ComplaintsforHealth Net of California, Inc.

• Initial Complaint

  06/24/2022

  Complaint Type:

  Customer Service Issues

  Status:

  Resolved

  More info

  ******** Healthnet sent me an email June 3, 2022 canceling my insurance. No reason was provided. Upon calling them the following week, a representative said it was canceled for non-payment. However, all email billing statements I received from Healthnet since February 2022 have been for $0 due, so I do not understand how my policy can be canceled for nonpayment if all my billing statements were for $0. Since I am a freelance entertainment industry employee in the state of **********, I do not work steadily. I obtained my insurance through Healthnet through the open marketplace, and I update my income regularly with Covered **********. They are supposed to provide Healthnet with the amount of my monthly premium. I was told that COVERED ********** had an "issuer error (i.e., they messed up)" and told Healthnet the wrong information, and that's why Healthnet sent statements that said $0 was due between February and June. The premium I was supposed to be paying to Healthnet each month between February and June was supposed to be $89.61/month, not $0. If Covered ** had done their job correctly, I would not be in this situation now. But Healthnet says I now owe $537.66 to retroactively cover all those months (plus July's premium) by 7/16/22 or I will be canceled again. I am currently not working and cannot afford to pay that much at once, and I shouldn't have to because Covered ** made the error. When I contacted Healthnet today, 6/22, and explained that I am not working but that I can set up a payment plan in order to get caught up, the rep said they "do not do payment plans," so I hung up. I am a Type 1 diabetic and I NEED HEALTH INSURANCE TO PAY FOR INSULIN AND DIABETIC SUPPLIES IN ORDER TO SURVIVE. I have had to spend over two weeks and hours on the phone to get my coverage reinstated, and I wasn't even the one who made the mistake in the first place. I have gotten no help or understanding from anyone at Covered ** or Healthnet so I am filing this complaint now.

  Business response

  08/10/2022

  Business Response /* (1000, 5, 2022/08/02) */ Research was completed and found that Members premium's were not applied correctly with Covered CA. Therefore the Members invoices reflected the member had a $0 balance. Since this was not the error of the member, a one time payment plan for the member was requested. The payment plan was approved and member agreed to it. Member is aware of the due dates for his premiums. The members policy is active retro back to 1/1/2022. Consumer Response /* (2000, 7, 2022/08/09) */ (The consumer indicated he/she ACCEPTED the response from the business.) I still had to jump through hoops with the ******** rep assigned to setting up the payment plan as well as dealing with her horrible communication skills, or lack thereof, and the web site STILL does not have the correct amount that I owe (reflecting the agreed upon payment plan details), so it is still extremely confusing and I will be going off the paper copy of the payment plan I received when I make my payments. I will be re-opening the claim (or filing a new one) if I have any further issues.

• Initial Complaint

  06/21/2022

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  Last year Health Net was my medical provider. I visited my primary family doctor several times. My family doctor's office is approximately one half mile from my residence. Health Net is not paying my doctor for one of those visits, their reasoning is that I went out of my designated coverage area for that particular visit. When they sent me the information on that particular visit, it's the same address as my family doctor the doctor's name is different but he works out of the same office building. I have explained this on 3 different occasions to 3 different customer service employees. Each one reassured me that there really wasn't a problem and not to worry about it. Today I got a phone call from their complaints dept but I thought it was a marketing caller. I called back and I left a message but I just want them to pay my family doctor what he is owed.

  Business response

  07/19/2022

  Business Response /* (1000, 5, 2022/07/07) */ Health Net contacted Dr. ************'s office, the provider member stated receive a bill from, and was informed by ****** the member has no outstanding balance and is not being billed. Member was going to send additional details but the information from the member has not received. Followed up has been completed to the member on 7/6/22 to inform that the additional information on the unpaid claim has not been received.

• Initial Complaint

  05/27/2022

  Complaint Type:

  Customer Service Issues

  Status:

  Answered

  More info

  Healthnet refused to refill my Rx a few weeks early after my bag got stolen at work because they don't "allow override of Rx because of lost medications." The lost medications were my BP and thyroid pill. I called and explained that I cannot suddenly stop either of those medications and need those refilled but I was told that it was not possible. Healthnet is willing to put their members health at risk. I could have a stoke, heart attack or complications from thyroid issues by suddenly stopping these medications but Healthnet clearly does not care. What a shameful way of dealing with the situation and showing clearly how little they care about their members. I will be changing insurance as soon as possible and I urge you to reconsider before choosing Healthnet.

