From Jim Gilliam's blog archives
Health Net routinely denies claims and treatments

January 10, 2006 3:14 PM

Consider this a warning. If you have health insurance through HealthNet, you should consider switching to another provider if you can. You may think you're covered, but they do whatever they can to not only deny your claims, but delay approval for treatments your doctors say you need.

If switching is not an option and they are stalling or refusing approval for your treatment, get a lawyer and have him/her contact Health Net on your behalf. Things will move along much faster.

More from the archive in Health, Lies and Deceit.

Health Net routinely denies claims and treatments (01.10.2006)

Next Entry: I'm on the lung transplant list!! (01.11.2006)
Previous Entry: Independent: Outfoxed one of twelve best open source projects (01.09.2006)

Read the 12 comments.


Fuck the man.

Congrats Jim. :-).

Tue Jan 10 2006 6:16 PM

Aug K:

I hope Michael Moore's new film about the health care and drug industry addresses these problems. If not, then it should be the next project for Brave New Films !

Tue Jan 10 2006 6:50 PM


Oh crap. (me, not you.)

Thu Jan 12 2006 7:28 PM


I like Health Net, its too bad things haven't been going your way with them.

Sun Jan 15 2006 1:34 AM


After years of declining coverage, rising co-payments, and deceptive and rude representitives (this means you Sonya J.), I have finally broke free from the evil that is Health Net. The straw that broke the camels back?: Not being allowed to speak to a manager upon repeated requests. I was outright refused by one representitive. When I called back the next representitive told me she sat across from the previous representitive that I had spoke with and she wouldn't transfer me either. These people are wackos.

Thu Feb 2 2006 10:29 PM


I am dealing with these idiots too. I am seeing a doctor for cancer treatment who is out of network. They are not covering him calling him alternative because of the name of his practice. I have filed a grievance. NOTHING is covered with this stupid insurance!

Fri May 5 2006 6:26 PM


I am dealing with United Health. Who after 3 denials for coverage for simultaneous following bi-lateral mastectomy reconstruction after breast cancer there most recent reason for denial is on United Healcare letterhead,

"we are not the inurer of your policy" and, "This is an ERISA policy so it is not subject to state laws."

It took 8 months of agony and battling and jumping through all of their hoops and meeting their requirements, only to have them change the rules every time I was able to substantiate my claim. Now they finally pull this one out of their but..."they are not the insurers of my policy." Why didn't they fess up to that in the very beginning instead of stringing me along and provide honest health CARE coverage.

In the process of battling for coverage I ended up going through with the surgery because I was BRAC2 gene positive and had an 85% chance of recurrance, not to mention the recommendation and backing of all of my oncologists who found suspicious areas on MRI. The pathology report from the mastectomy showed that a new primary cancer developed.

They are thieves and criminals.They stole a precious year of my life and perhaps many more.
I wrote my story to Michael Moore.
I want the media to expose what the insurance companies are doing to Americans.If anyone out there knows of any groups coming together with the goal of taking this further please don't hesitate to email me. [email protected]

Thu May 25 2006 7:24 PM


Sorry, my first paragraph of the previous post is a mess and should have read...

I devoted 8 months of battling insurance and after 3 denials for coverage for bi-lateral mastectomy with simultaneous reconstruction after breast cancer, they just repeatedly denied me. They would not cover the one type of reconstruction I am a candidate for which is microsurgery and not available in my state. Any true microsurgeon who really specializes in this procedure (DIEP flap- deep inferior epigastric perforator flap) is out of network. There are only approx. 12-15 in the country who specialize in this. there most recent reason for denial is on United Healcare letterhead,

Thu May 25 2006 7:32 PM

Deborah Weiss:

This is a HealthNet complaint. My 17 y.o. daughter had major knee surgery. My plan states that we have unlimited physical therapy services. HealthNet now works with OrthoNet, an evil company that doles out rehabilitation services in small increments until they ultimatly deny services. My daughter has two orthopedic surgeons and two physical therapists who are treating her. OrthoNet has denied PT services despite the fact the both doctors and physical therapists say that she needs to have continued services. We are in the process of appealing and losing valuable time.

Thu Nov 16 2006 4:50 PM

Diep denial:

I received a denial for DIEP from Blue Cross and Blue Shield of Arizona. They say that TRAM is good enough. I am undergoing bilateral reconstruction and no plastic surgeon will do a TRAM on me. They are forcing me into implants -even though I had radiation therapy - or come up with $100,000 to pay this on my own. This is a nightmare.

Sun Nov 26 2006 11:15 AM

Ex Orthonet Executive:

Orthonet is a circus. The CEO, Roger Shedlin, would sell his mother to make a buck. Big shyster. Serious doubts about his credentials.

Tue Jan 9 2007 1:36 PM


Ex-Ortho Exec:

Can you elaborate?

Fri Jan 26 2007 12:42 PM

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Jim Gilliam


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