. There are now 6 claims to the same pathologist that they have not paid going back to October 2018. Reached out of pocket maximum for 2019 on January 7th and they processed 2 more claims since them showing I still owed more money. Sadly this is to the same pathologist from 2018.
In-network doctors EOBs are showing as out of network on multiple in network doctors. This issue has been confirmed by numerous Health Net employees. Directory is NOT accurate. It is causing billing nightmares for people and they take forever to correct anything. As per their Evidence of Coverage, prescriptions should count towards out of pocket maximum and they don’t count them. I’ve already had 2 audits with a third in progress and none of the audits account for the prescriptions as part of the out of pocket maximum. It doesn’t seem as if any employee there is aware of AB 72 which offers many protections to us as insured.
I cannot understand how one needs multiple audits to get the math right. It’s as if they blindly process claims without confirming anything. For 2019 I met my out of pocket on one claim in January 7th. How can you still be processing claims with me owing anything in March? In-network or out of network doesn’t matter provided you're approved surgery was at an in network facility which mine was. It is your responsibility to know AB 72 and process claims accordingly. I cannot tell you how many times I’ve been escalated and the issues still exist. I am currently dealing with a wonderful girl in the grievance department but the issues continue to happen even while she’s trying to help. I demand resolution once and for all. This is unethical and added stress to already sick people. Both audits show...
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They will not cover any of your costs, even for very basic checkups. Their business model is to create so much red tape only a team of highly paid lawyers could actually find a way to get them to cover any costs.
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Just got on Health Net, and in two months already having issues. Getting a prescription filled is an interesting experience, you may not get what you need even with a doctor's prescription. I need to take my medicine twice a day, however this awful company only will cover once a day. Nevermind I'll be spitting up stomach acid and blood with this level of dosage, as long as they can save a couple bucks they'll do plenty of harm to you. We need to shut these third world country type of operations down.
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I called customer service to ask for some assistance regarding my wife. She had a heart attack and was rushed to the emergency at Oro Valley Hospital for treatment, following several days in ICU she was released and told to get a follow up appointment with the Cardiologist. I called her PCP but he has moved somewhere and the group that he was associated with told me they do not have any forwarding information. I know that she will need a PCP referral to go to see the Cardiologist so I called Health Net customer service and explained the problem to their associate that I was connected to and she told me that she would need a referral or otherwise Health Net will not pay for any of her Cardiologist appointments. I told her that our PCP had vanished and his office staff could not help me so what can I do to get a referral? I asked her if she could offer me any help or suggestions and she replied NO.
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I am the Surviving Spouse of a Marine Corp. Veteran. TRICARE PRIME used to offer me wonderful coverage, but they changed insurance carriers over a year ago and I have had to leave my previous Primary Care Manager and attempt to find one in Health Net's NETWORK DIRECTORY. The directory is full of outdated listings that stated they were taking new patients, yet every Physician's Office I called stated "We aren't accepting new patients," or "We don't accept Tricare or Health Net insurance." Many of the phone numbers didn't work or the doctors had relocated.
I called Health Net Federal Services to get help and two or three times they picked a PCM for me and sent me an official letter with contact information and a membership card. When I tried to make an appointment with the Doctor, they refused to treat me for the above mentioned reasons. I haven't been able to get medical care or fill my prescriptions since Tricare switched to Health Net. It seems to me that no one in the Medical Community wants to deal with them! I've been paying my premiums monthly and getting no services. Tricare has really dropped the ball on this decision and our Military Service Members deserve so much more.
I have been with Health Net for two and half years, and if you don't have anything urgent this could be a fine plan for you however if you by chance have an accident and need immediate treatment you can't count on Health Net. Every time I called I was given different information by the staff which delayed getting a referral approval. Too many employees who don't keep their word and follow up. I spoke with someone who sound so efficient and said he was calling my provider and call me back by end of day, nope never happened. But even worse I called the next day and they tried to connect me to this person and had me on hold and said I guess he isn't at his desk and the person on the phone couldn't help me since he had the keys to the file.
I called again the next day, same thing happened, he wasn't at his desk and not available. Okay, so he is not available when I call but at least give me the courtesy of calling me back, nope never happened. I finally get a call the following week by a different department and have to start the filing process all over again. Meanwhile my injury is getting worse. I have changed Dr.'s, looking at changing the network and will definitely change insurance when I get the opportunity. Filing something urgent is supposed to take 3 days, it's been 12 days now and again the three day period started all over this past Monday. I am frustrated with the incompetent service I have received, each person from Health Net gave me different information.
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I have been with Health Net for 10 years, the last year has been absolute hell. I checked online to see if my insurance covered chiropractic, it did. Yet it's not being covered and there's no record of claims on my file, despite my Dr's office sending in the claims and getting the denial of claim back, which I have seen with my own eyes. Problem #2- they pre-authorized a MRI for my daughter. She had the MRI and the claim was denied. $1200. It is being resubmitted for the third or fourth time right now. Problem #3 - I have never had a deductible. Only copayments. Until this year, unknown to me. Until I received the bill from my Dr for my daughter's appt thats in the hundreds. I was on the phone today for 2 hours and got nowhere. I am still going in circles and dont have anything figured out yet. I am beyond livid.
We’re sorry for your experience, Shannon. Please check your private messages.
I signed up for Health Net PPO minimum coverage Jan 2019 through Covered California as a downgrade from my more expensive previous medical insurance. I paid my first payment and made an account using my subscriber number, no red flags yet. Fast forward a couple weeks I receive my card in the mail. I notice it has a hospital listed on it as my main doctors, when I never chose a specific one, and I’ve never seen that listed before. I want to look for a doctor in my area so on the website I search very specific results 20 mi radius, my specific min coverage PPO plan through CC and I notice it says 3,500 doctors in my area (red flag) and I’m thinking there’s no way and every single one says accepting new patients.
