ComplaintsforHealth Net of California, Inc.

• Initial Complaint

  07/12/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  I have called Healthnet to see PCP. When I call every person I talk to tells me they will solve issue but they never do, they just make me wait on the phone for hours. Last week I talked to ******* who assured me she will find a PCP for me to see and will call me this week. This week she called me assigned me to a new PCP, told me that she will call me in one to schedule visit with PCP. So she told me to wait another month to schedule an appointment. She told me I will change your PCP today but you cant make an appointment with this doctor **** I have been calling Healthnet multiple times in the last couple of months I have a record of all the calls I have made and how much time I have spent with Healthnet. Yesterday, she called me from a number that in my call logs says Scam Likely. I tried calling that same number today, it says that number is not in service. Healthnet insurance is a scam, literally my phone shows me that they called me yesterday from a scam number. Today I called the office of new PCP they assigned and they told me the first available app. they have is March 2025. Now I have to call Healthnet again. So far I have been on the phone with Healthnet for hours upon hoursm each time they cannot find any doctor for me to see. All the PCPs they have assigned to me are not accepting new patients. Their website shows lots of doctors, all the doctors I have called, all the offices I have called they are not accepting new patients. I have received an email from Healthnet stating that their website is updated frequently, but in reality their website is not updated at all, they dont actually have any doctors. This is a class action lawsuit waiting to happen. I am a physical therapist myself and I provide medical care to patients everyday and I cannot get medical care. No one is actually accepting this insurance. Just now I was on the phone with Healthnet the guy told me he will help and had me on hold for 35 minutes, then hung up on me.

  Business response

  07/23/2024

  Was able to make change members PCP *************** Parnian  effective 8/01/24. Member has been noifited of the outcome. 

• Initial Complaint

  02/06/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  We chose health net PPO for our insurance for 2024. We have used the same health care broker for years and she made sure our medical network (****** ************* / ****** Health) was covered and contracted with this insurance. I also called ****** health network to confirm they were contracted. It also lists this network on their website and covered CA. After taking my son to his 1 year well visit and vaccinations, i find out that his doctor is not covered and the reason being (although this verbiage is listed NOWHERE to delineate between the two when advertising or speaking to customer service) is on vs off exchange. I now have a $1600 bill for a routine well visit for my child. It was false advertising and they made me believe that my sonss doctor was covered. I have since gone to your website to read the reviews on health net and ive actually never seen so many 1 star reviews. They are fraudulent and need to be looked into. Ive file an appeal to have my bill paid through healthnet to no avail. I will file a complaint with CDI as well. Its unacceptable what they are doing tk their customers. They should be stopped.

  Business response

  03/12/2024

  The claim for the well visit that the member son received on 1/16/2023 was reprocessed and pd by Health Net on 2/28/2024 to the provider of service.  The provider has been notified of the payment and the member should not receive any further bills. 

• Initial Complaint

  12/19/2023

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I am on a health plan with my mother. I turned 26 this year and immediately received a letter that said I had to leave the insurance with my mom because of my age. I was sent the letter in August 2023 and was told that by October 2023 I had to call Health Net and remove myself from this health plan. Health Net is now charging my mom a single payment of $600 because I am no longer in the insurance. How are you going to charge this when the insurance themselves said I could no longer be in this plan ? Please be careful with this insurance they will bill you for no reason!!

  Business response

  01/02/2024

  We have made multiple attempts on 12/20/2023, 12/26/2023, and 12/28/2023 to reach the member by email and phone to obtain information regarding this complaint.  We have received no response from the member at this time.  Please have the member reach out to us for further assistance. 

