ComplaintsforHealth Net of California, Inc.

• Initial Complaint

  05/30/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  Im with HN for 6 years, and never used it. Paying almost $1,000 a month. I have developed high blood pressure and my ** is not in control. Because I dont know how long Im having this issue, I wanted to check my heart, what my primary physician also recommended. I already got two appointments with ***************, but my insurance is evaluated to pay for my cardio procedure since May 1th. Called many times, but no positive answer. Health Net is willing to put their members ***** at risk, this business doesnt care. I will definitely change my health insurance asap.

  Business response

  06/08/2023

  Members authorization was submitted to *** on 5/1/2023, a representative from *** reached out to members provider on 5/1/2023 requesting medical records in order to process this request. These record were not received until 5/18/23, On 5/30/23 the request was denied due to lack of medical documentation. 05/31/2023 member provider submitted additional records, 06/08/2023 Your request was not approved. Please reach out to your provider for additional information they have been notified of the decision via fax. 

• Initial Complaint

  03/21/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Resolved

  More info

  I was a member effective 12/1/22. I received a letter that I would be automatically enrolled for ******* 2023 if I paid the bill I would receive in Dec. I didn't get a bill so I call on 12/28/22 to check I was signed up for ******* and was told there was a problem with enrollment. They had an error and were too busy. I called multiple times for weeks with people promising to handle it and call me back to no avail. I have multiple reference numbers: I91921991, I92155685, I92179965, I92215356, I92611041, I93795302, I94628703, and R20649818. I was also given the email ************************************************* with the code Mmktca-***** with no help. Up until 1/18/23 I was told I was not yet enrolled and which was stressful that my family was not covered. Also, my family could not refill prescriptions or go to doctors for all of ******* because we didn't get any cards after the supposed 1/18/23 enroll date. I was told at the end of ******* that they had mis-entered my social security number so my account wouldnt link. I also called on 1/26/23 to cancel my enrollment immediately because Healthnet was horrible to me. I was told by **** (ref #II94628703) that I was cancelled effective 1/31/23. I called to check on my refund 2/2 and I was told by ***** (R20649818) that I was not cancelled for 1/31/23 so no automatic refund. I have never used Healthnet for 2023. I have spent 20 plus hours on the phone as well as having to file numerous grievances.On a letter dated February 28th, I was told my grievance was denied and I would not receive a refund stating instead that I had to prove I had other insurance even though they show that I cancelled for February. They also acknowledge on the phone that I did not receive enrollment ******* 1 and could not use my health insurance for ******* due to their enrollment mistakes.I am owed $4612.72. Healthnets denial letter reference #MMKTCA-53161. Evidence of Coverage for Healthnet Ambetter Plan # ********. Please help, thank you.

  Business response

  03/30/2023

  Member request to be reimbursed for ******* and February premiums were approved. We are currently working on processing the refund in the Amount of $4612.72 back to members payment source on file. I call was made to the member to advise, but only voicemail was available. We will continue to make outreach to the member to confirm receipt of the refund

  Customer response

  04/18/2023

   
  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

  02/28/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  Since October Ive been having automated withdrawals. So I should have healthcare. When I try to make an appointment. They say they have no record of me. I called health net over and over and over again. They say that Im not covered. Ive been trying to get a mammogram. I made the appointment 3 months ago and still I have no insurance even though health net keeps taking money.Im going to have to close my baking account because you keep taking money and refusing to provide the insurance you are taking money to cover.I kept getting pushed from on incompetent phone operator to the next. I keep having work my way through the stupid auto voice demanding information. And then again to another operator that will connect me to the right department which is the exact same place that I called into. Wash rinse repeat. Maybe if the health care people paid for was actually available for them to use; your staff could take care of their collective brain tumor & be able to manage answering phones.Its vile to steal money and not provide the service.

  Business response

  03/10/2023

  Health Net has researched your account and reached out to Covered CA.  Per Covered CA they do not show an active account for 1/1/2023. Per Covered CA the account was cancelled for the 2023 enrollment year. If this is an error, please contact Covered CA ************ to discuss your options. We did find that two payments of $52.25 show were drafted but are showing they were returned by your financial institution.  A payment audit has been submitted to do a full review of your payment history, but has not been completed yet. Once completed, we will provide the member with an update directly.  

• Initial Complaint

  02/23/2023

  Complaint Type:

  Order Issues

  Status:

  Answered

  More info

  Just found out that HEALTHNET INSURANCE have held my commissions since 2018 and they refuse to pay me on a technicality.I am fully licensed and insurance since 2006

  Business response

  03/22/2023

  I was unable to reach ***********************, No research was completed because I was unable to gather any details on which members commissions were not paid. 