I try to sign it to look at the doctors more detailed and it couldn’t find my account, I tried using my subscriber number again and it said I wasn’t in the system, all of a sudden (red flag). I also notice a glitch on the top of their page too. I google Health Net and about 15 locations pop up in my radius, I question why would there be locations. I click on the links. Pictures pop up of blank buildings in office areas (red flag). I decide to good Health Net reviews and it led me to this website and I believe everyone on here. I don’t want to be with them no longer and I can’t believe they are a “major medical provider network” and act this sketchy.
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Buyer Beware!! In 2018 my premium was $30.00 a month and my 3 tier prescription was $35.00 a month. One year later 2019 my premium went to $104.00 and prescription went to $85.00. I can understand and increase but this is highway robbery to increase this much!! Thank goodness I go on Medicare and get rid of Covered California and Health Net in March. This is why Obamacare will implode by itself. It will price itself out of the average person affording it.
We are sorry for your experience Sandra. We hope that we can continue to serve you in the future. If you need assistance during your time with us please let us know. We have sent you a private message.
The problems I've experienced have gone back and forth between them and Care1st, one always forwarding me to another. Me, often getting stressed due to a clerical error on their end -- the last one over Christmastime was corrected as it wasn't my fault. Well now I'm dealing with even more liars and agree with every bad review on this site about them! I've had to call and wait only to get no one on the other end or people that were entirely unhelpful.
The problem revolves around one horrible representative who completed an application on the phone with me and said that's all I had to do before January 31. (And best believe I've emailed them about this, too.) She never said there was a problem. It was recorded or so she said. Later I'm informed I have no insurance despite the renewal. Well what do you know - I call and 2 people tell me there's no record of the renewal. I ask about the recording. My phone log indicates clearly that I've called. But oh no, they know nothing about. Fast forward to today - someone reached another department for me. Suddenly there's a record of the call but a comment that I didn't answer all the questions? We asked, "Which questions weren't answered?"
I had surgery scheduled for Feb 1 which thankfully I cancelled as to avoid complications and symptoms! But without insurance I would've been stuck footing the bill that they said in a letter was covered! I like everyone here have no reason to jeopardize my own insurance! I emailed again and am asking "What happened to that recording?" I took my time to complete it. That girl on the phone could have asked me anything and I would've answered to get my insurance, and I did. It's there on the recording wherever it is. But it looks like they can't even keep track of one phone call nor can they keep their record straight! About whether I renewed or not!
Most pathetic customer service I've witnessed in all my life, and I'm someone who has never been fired and left my last job, getting compliments and gifts! It would be easier for anyone to just die a quick and painless death than to work with this seemingly Intentionally Evil company. Why else are we all here with horror stories? Because we like being stressed out? ** this company.
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This is the worst medical insurance! My husband was diagnosed with cancer on January 23, 2019. He had us biopsy on January 21st but Little Company of Mary wanted to ensure that they received their $500.00 deductible prior to the procedure. His primary doctor scheduled an appointment on January 23rd to check his BP, when we had an appointment to see the doctor on January 25th to get the results of his biopsy. Needless to say, my husband was given his diagnosis on January 23rd, how messed up was that? He paid $20 to find out that he had cancer. We have been waiting for a referral to a thoracic surgeon since January 24th. The first thoracic surgeon scheduled my husband for surgery before receiving the PET Scan results. The primary doctor, Dr. Stanley ** sucks!
He put the referral in for the second Thoracic Surgeon as “routine” when my husband needs a surgeon asap. I called Health Net today only to be referred to my husband’s medical group which is Axminster Group. My husband was scheduled for an MRI by his Hematologist the day after his appointment, what sense does that make? I ended up canceling that appointment until after the MRI. Time is of the essence and I realize that Health Net is about money collection period! They do not care about the wellness of their patients. You can’t reach the primary doctor directly, you have to go through their call center. Who wants to go through that when facing a medical emergency?
I don’t have faith in my husband's primary doctor because my husband has been complaining about chest pains since 2017. What does Dr. ** do? He request an EKG which turned out negative for abnormalities, no follow-up at all! Even though my husband's symptoms have not subsided and now he has cancer. Just because you’re a Dr. doesn’t mean that you scored well or are at the top of your field or that you have the well being of your patient at heart. Please pay a few extra dollars for a PPO, it could mean the difference between life and death for you or your loved ones.
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Health Net expert review by Joseph Burns
Health Net offers coverage to people in Arizona, California and Colorado. It is a California Market Plan associate, which means that low-income patients in California can get discounted insurance via Health Net under ACA rules.
Choice between HMO and PPO plans: Consumers have the ability to decide whether they want an HMO plan, which offers a limited amount of in-network doctors, or a PPO plan that gives them access to more doctors.
An ACA Health Insurance Marketplace company: Under the Affordable Care Act, or ACA, every state must offer low-cost health insurance through either its own Health Insurance Marketplace or the federal Health Insurance Marketplace. Health Net is affiliated with the ACA Health Insurance Marketplace, which means consumers can expect lower costs and the ability to use tax credits to cover part or all of their premiums.
Large variety of plans: There are lots of plans available, including Medicare coverage and coverage for students.
Customer service: Although Health Net offers round-the-clock customer service, the sheer number of people calling in may lead to long wait times.
Deductibles: Health Net’s low premium rates often mean high deductibles.
Best for: Students, senior citizens, employees
Health Net Company Information
- Company Name:
- Health Net