UC Irvine professor sues Health Net after lengthy coverage battle over injury

IRVINE, Calif. (KABC) -- A University of California, Irvine professor is suing Health Net after being denied coverage by the insurance provider. She spoke out in an exclusive interview with Eyewitness News.

AnneMarie Conley, a 39-year-old mother of three and assistant professor at UCI, injured her hip during yoga nearly two years ago.

"It was a labral tear. The entire hip capsule was shredded," Conley described. "I want anything that's going to reduce pain."

Conley used to run and swim. Now, she relies on an ice pack to get through the day.

"It was a bad injury, but it shouldn't still be this bad," she said.

Conley blames her insurance company Health Net of California for adding to her pain.

"I paid into it, my parents paid into Health Net, and I get injured and they're not there," Conley said.

Conley claims two different orthopedic surgeons recommended hip arthroscopy as soon as possible. Both doctors told her there were no in-network doctors who specialized in the procedure. The only local specialist was out-of-network.

"Both of these in-network physicians told AnneMarie to go to this specialist that's five miles away here in Newport Beach, but yet they refused to pay for it," said Gregory Bentley, Conley's attorney.

Conley, who is suing Health Net, alleges the company stated the surgery was not "medically necessary," and therefore not covered.

She appealed, calling Health Net almost daily, while the pain worsened. She said overcompensating to protect her hip led to other complications.

"I couldn't take care of myself. I have three little kids," Conley said.

Nearly five months after the injury, according to the complaint, Health Net reversed its position and approved the surgery.

But the approval came after the scheduled surgery date. So Conley waited some more, eventually undergoing surgery last year.

While Conley relearns how to walk, she says her family was left with more than $200,000 in medical bills.

Health Net has refused to cover the cost. Her policy expired before she had surgery.

Conley thought her surgery would happen while still covered by Health Net, but she said she felt so betrayed by the company that she did not renew her coverage.

Her attorney said if Health Net had not delayed, she would have received surgery in just weeks, while still covered by the company,

"Health Net is the one that's supposed to find the care that she needs and pay for it." Bentley said.

Eyewitness News contacted Health Net, but the company would only say it "has a policy of not commenting on matters involving litigation."