In advance of a California legislative hearing on health care "costs" not scheduled to include testimony from consumers, consumer advocates will discuss the real financial threat patients face in a class-action lawsuit against Health Net for misrepresenting their physician and hospital networks. The lawsuit was filed late in 2014 and will receive an initial hearing by the Los Angeles Superior Court later this month.
Of all the leading insurance companies in California, Health Net made the fewest doctors available to its enrollees in 2014, according to the lawsuit—less than half what some other companies are offering in Southern California—and made further reductions in 2015.
As a result of Health Net's limited hospital and doctor network, patients are at risk of delays in accessing needed medical care, and unpaid medical bills if they are forced to seek care out-of-network.
The Health Net consumer who will describe her ordeal at the press conference today was forced to pay $12,000 out-of-pocket for a double mastectomy and breast reconstruction surgery even though federal health reform caps in-networks costs at $6,600. The federal health reform caps do not apply to care received outside an insurer's approved network.
In a letter sent today, Consumer Watchdog urged Senator Ed Hernandez to include consumers at Wednesday's Senate Health Committee Hearing.
According to Consumer Watchdog's letter:
"Saving money for patients requires hearing how consumers are being overcharged by health insurance companies through abusive practices, not merely listening to the institutional stakeholders complain about each other's role in the cost run-ups. We urge you to include a consumer voice on the panel for Wednesday's hearing."
Delaying Access to Care, Big Out-of-Pocket Costs
Heather Brianna Womick, an actress, stunt performer, and professional dancer was diagnosed with breast cancer in early 2014 and immediately saw an oncologist and began chemotherapy.
When a double mastectomy became unavoidable, a plastic surgeon had to be added to Heather's surgical team. Brianna's doctors suggested 8 different surgeons on Health Net's list of "in-network" doctors. Shockingly, 6 of the 8 surgeons did not even accept Brianna's Health Net plan. Of the other two, one was unavailable because she was on maternity leave and the other doctor specialized in rhinoplasty, not breast reconstruction.
Brianna spent hours on the phone with Health Net trying to identify an in-network surgeon. Unwilling and unable to delay her treatment any longer, Brianna eventually underwent a successful double mastectomy and breast reconstruction surgery on September 2014. As a result of Health Net's inadequate network, Brianna incurred more than $12,000 in charges for the procedure that should have been available in-network and largely paid for by Health Net.
"Health Net misrepresented the doctors and providers in its subscriber network – the old bait and switch," said Travis Corby of Shernoff Bidart Echeverria Bentley LLP, an attorney representing Health Net consumers. "Heath Net betrayed its members' trust, and left its members with huge medical bills."
During the 2014 Open Enrollment Period, Health Net offered HMO and PPO plans to California consumers both inside and outside the Covered California exchange. But, as of December 31, 2014 Health Net cancelled its Covered California PPO plans, including Brianna's. Consumers enrolled in the cancelled PPO plans must seek new coverage for 2015, including new so-called Exclusive Provider Organization ("EPO") plans sold by Health Net. Compared to Health Net's PPO plans, Health Net's EPO plans offer 54% fewer doctors and no out-of-network coverage, a fact that Health Net misrepresented, according to the lawsuit. If a consumer receives care from a physician not participating in Health Net's limited network, the consumer must pay the full cost of care out-of-pocket.
"Consumers are now required to buy health insurance that can cost thousands of dollars each month or pay a tax fine, but if companies are allowed to sell a plan with too few doctors to provide treatment the coverage isn't worth a dime," said Laura Antonini, staff attorney for Consumer Watchdog.
The class action lawsuit against Health Net (Case No. BC567361) was filed in Los Angeles County Superior Court.