Health Net of California
Reviews and Complaints

I'm facing a Coordination of Benefits issue after enrolling my spouse in my health insurance plan, who is also covered under a university's group health plan. By law, a group plan should be secondary, but despite confirmation and numerous calls to the health insurance provider, there's confusion as they incorrectly insist that the university plan is primary, leading to a back-and-forth situation.

Thursday, January 14th: To whom it may concern, please remove my phone number from your calling lists immediately. This includes any harassment, telemarketing, and robocall lists. I expressly do not wish to receive any calls. Legal actions may be considered if this request is ignored. For any necessary contact, email will be the only acceptable method moving forward. Do not force me to repeat this request. Remove my number immediately. Sincerely, an upset customer.

They still have not paid for a doctor visit of mine (in network) from march . I am facing collections..Every call, they say they'll send check. I visited an in network doctor in march . I was billed *** Health net said they would cover but had old address of doctor on file . They had to cancel check, I facilitated new address by requesting doctor billing address to fill out new paperwork. Health net received new address and said they would send another check. The doctor still sends me bills. I call every month and someone from health net says they will send check and it should be resolved soon. It's been 15 months and I have to call with every billing statement to make sure I dont get sent to collections. I dont understand who at healthnet is lagging to send payments. I no longer have healthnet and I do not see that doctor anymore. It is very stressful to still be calling and not even be a member.

I have a condition and had been experiencing symptoms. My doctor prescribed a high dose of medication and planned to transition me to a specific drug, the only one suitable for my condition, as soon as possible while discontinuing the others. In the past two months, I contacted the insurance, medical group, and specialty pharmacies numerous times. The pharmacies wouldn't dispense the drug without prior authorization from the insurance, but the insurance insisted that authorization should come from the medical group, who would pay for the specialty medication. The insurance struggled to resolve this with the pharmacies and attempted to fast-track a formal grievance on my behalf, only to later send a letter denying the expedited process. This bureaucratic tangle has been incredibly stressful and has exacerbated my condition. The treatment delay has led to hair loss, bald spots, bone and muscle loss, joint damage, and more. I am feeling hopeless and frustrated as my insurance fails to assist.

For approximately the last 2-3 years, I have used Health Net of California for my medical insurance provided under Covered California. In anticipation of turning 65 on 01-14-2022 and starting Medicare, I contacted Health Net & Covered California to cancel my coverage. My first attempt was somewhere last October. I requested to have my coverage end on 10/31. When the billing continued, I called again in January to inform Health Net that I had previously requested my coverage to be terminated. To this date, I am still receiving monthly billing from Health Net The uploaded invoice, dated 2/10/2022, has now grown to $***. The monthly premium is $896.16. During my actual coverage, my monthly premiums fluctuated between $50 and $250. I have no idea why the premium increased so drastically after I cancelled. When I first attempted to cancel last October, I was on auto-pay so my balance was $0. When I received my first bill after I cancelled, I went into my HN account and discontinued my auto-pay. My desired resolution is to hear from Health Net that they have stopped my coverage without a balance due. Thanks.

My daughter is unable to see a doctor after having a seizure because of needing to change her PCP. My *** year old daughter had a seizure and was taken to the ER by ambulance. When i called the PCP Health Net assigned to her I was told that they are not accepting new patients. I then found a PCP that was in network and called Health Net to have then change her PCP to the one I found. I explained the situation and urgency of her needing to see a doctor. I was told that the change would take effect immediately and to go a head a schedule her appointment for the next day. The day of her appointment i received a call informing me that the change of pcp was not going to go into effect until November 1st (This is the first week of October) because my daughter had gon the the ER in October and ,as they put it, "received services" they were unable to change her PCP that month and she had to wait till November to see her new doctor! I again informed the Health Net worker i was speaking with of the situation (My *** had a seizure and needed to see a pediatrician immediately) and i was told there was nothing they could do and that I was just going to have to wait till November!

HealthNet Claims are taking more than half a year to process. My mother, a HealthNet Member, is under my representation. She suffered a heart attack in the Philippines and was hospitalized from November 16 to December 17. Currently, she's unable to leave the Philippines due to COVID-19 travel restrictions. We filed a claim with HealthNet and received a claim number in January. Despite numerous calls for a status update, we've faced inconsistent responses. Initially, they claimed not to have received the claim, prompting a resubmission. Later, they acknowledged receipt but had yet to process it. Most recently, they couldn't locate the claim details, though they confirmed something was on record. Each call yields a different narrative. I've asked for updates or notifications regarding the claim, but they only respond if it's denied or additional information is needed. There's no communication during processing, leaving us in limbo. My mother, still in the Philippines, was recently re-hospitalized. It's unclear whether HealthNet's failure to process the claim is due to disorganization or deliberate avoidance, but either way, it's a terrible way to treat a customer.