  Business response

  07/26/2022

  Business Response /* (1000, 5, 2022/06/16) */ Health Net has made multiple attempts to contact the member and have been unsuccessful. We have also received a formal grievance on 5/27/2022 from the member. This grievance is still being worked and we will provide a resolution within 30 days of the receipt date. Consumer Response /* (3000, 7, 2022/06/23) */ (The consumer indicated he/she DID NOT accept the response from the business.) Healthnet's grievance process is a joke. Every single time to have dealt with it, they take their time and I think he end it's always a no. It's always a denial of benefits. They don't care about their members. I will be leaving this insurance shortly. The public should know that healthnet has a policy if your medication gets lost or stolen, they will refuse to replace it. You must pay out of pocket for that medication. Business Response /* (4000, 9, 2022/07/08) */ Member was able to obtain Medication on 5/27/22. A one time exception to override 30-day supply for both medications on dos:5/27/22 was completed. Member is responsible for any copayments. CVS Pharmacy was contacted and informed to provide a 30 day supply.

• Initial Complaint

  05/18/2022

  Complaint Type:

  Billing Issues

  Status:

  Resolved

  More info

  At 4 AM on March 25th I was feeling cramps *************************************************************** filling the entire toilet bowl. I called Healthnet around **** ** *** and they advised me to go to the ER immediately. I did that. The ER doctors took ***** tests etc and other measurements and then decided to do a *********** the following morning. There continued to be large amounts of ***** in my stools. I felt Ok and thought I would be discharged after the colonoscopy but the doctors then said that my ***** tests necessitated keeping me in the hospital. They were not able to find the location of where the ***** was coming from. Blood measurements did not improve sufficiently until March 29th when I was finally released. In early April I then got a notice from Healthnet saying that my admission in to the hospital had been denied and so the ******* bill for the hospital stay was being denied. The denial they said was based on the ****************************************************. There had been no great loss of *****, labored breathing or a couple of other criteria they said. I tried unsuccessfully to get an explanation from ******* Hospital as to their reasons for keeping me. I tried frequently and unsuccessfully to talk with Healthnet but for 4 weeks the case officer never returned my calls. I then escalated the process through ****. That seemed to trigger a new case review at Healthnet. However, both of the ongoing reviews were terminated by *** **** and Healthnet once again denied the charges. No reason given for the denials. I finally succeeded in speaking to someone at Healthnet on *** **** and they agreed to open a new case review. I asked Healthnet how it's possible for them to insist that I go to the ER and then deny insurance payment for that. They had no answer to that question or any other one. Because Healthnet does not return calls, it seems unlikely that I'll ever be able to talk with them again.

  Business response

  06/23/2022

  Business Response /* (1000, 5, 2022/06/07) */ The claim for this Emergency Visit has been received by Health Net and processed. The member copayment/deductible responsibility is $********. Member requested a EOP for his record. Per the member, he is not disputing the member responsibility he is satisfied with the outcome. Consumer Response /* (2000, 7, 2022/06/22) */ (The consumer indicated he/she ACCEPTED the response from the business.) My total out of pocket cost was only around $***** unless something changes. I don't think it will since it appears that the entire bill is now resolved. I'm happpy with the outcome although I do find it strange that I never once talked with anyone at Healthnet at any point in time who had knowledge of my case. It's mysterious why they have now agreed to pay the insurance. I would like to think that my reasoning is what convinced them but I'm not sure I'll ever know.

• Initial Complaint

  05/17/2022

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I have coverage with Ambetter Healthnet as of 4/1/22 through my business/ covered **. Even through I'm paying regular premiums and I have an active status through Covered **, Healthnet will not issue me a subscriber ID. I've called healthnet on 4 different occasions and every time I call they transfer me around, hang up on me, or say they have no record I have health insurance. I've called covered ** on 3 different occasions. They are quite helpful. They keep requesting my subscriber ID from Healthnet and Healthnet will not issue it. Not having a subscriber ID makes it nearly impossible to seek medical attention and prove I have any kind of coverage. I would like this rectified immediately so I can use the coverage I'm paying for. It's fraudulent to pay monthly premiums every month and not have any record of coverage. If something is not done about this soon I will be seeking counsel to sue Healthnet.

  Business response

  06/24/2022

  Business Response /* (1000, 5, 2022/06/07) */ Health Net contacted*********** to confirm members coverage. HN was advised by Covered CA that members plan termed effective 1/31/22 under. Member new enrollment under her employer group plan became effective as of 4/1/2022 with a new ID number and card being issued.