• Initial Complaint

  11/21/2023

  Complaint Type:

  Product Issues

  Status:

  Resolved

  More info

  This is about a Pending approval on crowns/ ID # ************ :My general dentist submitted it first on 11/08/2023, and supposedly it was never received, which I do not believe, and submitted it again on 11/15/2023, and now your department is telling my dentist it will take 7 to 10 days to get an answer from you.It is an emergency, why would you even consider ask me to wait that long, when I am in pain, I just had three root canals and have wholes in my teeth & am at risk of infection ???? I also have a lot of decay under other teeth with existing crowns, it cannot wait !Are you joking ?This should have been approved on the same day it was requested !Your lack of professionalism is endangering my health !!!!Unacceptable !I am filing a complaint today with the Better Business Bureau and contacting the medical board of dentistry in CA with another complaint as well.Additionally, I am contacting Medical with a third complaint, and also recommend they no longer do business with your company.This is absolutely outrageous !Contact my through the BBB website with an answer/resolution, do not contact me privately.***************************

  Business response

  12/01/2023

  The Members complaint was file through the appeals process and a decision by the Appeals team with Healthnet was made to uphold the denial for the Dental Authorization as the Member did not meet the Medi-Cal Dental Manual of Criteria for the crown which explains that a crown cannot be placed on a tooth that still has half of the tooth structure remaining that is not damaged from decay or trauma.

  Customer response

  12/01/2023

   
  Complaint: 20893341
  
  I am rejecting this response because:

  Clearly, whoever handled the claim does not know how to read !

  My general dentist has shown proof by providing x-rays to Health Net that there is "severe decay", I repeat, "severe decay" under the crown, it is already causing me to be in pain, as it has been there for a long time.

  Since Health Net is refusing to provide me with the dental care I desperately need, I will follow by filing another complaint with the CDI which regulates dental insurances in California, I will also file a complaint with the attorney general of California, and will go all the way up to the ***************** with a complaint if necessary, I will also consult the services of an attorney, and since I have this insurance through Medical, I will contact Medical with another complaint and recommend that they no longer do business with Health Net, not to mention all the online negative reviews I will leave about Health Net, to expose the appalling way they treat patients, people will know about it, which could very likely affect this company's bottom line.

  This is an outrage & I will not stand for it !
  
  
  

  Business response

  04/02/2024

  An appeal for the Members complaint completed by both Liberty Dental and Healthnet and both appeals were upheld stating the Member did not meet the Medi-Cal Dental Manual of Criteria for the crown which explains that a crown cannot be placed on a tooth that still has half of the tooth structure remaining that is not damaged from decay or trauma.  What this means is that approximately half of the tooth structure must be missing from trauma or disease. The **ray(s) do not show that this tooth has had that much damage. 

  Customer response

  04/03/2024

   
  Complaint: 20893341
  
  I am rejecting this response because:

  Actually, this decision was overturned weeks ago and treatment was received, so the person who wrote this reply is obviously clueless & misinformed, which is really unprofessional and laughable.
  
  Sincerely,
  
  ***************************

  Business response

  04/05/2024

  We have reached out to Liberty Dental and confirmed that they did overturn the member's appeal on 2/5/2024.  We apologize for the inconvenience. 

  Customer response

  04/09/2024

   
  Better Business Bureau:
  

  I am not impressed by the lack of communication and professionalism.
   
  ***************************

• Initial Complaint

  11/01/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Resolved

  More info

  This has been going on for many years now, I used to have Health *** services and I've moved on to a different service. The problem is, they would issue a refund for psychotherapy sessions which they assured would be refunded, I've called throughout the years getting different answers and different coordinators that would resolve the issue, the last coordinator that attended me was ******************** The the Appeals and Grievances Case Coordinator in which was following my case, she knew the amount I'd be refunded also which I have on file, I've tried calling back but her number reports as not available anymore, her number was ************ which I've tried contacting many times with no luck. I have the receipts, their 2 letters and all the required information that *** be necessary. I've also sent them emails, contacted customer service and such and there has been no resolution. **** receipts are from 2014 and 2015 respectfully and the letter they issued was from April of the present year of 2023.

  Business response

  11/10/2023

  We have been working with the Member to get the reimbursement checks for his services re-issued.  The original checks were mailed to the Members' old address that we had on file. Check#******** $98.85 and CK#******** $1459.88 have been voided and reissued to the Member.  These checks were sent via ***** (************), the Member emailed that he received the checks.  We are still in the process of getting the final check $5641.27 voided and reissued.  We will continue to be in contact with the Member until the final check is received. 

  Customer response

  11/14/2023

   
  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution is satisfactory to me.
  