Unable to get the desired breast pump through insurance, I find it extremely frustrating dealing with the insurance company and the physician network medical group in trying to acquire a specific breast pump. As a nurse practitioner with a demanding job, I need a wearable/portable breast pump for hands-free use at work, such as a well-known brand. Repeated calls to both insurance and the medical group yield inconsistent responses. The insurance company points to the medical group for payment, while the medical group insists it's the insurer's responsibility. The insurance provided two vendor options, neither of which stocks the pump. Despite prior authorization and my willingness to pay upfront, there's no assurance of reimbursement for the costly pump. The lack of clear coverage information, despite pre-authorization and medical group approval, is baffling. Denying a breast pump to a pregnant woman is not only illegal but also forces me to consider alternatives that are impractical for my work situation, potentially leading to formula feeding. This entire ordeal has been incredibly stressful during my pregnancy as I attempt to secure a necessary pump.

The charge for service at California rehab Sports Therapy are processed incorrectly. My responsibility for each occupation therapy should be $15. I have contacted Health Net Billing department(where the claim are processed by Adoc Medical Group)since April regarding the claims for service at California Rehab Sports Therapy. The service dates are 1/28, 2/3, 2/10, 2/17, and 2/24. With my Platinum 90 CommunityCare HMO membership, my responsibility for each occupation therapy should be $15 per service. The claim were processed and ask me to pay $30 for each service which is why I am getting bills from California Rehab Sports Therapy after I made $15 copay for each service. Here is history with billing department: 4/27: Spoke w/ *** 1. Confirmed the copay should be $15 for therapies, will reprocess the claim. 2. Will take about 30-40 Business Days. 5/20: Spoke w/ *** 1. Re-send clarification for $15/copay will take 24-72hrs to reprocess. 2. For service 1/28, 2/3, 2/10, 2/17, 2/24 5/22: Spoke w/ *** 1. Confirmed the clarification of $15/copay. -done 2. *** emailed management to look into the issue yesterday 5/21 why the claim department said it is process correctly. 6/02: Spoke w/ *** 1. Management has not receive response back. 2. Will send another request and call 9030 when result comes back. 6/09 No one anwsers, cannot leave voice message. 6/16 Spoke w/ *** Follow up EOB Status. Pending for call back(no return call as promised)

Health Net Healthy Rewards Program offered incentives for completing certain medical visits during 2021. They sent me gift cards for two visits: an annual checkup and osteoporosis management. On December 31, I received my flu shot. I provided the required information: the date of the shot and selected a gift card valued at $25.00. My mammogram was on July 21; the reward amount slips my mind. There were one or two additional doctor visits I completed, but I can't recall the specifics. I didn't note them down as they were all marked as 'Active' on their website, which I had bookmarked, so I frequently checked their status. When only two gift cards arrived and not the others, I contacted them. They declined to honor their reward program by sending the remaining cards, stating the program ended on December 31. This was despite my timely submissions and selections for the rewards. Upon revisiting their website, I found they had removed all the 'Active' statuses, except for the two aforementioned visits. Being homebound, I rely on delivery services for my needs, hence my choice of gift cards. I completed all required medical visits, except the osteoporosis test, which my doctor deemed unnecessary. I would like the other gift cards for the completed and recorded visits. I met all the requirements for the rewards by the end date of December 31, except for the osteoporosis exam.

Healthnet made an error in coverage enrollment that I am now being responsible for. Healthnet is the contractor for Tricare-West and I wish the DoD didn't subcontract things like this out. Healthnet (along with Humana) constantly makes mistakes and never own up to them. The customer service is terrible. Nothing is ever document properly and you have to continually reiterate your issue to whoever answers the phone. They will always blame the error on someone else and say there is nothing they can do. My current issue with them is that my daughter was moved from the east to west, however was never put on a plan (Prime, Select,etc). I was unaware of this until I took her to the ER ad was later notified I had no coverage. I asked them why she did not have a plan when it was a simple PCS move. They stated it was common for eligible people to not use TRICARE. HOWEVER, I'm an active duty single parent, therefore this is the only medical coverage she has. In addition, its 100% covered by the military. My daughter has been on Tricare since she was born 3 years ago. Due to deployments and PCSs in the last 2 years, she has moved from TRICARE East to west, back to East, and now back to West, with occasional slight issues. But never an error this bad. I am now left with a ER bill but to their error. I submitted an exception waiver, explaining everything and it was denied. Seriously?!?! I don't feel like they read or care what you write on the forms or don't' fully understand the dynamics of military, PCSing, switching medical coverage. One of the reps told me they have some criteria where they automatically deny if you meet one of those, regardless of your justification. I've been advised by my PCM and advocate to contact Defense Health Agency and legal if need be. No one should have to fight this hard for coverage they've earned or fix Healthnet's mistake.

