What to Do if Health Net Denies Chemotherapy Claim

A cancer diagnosis is terrible, but in the modern era, it is not necessarily a death sentence. Cancer treatments have advanced radically in the past few decades. Treatments such as chemotherapy are, unfortunately, extremely expensive. Several years of treatment can bankrupt a family if their insurance does not cover the procedures. Insurance providers that try to wrongfully deny cancer treatments are the lowest of the low. Health Net, one of California’s largest for-profit insurance providers, has a history of dropping policyholders in the middle of cancer treatments and otherwise trying to get around its financial obligations. If you have a policy issued through Health Net and your coverage has been denied, read on for how to respond. Our dedicated California health insurance denial attorneys are ready to help policyholders get the coverage they are owed.

Health Net’s History of Wrongful Conduct

Health Net has been in legal trouble many times over the years for trying to skirt its obligations to pay for medical procedures. For a time, Health Net maintained a practice of canceling policies for sick policyholders in order to avoid continuing payments. In one instance, for example, the company dropped a breast cancer patient in the middle of her chemotherapy treatments. She was left with more than $129,000 in bills and was forced to stop her chemotherapy in the middle of the treatment cycle. The policyholder fought back in a private arbitration proceeding, at the end of which Health Net was forced to pay more than $9 million to the aggrieved cancer patient. Health Net was forced to revise its cancellation practices, and the substantial award prompted other California insurers to do the same.

Health Net has met other lawsuits over the years for similar bad faith conduct. They have faced liability for falsely inflating their list of in-network doctors, only to tell patients after the fact that their physician was actually out-of-network and thus not covered. They have been sued for wrongfully denying coverage for procedures as not medically necessary even after multiple physicians recommended the treatment. In one instance, insurance denial attorney Robert Gianelli won more than $7 million against Health Net on behalf of a client whom Health Net failed to refer to a surgeon in a timely manner, resulting in significant harm.

What if Health Net Denied My Chemo Claim?

If you have had a chemotherapy claim denied by Health Net, you have the right to push back. Policyholders can appeal a claim denial through several levels of internal review, arguing that the reasons for denial were improper or that there was no justification at all. Policyholders can ask for expedited review for urgent matters. Failing that, policyholders can also seek external review so that the insurance provider does not get the final word. Depending on the reasons for the denial, the policyholder can obtain an Independent Medical Review from the California Department of Insurance or seek other external review.

If the denial is upheld, or if Health Net engaged in bad faith practices throughout the claims process, the patient can pursue arbitration or litigation. Policyholders have the right to hold their insurance providers to task for any wrongful conduct, including improper policy cancellations, improper denial, delay tactics, underpayment, and any other shady actions. Talk to your insurance denial and insurance bad faith attorney to discuss your options for getting the medical care and the financial coverage you are owed.

Call For Assistance With a California Health Insurance Claim

If your health insurance claim has been unreasonably denied or if you are dealing with other bad faith insurance issues in California, fight for the coverage you are owed with the help of the passionate and talented Los Angeles insurance claim denial lawyers at Gianelli & Morris. Call for a free consultation at 213-489-1600.