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Lawsuit alleges Health Net denied coverage of life-saving treatments

September 13, 2012 12:00:00 AM PDT
A lawsuit alleges insurance provider Health Net engaged in unfair and unlawful practices, denying patients life-saving treatments.

At a news conference in downtown Los Angeles Thursday, customers of Health Net Insurance said they were denied coverage because the treatments were considered medically unnecessary.

Monrovia resident Robert Mendoza, 59, says he had to pay $30,000 out of his own pocket to receive cancer surgery that had been denied by Health Net.

Mendoza and Kalana Penner of La Canada Flintridge have filed suit against Health Net, alleging that the insurance giant illegally denied legitimate claims for medical treatment. The Los Angeles County Medical Association has joined them in the lawsuit, seeking an injunction against the company's denial policy.

"It's illegal, it's morally offensive, and not defensible on any level," said Rocky Delgadillo, L.A. County Medical Association chief executive.

Bonnie Scott is not part of the lawsuit, but says she too was denied coverage for a legitimate claim. She says the company reversed its position after she filed suit.

"Why am I paying this if they're not going to cover it? I want it to stop," said Scott.

Health Net is based in Woodland Hills. The company would not comment specifically on the lawsuit, but a spokesman did issue a statement:

"Medical care is complex, and sometimes there are differing medical opinions as to what constitutes medically necessary care. In these instances, Health Net carefully follows the guidelines established by the state of California's two regulators, the Department Of Managed Health Care and the Department of Insurance."

According to the Department of Managed Health Care, the state gets about 1,200 requests for independent reviews about medical necessity each year. And last year, the insurance company's decisions were upheld about 39 percent of the time.

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