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 Complaintsboard.com says do not include account numbers or member numbers. I would like to give it to Complaintsboard.com 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 Complaintsboard.com and affiliates to help in thses matters aand to use the numbers.

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 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.

Cancellation of policy a month prior with slightly less of a months dues paid and refunded. Im not sure of the actual dates. But all I know is that when I initially got coverage. I asked all kinds of questions regarding late payments, and how its dealt with and so forth. I asked a question about what happens if i fall behind? I was told that with this plan if you fall behind you are given 90 days to catch up. I asked How are partial payments handled, and do they buy me time, meaning like If i pay *** or so towards the plan do I get more time, like does it buy me a few days to a week? I was told yes as long as you are paying something it does buy you time. And I used an example and I elaborated on the example because I know I have been known to fall behind and I did say that to them. And was told that it doesn buy you days. So I was paying some on time and some behind the time, a couple times came close to being 90 days but got caught up or bought me some time. and then this last time I got very close. My monthly premium was about *** and change. i had paid up to *** one month leaving about *** or so unpaid for that month. and if you do some math it was about a day or two that wasnt paid for for the month. And at the time I would have been a little over 60 days past due, not 90 days past. And I was having a hard time because of this Corona Virus ***, (thank you *** My hours got reduced but cost of living remained the same. That drop in the bucket of a stimulus didnt go very far. And I was still behind in rent. Anyway back to the complaint. I was about 2 months behind and was going into the 3rd month when all a sudden I get a refund of close to a months premium. I called in immediately to see what was happening, and thats when I was told that I was 90 days or more past due. I said how can this be especially when I was "buying time." plus it being a day or two without full payment for the month. I should have been added to the next bill which I know it was. And how come in the middle or start of this pandemic would an insurance company cancel a policy that is vital to the persons well being and health. Especially when I was making an effort to pay. And I know that there are some that are not making an effort to pay. Bottom line, Why was almost a full months premium refunded to me? Possibly so they can make the point that I was 90 days past due and cancel me. also I pointed out to them that they tried to say I was more than 90 days past due. And I said not with the last bill I received I wasn't but companies will say they mailed it out and the envelope is still in their hand. But also why during a pandemic they decide to cancel someone who is making an effort to pay? Possibly cause they don't want more people to insure so its less that they have to pay out.

Our credit card was charged without authorization. HealthNet has not provided an explanation. On May-15, I received an email notice that our credit card had been billed by Heath Net. Normally, this is a $652 charge, representing an unauthorized withdrawal. Before the email notification, I attempted to purchase medicine. CVS requested $500 for something that usually costs $15, so I declined. I didn't suspect an insurance issue as we pay the premium monthly in advance. After the notice, I checked online and discovered my account was suspended. On May-15, I contacted Health Net customer service and learned the charge was from Covered CA. We had Covered CA in 2019, then switched to a cash individual policy for 2020. My wife was also on the account in 2019, then moved to Medicare at 65 in August. The representative couldn't identify the charge. I was transferred to a non-working Covered CA line and couldn't speak to anyone. I informed the insurance agent, who was told by Health Net that they needed 2-3 business days to investigate. On May-17, I received a paper invoice for June/2020 titled 'Adjustment' for 'Invoice Correction'. On May 21, I followed up with the agent. She was on the phone with Health Net, who hadn't resolved the billing issue with Covered CA. She mentioned our policy was active again. My wife called Covered CA and learned the charge was for her post-Medicare transfer costs and was advised to file a grievance. I called Health Net and a representative, after a long hold, read the 'Adjustment' for 'Invoice Correction' from the invoice's back. I requested a supervisor. After delays and assurances, I spoke to one, who was unhelpful and couldn't connect me with the 'Billing Team'. Frustrated, I handed the phone to my wife, who was transferred to the 'Resolution Team'. She had to repeat our information and insist on my verbal authorization for her to discuss my account. We were offered two options: remove automatic payments and reverse the charges, waiting for a revised bill, or request a 'Billing Team' review, taking 10 days. We chose the review. The call lasted 1 hour and 44 minutes without resolving the unauthorized charge. I'm contacting Complaintsboard.com due to little faith in Health Net's billing issue resolution. No acknowledgment of our requests on 5-15 and 5-21 has been made by Health Net's billing department.