• Initial Complaint

  05/16/2022

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  I need a specialized physical therapy, and my only in-network provider is no longer accepting patients. I called the number on my insuance card and (after explaining multiple times that the specific therapy I needed is not one provided by all physical therapists but rather by a specialist) the representative told me to have the PT I am seeing file a peer-to-peer authorization. They have tried multiple times to call HealthNet, only to be bounced back and forth literally between the same two phone numbers. I have tried to contact them myself to no avail. All I want is for the peer to peer authorization to be initiated and processed because I cannot afford medical care out of network.

  Business response

  08/01/2022

  Business Response /* (1000, 5, 2022/06/09) */ A Peer to Peer was requested by the provider the member was seeing. The suggested Peer to Peer was not completed since there was no denied authorization for the services from the provider. In order for the health plan to request a Peer-to-peer a denied PA would have to be on file. We are working with the members provider to have a PA submitted for review, once this pa is received and received a peer-to-peer can be completed if the pa is denied. I was also able to locate a in-network provider that can assist the member with an open availability I provided member this information an she declined. Consumer Response /* (3000, 7, 2022/06/15) */ (The consumer indicated he/she DID NOT accept the response from the business.) The one provider that HealthNet sent me last week had more than a month wait - to see me in July - and I have been seeking a specialist since *******. Attached you will find documentation from ******* that ******** **********, my main provider, told me they were not accepting new patients and a list of offices they recommended (from which my current specialist was found). Business Response /* (4000, 9, 2022/06/27) */ we have been working with the provider Origin Physical Therapy, who the member wants to see, to obtain an authorization request from them so services can be rendered. We have not received the Prior authorization from this provider yet. WE are in contact with the Member and Provider constantly trying to get the authorization. Consumer Response /* (4200, 11, 2022/07/08) */ (The consumer indicated he/she DID NOT accept the response from the business.) My provider has responded to HealthNet awaiting more information. I am waiting to hear back from HealthNet so that the peer to peer authorization can be processed. Since this complaint is the only way I have ever been able to successfully hear back from HealthNet, I am hoping this will lead to a resolution, but HealthNet has not provided one yet. Business Response /* (4000, 13, 2022/07/18) */ We have been in contact with the members provider and have provided the correct steps on how to request the prior authorization for the members services. Health Net has requested medical records and a corrected authorization request with additional information that was missing on the original authorization request. The requested medical records were received on 7/18/2022 and the provider has advised us that they will re-submit the authorization request by end of day 7/18/2022. We will escalate the processing of the Authorization request once received.

• Initial Complaint

  05/12/2022

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  My daughter was born ******* and I had a really hard time getting her added to my insurance with HealthNet, which she was finally resolved towards the end of the year 2021 and was activated retroactive starting at her birthdate. At the beginning of November 2021, my 7 week old baby got sick and I took her to her pediatrician (11/5/21), having a HealthNet representative on the phone in the waiting room trying to figure out why they have not processed my paperwork and why she was not yet added to my plan As things took a turn for the worse, we got picked up by an ambulance from that doctors office and got transferred to the nearest hospital where she was stabilized to get transported to **** children's hospital, where she was in the PICU for 3 days. On 11/9/2021 we had a follow up visit with the pediatrician to make sure things were moving in the right direction. Earlier this month (May 2022) I received a bill from the pediatricians office, stating that insurance has declined coverage because the visit wasn't pre approved. I got on the phone with HealthNet, where I spoke to a lady that did not understand what I was talking about at all. She kept repeating that I needed to find insurance somewhere else, which is not at all what my concern is.

  Business response

  06/24/2022

  Business Response /* (1000, 5, 2022/06/07) */ The newborn was added to the plan effective 12/1/2021, this was after the child had service. The claims for the services that were received in November has been submitted for reprocessing to be covered. Member has been notified of outcome by email

• Initial Complaint

  05/02/2022

  Complaint Type:

  Product Issues

  Status:

  Resolved

  More info

  I purchased covid19 self-test kits, they are covered for reimbursement by Federal Law. I called Health Net to know the procedure to have the covid19 test kits reimbursed, the customer service representative on the line made me wait for over 2hs on the line to tell me the correct form, he wasn't educated on the issue. I filled out the form and put the receipts, and mailed them out to the address on the form. The form was received within 2 days. I called Health Net to have a payment date, since it has been over 15 days that they received my claim form and I've been in the line with Supervisor *****. for over 2hs, they are saying that they didn't receive the claim form. In 2hs that I have been on the phone, the supervisor above is going in circle and is making me wait for over 30 minutes at a time for me to give up and hang up the phone. Very frustrating and stressful situation without a resolution. On 02/18/2022 I received an email from: ***** ******** ERU/ Escalations Response Unit Appeals and Grievance Coordinator II, asking for my information to make the payment. The information was promptly forwarded. On Mar 1, 2022, at 2:36 PM, EXEC_ESC <********@healthnet.com> wrote: Hello **. *******, The claim has processed. You will be receiving a check for $57.98. Please allow 7-14 business days to receive your check. Thank you, ************** ERU/ Escalations Response Unit Appeals and Grievance Coordinator II On 03/17/2022 I sent the email below to ** ********: Hi I didn't receive my check yet. It has been over 14 business days. What day am I going to receive it? I received the answer below on 03/21/2022: Good Morning **. *******, I had a check tracer done on your check and it shows that it is with USPS in Santa Clarita, CA as of yesterday 3/20/22. So hopefully you will get it very soon. I do apologies for the delay. Thank you, ************** I contacted **. ******** a few times after this last email and she never answered me back.

  Business response

  06/23/2022

  Business Response /* (1000, 5, 2022/05/26) */ The COVID claim reimbursement has been processed and a check issued to the member. The original check was lost with USPS and a stop payment and reissue was submitted. The member confirmed on 5/26/22 that he has received his check. Consumer Response /* (2000, 7, 2022/05/27) */ (The consumer indicated he/she ACCEPTED the response from the business.) It took months until I got the check. I needed to go to BBB to solve my issue since Health Net didn't solve the issue in a friendly manner. Hopefully next time I won't need to do all the work that I did to get the money that health net owned me.

• Initial Complaint

  04/18/2022

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  Health Net's provider network is so terribly outdated that I cannot find a neurologist. I asked Health Net to intervene/help, but never received a reply.

  Business response

  06/14/2022

  Business Response /* (1000, 5, 2022/05/05) */ An updated list of Neurologists was emailed to the member. Outreach contact was also made to a specialist with UCSF Neurology to confirm they had an available appoint on 5/16/2022. A request was sent to the member to reach out to the specialist to set an appointment. Consumer Response /* (3000, 7, 2022/05/11) */ (The consumer indicated he/she DID NOT accept the response from the business.) I was referred to a neurology dept. that specializes in MS, which I do not have. I was promised that Health Net would find me a different specialist, but that has not happened. Business Response /* (4000, 9, 2022/05/26) */ Further research was completed and we were able to locate a provider for the member with an appointment for the the first week of June. The member indicated that as of 6/1/2022 he would no longer have coverage through his employer. Member advised he would find out more information once he has Health insurance again. Consumer Response /* (4200, 11, 2022/05/29) */ (The consumer indicated he/she DID NOT accept the response from the business.) I kept using Health Net's provider list to find a neurologist. Several doctors listed in the directory were 1.) not accepting patients, 2.) had left the respective clinic/office years ago, 3.) disappeared from the provider list once I got all the paperwork ready. As a result, it took me two months to find a neurologist, but by then, I had lost my coverage. Health Net should be ashamed of itself!

• Initial Complaint

  04/16/2022

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  HealthNetMediCal has me as $0 HealthNetMediCal as of January 1, 2022. HealthNetCoveredCalifornia has me owing monthly payments as of January 1, 2022. DPSS/MediCal has me as "full MediCal" "$0" "Free" "MediCal. Regal Medical Group has me as HealthNetCoveredCalifornia and won't payout to a Specialist that I saw on 2/2/22, because HealthNetCoveredCalifornia has not been payed for all months owed. 1. HealthNetMediCal refuses to contact HealthNetCoveredCalifornia. and HealthNetCoveredCalifornia refuses to contact HealthNetMediCal. 2. Regal Medical Group only contacted HealthNetCoveredCalifornia and refuses to contact HealthNetCoveredCalifornia. After many hours of abuse from calling each call-center; the result is cruel apathy, and sending me to contact someone else in endless circles. Many requests for supervisors & managers to callback; resulted in increased apathy and a lack of concern. It is obvious to me that HealthNetCoveredCalifornia doesn't want to lose money, although it is my right to be represented truthfully, by HealthNet of California. This website of BBB says do not include account numbers or member numbers. I would like to give it to BBB or any appropriate help to this. I AM SEEKING THE RESULT OF: HealthNetCoveredCalifornia removing all owed from January 1 2022 as of them acknowledging that I have HealthNetMediCal which is free for me as of January 1 2022 to current, and for HealthNetMediCal to change me back to Regal Medical Group that I had before the mistake, and for Regal Medical Group to acknowledge that I have HealthNetMediCal, and for Regal Medical Group to payout to the services given to me on 2/2/22 by ******** in Los Angeles that Regal Medical Group sees in their computer. MediCal ID#********* for DPSS/MediCal & HealthNetMediCal *********** for HealthNetCalifornia and I give permission for BBB and affiliates to help in thses matters aand to use the numbers.

