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I have been with Health Net PPO plan for 2 years, so far, the doctors are not accepting the Health Net PPO plan. I chose PPO plan because where I live, don't have Korean doctor and that's is why I chose the PPO plan. Yet, no doctors accept the Health Net PPO. What problem with Health Net? Now, my wife is pregnant and she need to drive for at least one hour to doctor who accept the Health Net PPO, if I am lucky to find within one hour drive. Consider that if my wife needs to drive with big belly, will cause the problem to the baby inside womb. I want to choose my doctor as normal PPO plan where close to my home.
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I have multiple sclerosis and need to be on a new medication for treatment but Health Net won't cover it unless I try two other drugs. The issue is the two other medications they want me to try I cannot due to preexisting conditions but they won't listen. My neurologist office was on the phone with them for over an hour and half trying to explain that but they wouldn't budge. They don't care about the individual, just bottom line money. I'm going to look for a new insurance when open enrollment opens.
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I've been a Tricare member since my retirement in 2014 and I've had the same provider the entire time. My wife is on her second due to her initial provider moving. We both recently received letters telling us that our PCM has or is changing. No reason was given and I had to play detective to figure out what happened. This is the second time it happened to me, the first time I was never told about it and I only found out because a referral my doctor wrote for me was rejected. I was able to revert back to my original PCM but I was still frustrated what had happened. This Friday I looked at my milConnect account and found that my wife's PCM had already been changed and my was set to change in the future.
I called Tricare (Health Net) and spoke to a Mr. ** (I told him that I was going to mention him) and was told that I could not make any changes and our providers would have to call and correct their accounts. And if they cared about their business they need to do so but I was never told what was wrong with their profiles. I told him that it sounded like your database is corrupted and someone needs to bring it to someones who could fix it attention. I was told there is nothing I can do and nothing he could do, and it was for our providers to work out with Tricare. Long story-short, I called our providers today and was told by the nurse they were Tricare members also and it happened to them too. Our providers did call Tricare and were able to correct the problems to their profiles and others.
It turns out I was correct. Tricare's database or record keeping is flawed. When Health Net took over the contract they asked the providers for profile information and our providers provided it. Possibly, Health Net never entered the data or it was corrupted according to my source, it was all incorrect and they had to reverify their information. The bottom line is I would say this is bureaucracy at its best; Health Net's inability to manage data has pushed their responsibility to paying customers and providers to correct their mistakes. Look, time is money and I had to take time out of my workday to contact and explain this situation to my provider and then my provider had to call Tricare to correct their erroneous data. Health Net really needs to get their stuff together.
For assistance with Health Net Federal Services issues, you can send a private message on their Facebook page
My friend has Health Net Silver 87 Community Plan and has been hospitalized 3 today in the past two months. He is ready to be discharged but needs to go to a short term Skilled Nursing Facility as he is too weak to go his me with no help. Our Hospital Caseworker is saying she is having a hard time getting Health Net to place him somewhere!!! It’s on his plan so why is he having problems.
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Partial resolution. Regarding my wife's hospital visit, the charges were correct.
Otherwise, the main issue seems to be that few care givers know who is covered by what and incorrect charge codes are often submitted. Admittedly, part of that fault goes to the care giver. Then again, I have never experienced this constant lack of knowledge on coverage or charge code issue before.
My wife is pregnant. We scheduled an appointment with a doctor and double checked we were covered. Turns out we aren't after the fact and we are stuck with thousands of dollars in bills. I went to a routine check-up. Verified doctor is covered. One year later I get a bill for $350. Health Net covered nothing, not even the 50%. My wife had an emergency surgery last year. Finally we get a bill. Guess what... All out of network again of course. More money, more wasted time following up. Just about every other hospital visit charges are incorrect and we spend hours on the phone with both the hospital and Health Net sometimes getting charges to be corrected. Biggest hassle. Biggest scam. Expect nothing to be in network. Expect no one to tell you what is in network.
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I joined Health Net through Covered California in 2019. I chose them over Kaiser, which I previously had, so I might have the option of different doctors. Big MISTAKE. This has been the worst experience I have ever had with a health provider. The first doctor I chose, her office was filthy. The office did not have medical filing cabinets, but rather just stacked all of the patients files on a desk and shelf in a back room and shuffled them around when looking for someone's file. The medical receptionist had no idea what she was doing and could not pronounce basic medical procedures. They did not send referrals in, lied about, and when they did do, they did it incorrectly. I called Health Net, as this was all very concerning. They advised me to switch PCP, which I did.
I spent weeks researching different doctors that had higher than 2 star review, and finally chose one. Nowhere on Health Net Website did it say that doctor was for SENIOR CITIZENS ONLY. I only found after spending 5 weeks trying to get an appointment to get a prescription refilled, and his office manager advised me to change doctors again. Calling the customer service line is useless, and resulted in me doing all the work for the 3rd time in 6 months. Their reasoning was "sometimes information changes on a daily basis, and not all doctors have their information up to date. I am sorry about that, and will notate it." Unless this new doctor is the BEST doctor ever, I will 100% switching back to Kaiser when open enrollment is available. I'd rather have the only option be to see a Kaiser network doctor than to deal with the nightmare that has been Health Net.
We’re sorry for your experience, Erin. If you are still in need of assistance, please check your private messages.
I chose Health Net PPO California for our covered California plan back in 2017. It took effect 1/1/2018. It was the biggest mistake that took until April 2019 to finally get resolved. Their claims department processed all of my claims as out of network. Including my general practitioner who is on my medical card as a recommended doctor and others that I got directly from their website. After making a 2 complaints to the Department of Insurance and working with the legal department for Health Net, all of my claims finally got paid minus a $15.00 Co-pay that the Charles in the legal department said the only thing I could do is file a grievance. So I will be paying this final $15's just to finally be done with this company. I would have given 0 stars but it won't let you.
My Son was born on 10/26/2018. On 10/27 I purchased Health Net insurance for him. He had his first check a few days after leaving the hospital. Unfortunately I did not have a policy number to provide to his doctor so I paid $125 out of pocket for the visit. I submitted the form for reimbursement and was told a check was issued and sent to me on 1/25/2019. I never received the check. I was told that the check would be issued. I have to talked to numerous reps and supervisor each time getting the different answers. The last supervisor I spoke to said that they are confirming the original check has not been cashed before they issue a new check. That was 3 weeks ago. Still no check. 5 months of run around. I think they want to you give up so they can keep your money!
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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!!!
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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!!??
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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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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