  Customer response

  03/22/2023

   
  Complaint: 19459086
  
  I am rejecting this response because: They have been collecting premiums for more than a year and make excuses not to pay my commissions based on a stupid technicality
  
  Sincerely,
  
  ***********************

  Business response

  04/20/2023

  ****** was paid commissions for the clients under his individual name. Health net is not able to pay commissions under the Agency name because he doesnt have a contract with Health net under the agency only his individual name. ****** must submit a contract with Health net in order to get paid commissions for clients listed under his agency. 

• Initial Complaint

  01/28/2023

  Complaint Type:

  Customer Service Issues

  Status:

  Answered

  More info

  Hi,Thanks for your help this is a bit of an odd case but here goes. I move about every two weeks due to many factors and I have not seen a Healthnet provider for a while. Despite them already sending me all my EOBs (explanation of benefits) for ALL of my previous appointments, they mail me them over and over and over again. This places my mail and personal information into the hands of whoever is in the Airbnb after me. I move so much that I am just using general delivery now. The problem is I don't need repeats of the same EOBs I have already seen and legally they only have to send it ONE time. I asked them to stop because of HIPPA reasons and they won't. They tell me they will but they keep mailing me the same EOBs- I get at least two a week it seems. Please, can you help me have them stop? I am not even a member anymore! It's nuts. I don't want my old member number and personal medical reasons for visits floating around and again, they don't have to send more than one. And since I have seen them all, I am fine. They told me legally they have to send them. But legally it's only once.

  Business response

  02/13/2023

  We should have the capability to email EOB's to our members, however until or systems are updated to allow them to be emailed we are required by state law to mail the Explanation of Benefits to the members if a new claim is billed or an update is made to an existing claim.  This would be the only time the member would receive a new or updated EOB.

  Customer response

  03/04/2023

   
  Complaint: 19325797
  
  I am rejecting this response because I have not been a member of Healhnets since 2022. I have not seen a doctor in months. I have already received every single EOB MULTIPLE TIMES and they continue to send them. Their lazy response is the same, and that is that legally they can send them. What they shoudln't be able to do legally, and I am right on this because I researched it, is send it over and over and over. Can they do it because they want to? Yes. They can choose to harass people and be a pain. But, legally they are only REQUIRED TO SEND IT ONCE. Therefore, they are choosing not to honor my request and continuing to blame it on their legal choices, failing to remember that if they want to use legality, it's actually one time. I don't need the same EOBs over and over. Does this make sense? I have seen the same ones like five times and I am paid up and they won't stop it.
  
  Sincerely,
  
  ***********************

  Business response

  04/03/2023

  Your preferences have been opted out to not contacted by mail. However, please note below.  EOB's on a claim are sent every time there is a change in the processing of a claim, due to additional information that *** have been sent to Health Net by the provider.  Centene Corporation, and its affiliated websites, will strive to honor your chosen preferences. However there *** be instances where we are required by law to send you information about your policy in non-preferred communication channels(i.e certain regulatory pieces that are required to be mailed.)
  

• Initial Complaint

  01/24/2023

  Complaint Type:

  Product Issues

  Status:

  Answered

  More info

  in 12/21 I cancelled my HealthNet medical insurance. However, Health Net did not properly cancel my policy. On 1/1/22 I signed up for BX/BS health Insurance. From 1/1/22 until 12/31/22 HelathNet illeagally and without my permission, withdrew $381.00 from my checking accout without my knowledge. HealthNet also billed for every visit I had at *** during 2022 without my knowledge. I never presented a HealthNet card at ***,when I realized their gross negligence and unethical practices I contacted them immediately. I requested the entire amount taken from my account, $4572,00 retruned to me immediatly. All documents requested which proved their poor business practices and HIPPA VIOLATIONS. I want all money taken illegally, with interest for the year of 2022. They have refused refund my money after 3 months of my attempts

  Business response

  02/13/2023

  A refund has been issued to the member on 2/3/2022 in the amount of $3088.00.  The amount refund covers the months of January 2022 to October 2022. Our records indicated that there was no draft taken from Members account for November and December.  The Member is in the process of providing proof of draft for November and December 2022.  Once the proof of draft is received from the member we will research payment further.  Interest on the Members premium refund will not be paid as Health Net processed the requested refund with in the time frame advised.  

  Customer response

  03/02/2023

   
  Complaint: 19320349
  
  I am rejecting this response because:  The current amount owed is not the amount that Health Net states.  Currently my claim is for the monthly premiums of $381.00 X 10 months.

