Investigation into Inaccuracies in Health Net’s Provider Directory

December 24, 2014

Attorneys with Gibbs Law Group are investigating consumer complaints about Health Net’s provider lists for Arizona healthcare plans offered under the Affordable Care Act. Some consumers in Arizona are reporting that they looked at the Health Net website’s list of doctors and hospitals to see if they would be covered in network, but when they went to make appointments they found out that their providers were actually out of network.

Consumers may be harmed by inaccurate information about provider networks

Under the Affordable Care Act, also commonly called “Obamacare,” individuals who do not have health insurance from their employer or other sources can sign up for health insurance through marketplace exchanges. Many of these health insurance plans have federal subsidies to help consumers pay for their policies. Policies from the healthcare exchanges are administered by private health insurance companies, including Health Net.

Many health insurance companies, including companies that provide Affordable Care Act marketplace exchange plans, provide no coverage or less coverage for doctors, hospitals, and other medical care providers that are not in network. Members who see providers that are out of network may have much higher medical bills than if they had seen an in-network provider. Therefore, it is very important that consumers know which doctors, hospitals, and other providers are covered under the health insurance plan that they select.

Consumers who are given inaccurate information about providers may select a plan based on inaccurate information, when a different plan would have covered their doctors. Consumers who are given the wrong information by their healthcare insurance companies about whether their doctors are covered under their plan may mistakenly make appointments with doctors and hospitals that are out of network for their plan, only to get medical bills that are much higher than they would be if they had seen a doctor or hospital in network.

Consumer complaints about the Health Net website’s wrong provider information

An Arizona Republic reporter, Ken Alltucker, said that he has heard complaints from consumers about Health Net of Arizona plans. According to Alltucker, “they’ve gone to the website of Health Net. They see their doctor listed in the directory, but when they try to make an appointment with the doctor, they learn that he’s not in network or she’s not in network.”

In the Arizona Republic news article, Debra Mulligan, a resident of Rio Verde, Arizona who signed up for Health Net, stated that she chose Health Net because of the providers listed on Health Net’s website, but when she enrolled in Health Net those same providers told her that she could not see them. Ms. Mulligan states: “It’s as if you’re tricked into thinking there are doctors and there aren’t.”

In another Arizona Republic article, Jean Kilien, an Arizona consumer who is insured by Health Net, said that she chose Health Net because the company listed her preferred doctors as being in network, particularly her doctor at Spectrum Dermatology in Scottsdale, Arizona. When she signed up for Health Net and made an appointment, however, she found out that her provider was not covered. According to Ms. Kilian, “they said we take the ‘real’ Health Net but nothing through the marketplace.”

Consumers say they have had difficulties finding an in-network doctor for their Health Net plans

Consumers have reported that they have had difficulty finding a doctor that will accept their Affordable Care Act Health Net plan in Arizona. Joan Gray VanderLaan is a consumer in Arizona who has pre-leukemia and selected her Health Net plan because she believed that it allowed her a choice of oncologists and hematologists. When she tried to find a doctor to refill her chemotherapy prescription,she had difficulty finding anyone who was in network for her plan. She stated, “Health Net looks terrific on paper, but they don’t deliver the goods. I’ve had a lot of difficulty finding a provider.” Ms. VanderLaan said that she almost gave up when she could not find a doctor that was covered by her plan after calling 30 doctors, but she eventually found a doctor who she hopes will be able to treat her. Ms. VanderLaan also said that she has a lot of bone pain and that her difficulties trying to find a doctor who would treat her under her Health Net plan caused her to experience depression.

Complaints to the Arizona Department of Insurance about Health Net

According to the Arizona Republic, 89 of the 110 complaints filed with the Arizona Department of Insurance since January 1, 2014 were about Health Net. Consumers complained to the Arizona Department of Insurance about Health Net’s network of providers being inadequate, having difficulty getting medical care, payments not being properly processed, and policies being wrongfully cancelled.

Our experience in healthcare class action lawsuits

Attorneys with Gibbs Law Group and Gibbs Law Group successfully brought a class action case on behalf of Blue Shield members that resulted in a $6.5 million cash settlement for the class. Gibbs Law Group has two pending class action lawsuits against Blue Shield, one involving insurance deductibles, and another case involving alleged inaccuracies in Blue Shield’s provider lists.

The firm also successfully brought a class action case against Health Net involving a data breach. A judge granted final approval of the Health Net data breach class action settlement in 2014.

Are you a member of Health Net? Were your misled about whether your doctors were in network? If you are a member of Health Net who was misled about whether your doctors, hospitals, or other medical providers were covered by Health Net as in network, speak to one of our consumer attorneys now by calling toll-free (866) 981-4800 or by filling out the form to the right.