  Business response

  06/30/2022

  Business Response /* (1000, 5, 2022/05/05) */ Member was showing as having medical coverage with both Medi-Cal and Covered CA. Health New worked with Covered CA to get the member's Covered CA plan termed effective 12/31/2021. We care currently waiting on the termination letter to be generated in order to provide it to L.A county Medi-cal. The member has been notified of the update and is waiting for us to contact L.A county Medi-cal and fax the termination letter. Consumer Response /* (3000, 7, 2022/05/16) */ (The consumer indicated he/she DID NOT accept the response from the business.) 'Health Net' did 'termed': 'Health Net Covered California' and kept only 'Health Net MediCal'. What is not shown to BBB from 'Health Net'; that was mailed to me is: 'Health Net Covered California' is 'termed' effective January 31st 2022 to be effective February 1st 2022 because of 'non-payment'. This shows that 'Health Net' lied to BBB, and it shows that Health Net knew and is covering unethical behaviour, that looks as though it happened to many and not just me. 'Health Net' took adavantage of the late update back from 'DPSS/MediCal', to continue billing 'Health Net Covered California' customers that already have 'Health Net MediCal'. It is to note also that from my calls to 'Health Net MediCal' and to 'Health Net Covered California' that each of these sides of the same Health Net, they never share information and never communicate to each other; and that looks as though it is a diabolical intentional way of getting more money from alarmed customers. The result needs to be: 'termed' effective 12/31/21 because of me having Health Net MediCal as of 1/1/22, and not termed because of non-payment effective 2/1/22 as the final letter of Health Net to me says. Business Response /* (4000, 9, 2022/05/26) */ Health Net has contacted Covered California and Her Medi-County county office to try to get the eligibility issues resolved. The issue for the members eligibility effective date is with the Medi-Cal State system and Covered CA's eligibility systems. As the Health Plan only, we do not have any control over the effective date of a Medi-Cal Plan or a Plan enrolled through the Covered CA system. We only receive eligibility electronic feeds from these entities to update into our systems so that we can provide medical services. The member will need to contact her Medi-Cal County worker and Covered CA directly to get her eligibility dates corrected. Before Health Net can change eligibility in our system we have to receive the updated dates from the State Medi-Cal system and Covered California's systems. Consumer Response /* (4200, 11, 2022/06/01) */ (The consumer indicated he/she DID NOT accept the response from the business.) as of 6/1/22: there should be a generated retroactive start date of January 1 2022 of me having MediCal, this update is now in the systems of Healthnet MediCal and this needs to be confirmed by same of Health MediCal via these means/channels, as to have all interested parties to have the same latest update. Business Response /* (4000, 13, 2022/06/23) */ Since the members insurance is through the CA Medicaid plan, they members eligibility and effective dates are updated by the State Health system based off of the information updated by the county the member resides in. Health net confirmed with the county the member had continuous eligibility and enrollment with Medi-cal from 4/20/20 to current. We do not have access to Medi-cal eligibility and member will need to work directly with the county. There has been no updaed to the Medi-cal website at this time. Member will need to continue to work with Medi-cal case worker directly to get the updates completed. Consumer Response /* (4200, 15, 2022/06/30) */ (The consumer indicated he/she DID NOT accept the response from the business.) The response is completely wrong, and a generic routine mistake that shows a lack of effort as usual, I **** ****** do not have medicaid, and for sure HealthNet MediCal has the update of retroactive as of ******* *** **** as having retroactive MediCal through HealthNet MediCal. It shows that someone simply rushed through all complaints, with wrong answers, to simply complete all members complaints before the holiday. HealthNet needs to confirm the retroactive as explained in this. DPSs/MediCal has a 'liason' to HealthNet, so it is not true that a member has to only contact DPSS/MediCal for answers.

*Some consumers may elect to not publish the details of their complaints, some complaints may not meet BBB's standards for publication, or BBB may display a portion of complaints when a high volume is received for a particular business. ↩