  01/01/22-10/31/22

  The amoount owed  to me is $3810.00.  In addition,  I must be paid interest on thses funds, as Health Net removed these funds from my account WITHOUT my permission, thus, interest must be calculated for this 10 month period of time.

  Health Net acted unethically, deceptively and unprofessionally with my previous accout and must be held accountable.
  
  Sincerely,
  
  ***************************

  Business response

  04/05/2023

  A check in the amount for $3814.00 was mailed to the member on 3/3/2022 for the January 2022 to October 2022 premiums that were taken from her account.  After we completed our research, we could not locate a contact from the member prior to 11/2022 that indicated a request to cancel this plan for January 2022, this is the reason why premiums continued to be deducted from the members account.  A decision was made to cancel the members policy back to 1/1/2022.  Interest for these payment drafts will not be paid because refund was done within 60 days of the policy cancellation completion date.

• Initial Complaint

  01/06/2023

  Complaint Type:

  Delivery Issues

  Status:

  Answered

  More info

  I've been a Health Net customer for 20 years. In July, I changed jobs, but I stayed with Health Net keeping essentially the same coverage. Approximately 15 years ago, I was diagnosed with a medical condition called Interstitial Cystitis. It's very common, but there are very limited treatments for it that include opioids (not ideal), antihistamines (which I already take), and a medication called Elmiron. Elmiron is not cheap; it's about $6/pill and I'm supposed to take it 3 times a day. I don't. I take it once a day, saving both myself and Health Net a not-inconsiderable amount of money (by my calculations, somewhere in the area of $84,000 over 15 years).As of October 2022, I was told that there was a Prior Authorization request holding up my prescription. It took two weeks, but eventually, my doctor, the pharmacy, and Health Net finally figured out that there was no reason to hold it up. I got my meds.In December 2022, I went to my doctor for a check-up and she put in a new prescription for Elmiron. It was, once again, denied by Health Net and they required yet another Prior Authorization request to be submitted. Even though they got one just three months ago. Here's the thing. They're denying my request saying that my doctor hasn't "tried alternatives." However, as noted above, the ONLY alternatives that I don't currently take are opioids, which I'm ****% sure they don't want to prescribe unless it's absolutely necessary. In fact, I'm pretty sure it would be more difficult to get that prescription than the Elmiron.Health Net also claims that my records with them for the past 20 years as a member isn't a valid source of my medical history. Which is just ridiculous. If I were someone with less resilience, I'd have given up by now, which is exactly what I think they want. However, I also don't want to spend my days feeling like I have an ongoing urinary tract infection because of all of the hoops that they're putting up. It's time to take action.

  Business response

  01/23/2023

  Health ************************* has responded to our inquiry, and we have been advised an override has to be added to the system to allow your medication to be filled on June 29, 2022, and the override is active through December 31, 2023.

  Customer response

  01/25/2023

  (The consumer indicated he/she DID NOT accept the response from the business.)
  This is totally incorrect. I've been told repeatedly since December 12, 2022, by Health Net reps in the ******************* that they will not allow a prescription to be filled for this medication unless I try 3 others first, in spite of Elmiron working well for 15+ years.
  
  One of the medications I've already tried (Hydroxyzine) and had side effects (rapidly beating heart that triggered anxiety). One is an antidepressant with horrific side effects like suicidality and would prefer not to take it. And I'm currently taking the third medication (Cimetidine) in spite of it causing blood sugar drops to get done with this dog and pony show. It's ****% clear that this is based purely on how much Elmiron costs but that's on the pharmaceutical company that keeps fighting the production of Elmiron because they make so much money from it.
  
  My doctors office and pharmacy will gladly support my account of this issue.
  
  So no, I so NOT accept this response, as it's an outrigyt lie.

  Business response

  02/10/2023

  The Prior Authorization for medication has been overturned, test claim for medication has been processed and paid. I contacted member with outcome via phone no answer I left a brief voice mail indication medication can be picked up at her local pharmacy.
  
  

• Initial Complaint

  01/06/2023

  Complaint Type:

  Customer Service Issues

  Status:

  Answered

  More info

  I was Health Net (HN) of CA insurance member in 2022. I emailed on 11/15/2022 to cancel my insurance policy on 12/31/22 and stop auto enroll for 2023. I called HN on 11/21/22 to confirm cancelation on 12/31/22 and no auto enroll for 2023. Ref # I89397112. I asked for email confirmation, which I did not receive. I called again on 1/6/23 because I was auto enrolled 2023. Ref # I92837142. I spoke to rep ******** who said she'd have to transfer call to "escalation". Again, I waited and talked to yet another rep ********** who would not give me a new ref number. I have wasted far too much of my time (hours on hold) on this. I just want ***** Net to CANCEL the ************************************************************************* confirmation of cancelation. (I have been on endless hold, 1/6/23, waiting for the "LeAngela" rep to get back to me.

