Health Net Accused Of Misrepresenting Its Doctor And Hospital Networks

SANTA MONICA (CBSLA.com) — An actress claims Health Net's "bait and switch" tactics forced her to pay $12,000 out-of-pocket for cancer treatment, an accusation echoed by at least two more women who are part of a class-action lawsuit against the insurance company.

The lawsuit, which was filed late in 2014 and will receive an initial hearing by the Los Angeles Superior Court later this month, accuses Health Net of misrepresenting their physician and hospital networks. According to the advocacy group Consumer Watchdog, Health Net has the fewest doctors available to its enrollees of all the leading insurance companies in California in 2014 and has made further reductions in 2015.

Health Net's limited hospital and doctor network forced Heather Brianna Womick, an actress, stunt performer and professional dancer, to seek a surgeon outside of Health Net's network when she was diagnosed with breast cancer in early 2014 and had to undergo a double mastectomy, according to Consumer Watchdog.

Womick, one of the two plaintiffs listed in the class-action lawsuit, said of eight different surgeons on Health Net's list of "in-network" doctors, six did not accept her health plan, one was on maternity leave, and the last specialized in rhinoplasty, not breast reconstruction.

"I was contacting these surgeons, and one after the other kept telling me, ' Yeah, we're listed in-network, but we actually won't take your insurance plan,'" Womick said.

Because 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, Consumer Watchdog officials said.

"Many folks were looking to make sure specific doctors were under this plan, and the health insurance companies said, 'yes, yes, yes, they're all in, yes' and then only after folks have enrolled and they seek treatment that they find that the network's too small or that the specific doctor they thought was in is not in and often its not till they get the bill in the mail," attorney Jerry Flanagan said.

"Health Net strives to provide access to quality medical care and help our members navigate the health care system," the insurance company said in a written statement.