  Sincerely,
  
  ***********************

• Initial Complaint

  10/10/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  i am a member of healthnet. member ************. i purchased at home covid test, back in feburary 2022. i called in healthnet prior to purchasing the test to see if the test are covered, i was told the tests are covered, and will be reimbursed. Healthnet representative helped me file an appeal with my state for hearing the state denied the reimbursement. i want healthnet to reimburse my purchase, since their agent was the one who told me to purchase the test

  Business response

  10/20/2023

  Health Net has processed the members Covid test reimbursement request and will be issuing a check to the member.  Our team will continue to update the member .

   

• Initial Complaint

  08/23/2023

  Complaint Type:

  Customer Service Issues

  Status:

  Resolved

  More info

  I have been trying to get Health Net to add my ******* care physician added to my plan to receive my proper health care I have paid my premium and I'm unable to use my health insurance due to healthnets incompetent ability, they will not update this Doctors information and keep getting all my appointments and approvals cancelled im not able to get my health back *** u able to use my insurance i have paid my premiums and im not getting any health benefits..this has been going on for 3 weeks they jus keep telling my tomorrow and the 10 days have elapsed with no resolution

  Business response

  09/08/2023

  Members PCP ***************************** MD has been added to members account effective 8/1/2023.

  Customer response

  09/11/2023

   
  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution is satisfactory to me.
  
  Sincerely,
  
  ***************************

• Initial Complaint

  08/22/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Resolved

  More info

  I needed to remove my adult son from my policy because he moved to ***** and now has his own insurance through his work.I have called 4 times and have spent hours on the phone just to do this. I called the number listed on the back of the card **************. I was told last time I called that it would take 5-7 business days to process and I should receive an email confirmation and my updated monthly premium amount. I have not seen this email. I am currently on the phone yet again trying to confirm this. I first called the number above and spoke with someone who told me I called Ambetter and I need to call Healthnet about this. I told her I called the number on my healthnet card. She put me on hold to get me the number to healthnet. She gave me the exact same number that I called above! She said then that she would transfer me. I am back on hold again for extensive period of time awaiting her to look into my account. In addition I have asked to change my dentist twice and twice been told that they would email me a list of dentists in my network. I have never received those emails. I have spent so much time just trying to get answers done, It has taken hours away from my work and I still have not resolution. I need resolution to both these issues and a number I can call that actually gets me to someone that knows how to deal with this and not put me on hold for extended periods of time only to either transfer me to someone else who does the same, or tell me I will get confirmation and emails that never come.

  Business response

  09/01/2023

  Policy for Son has been termed as of 7/31/23

  Customer response

  09/07/2023

   
  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution is satisfactory to me.
  
  Sincerely,
  
  *****************************

• Initial Complaint

  08/01/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  I want to complain about Health Net transportation Ill see their commercials and then all their advertisements that they provide rides to the members even ones who are sick people who are sick and disabled and needing to go to the doctor I scheduled my ride over a week in advance guess what I never made it to the doctor and now I might die honestly I could I could die in this process I cannot believe how unprofessional they were to guess what guess what they use Lyft the stupid is the lamest cheapest ride service possible this isnt a medical ride this is a lift lived I want to be reimbursed and I need to stop using Lyft they need to upgrade to Uber if theyre just going to use a rideshare for these people and call themselves a medical transportation service youre really not youre really just from the streets it was horrible I cannot believe how unprofessional and what a bad experience this was and how much they ruined my life I want to be paid backI dont know that the Neurologist I was going to wouldnt answer the phone and God knows if I was still charged these people are so unprofessional they need to stop advertising that they give rides to people who are sick with brain injuries who cant walk

  Business response

  08/15/2023

  We have made several attempts to reach the member by telephone and email.  Our attempts were unsuccessful as we have not received  response from the member to assist with the transportation issues. 

• Initial Complaint

  06/08/2023

  Complaint Type:

  Product Issues

  Status:

  Resolved

  More info

  Overpayment of monthly ******** gap policy in March 2023. Unable to resolve.

  Business response

  07/07/2023

  'We ******* the overpayment that the Member has been trying to get reversed and credited the Members account in the amount of $244.00. 

  Customer response

  07/10/2023

   
  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution is satisfactory to me.  Very poor customer service taking 4 months to resolve their error.
  
  Sincerely,
  
  *******************

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