  Business response

  01/24/2023

  Covered CA notified ** of the plan cancellation on 1/11/2023, Health Net runs invoices on the 10th of each month. The invoice was created on 1/10/2023 before we received the cancellation. There is no amount due since we received the cancellation from Covered CA. We apologies for the inconvenience.

  Customer response

  01/26/2023

  (The consumer indicated he/she DID NOT accept the response from the business.)
  I think they must be mistaken because I did not get my insurance through Covered CA (so they would not have notified you of a cancellation from me on 1/11/23). In addition, I initiated the cancelation process in November of 2022 (well before the invoices for 2023). I was a Health Net (HN) of CA insurance member in 2022. I emailed on 11/15/2022 to cancel my insurance policy on 12/31/22 and to stop auto enroll for 2023. I called HN on 11/21/22 to confirm cancellation on 12/31/22 and no auto enrollment for 2023. Ref # I89397112. I asked for email confirmation, which I did not receive. I called again on 1/6/23 because I was auto enrolled 2023. Ref # I92837142. I spoke to a phone rep ******** who said she'd have to transfer the call to "escalation". Again, I waited and talked to yet another rep ********** who initially would not give me a new ref number, but eventually did. Ref # I92841494. Again, I requested but did not receive email confirmation. At that point, I filed a complaint with BBB because I was getting nowhere with customer service and still receiving bills for a 2023 policy in which I was auto enrolled against my specific directions.
  
  At this point, I can't confirm anything because I have never received an official cancellation from Health Net, and I don't know whether or not I will receive additional, erroneous bills in February.
  
  I do hope it is all finally resolved--Health Net policy cancelled with no amount owed by me--but I can't yet confirm.

  Business response

  02/10/2023

  The Plan this member was enrolled in with Health Net has been termed effective 1/1/2023.  The letter is being generated and will be mailed as well as emailed to the member as soon as it becomes available. Member was informed. 

• Initial Complaint

  01/05/2023

  Complaint Type:

  Customer Service Issues

  Status:

  Answered

  More info

  I renewed my health net insurance through covered ca on 12/28/22 and paid my premium for the following month. I've called my insurance health net multiple times and they keep saying I have to wait 5-7 business days for them to process the information and for my insurance to be active. When I asked what is taking so long they said they are behind because of the holidays. It is now 1/5/23 and my insurance was suppose to begin on 1/1/23. I had a prenatal visit today which I had to pay $280 out of pocket for. I received an email from health net today saying they got my information but to pay my premium which I already did on 12/28. I called them and they have no record of anything.

  Business response

  01/23/2023

  We contacted the providers office and a refund was issued back to your credit card. Your account is also in Active status. Our apologies for the inconvenience.
  

• Initial Complaint

  11/07/2022

  Complaint Type:

  Customer Service Issues

  Status:

  Answered

  More info

  I made a phone payment on 8/31/22 paying on two months of health coverage in which I received a confirmation number confirming payment. Moving forward and later down the road, I discovered the funds were not removed from my account and I am past due. I again made another phone payment on 10/31/22 incorporating the 8/31/22 payment (that never went through) as well as another two months of coverage, I received a confirmation number confirming payment. On 11/5/22 I decided to check my account and discovered that again, the payment did not go through! Now I believe there is an obvious issue with HealthNet's phone payment application. I contacted the customer service on this and on my first call I was told my account was terminated, they could not help and patched me through to Covered California. Covered California told me the issue needs to be resolved through HealthNet and to call them back and speak to a supervisor. I called HealthNet back, got the same rep, and asked to speak to a supervisor. Again, she was no help, and pretended not to be able to hear me then placed me on hold and never came back. I called back another 4 times and received various responses. One rep left me on hold for 42 minutes before I hung up, another 2 times they answered but no voice was heard, another rep told me she could not help and put me back in the "marketplace". The Marketplace told me they could help me because they are "federal and I am State .... sorry". Okay I spent several hours going around and around with customer service, who do not speak english well and are not in a hurry to help resolve issues. My intention on BOTH OCCASSIONS was to pay my premium in which I did via HealthNet's phone system. I received confirmation of payment ON BOTH OCCASSIONS. NOW, on 11/7/22, I am being told by HealthNet my insurance is terminated and I have no supervisor, or any knowledgeable person to speak to sort this mess out!! This is unacceptable customer service!

  Business response

  12/15/2022

  Business Response /* (1000, 8, 2022/11/25) */ Health Net was unable to locate payments taken from the members account. Member refused to provide proof of payment and/or confirmation numbers.

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