Health Net CA PS Patients who were denied

The most recent update on the class action suit against Health Net for ignoring CA law and denying requests for reconstructive surgery:

On May 16th, the judge in the case denied Health Net's disingenuous request to have the suit dismissed and ordered written discovery.  That means that Health Net is going to have to produce records of cases in which their insureds requested coverage of their reconstructive surgery and were denied, and in particular, where Health Net illegally used a "lack of medical necessity" reason for denial.

If you have submitted for reconstructive surgery and have been denied by Health Net since 1999, please send me a PM with your email and telephone contact information and I will put you in contact with the attorney in this case.  This includes the situation where Health Net may have approved one procedure but denied other procedures, or where they refused to cover what your PS said was appropriate for you but approved a different (and lesser) procedure.  I want to keep Health Net honest -- if we identify patients they should have included in their answers to written discovery but didn't (don't ask me why I suspect they might do this!), we may be able to get sanctions against them.

Greetings, Counselor- long time no see at least on a personal level with you and that charming husband of yours. Been meaning to drop you a line this week, but here and now is as good as anywhere. I had a most productive meeting with Rob, the lead on your your cited case who made a point to be down in Irvine on my behalf and some needed work in the area. Grateful, I didn't have to make the drive to LA. Would certainly have made the effort, though. I walked into an large all glass empty court reporting office finding him seated on a vast expansive conference table typing on a newly purchased MacBook Air, the thinnest fully functional laptop that exist in the world today. As Mac fan I was already duly impressed. You are overdo to make the switch as much as you seem to travel. **Smirk** Well, that and the fact he's almost totally bald like yours truly. Seriously, though, he was very thorough and well informed on the issues. Advised me appropriately pursuant to private right of actions that I would be waiving. No biggie there as I already knew as much and he had only recently discovered or someone reminded him that the statutes had run on those torts and I would have ethical issues making a case in my cir****tance anyway. Dashed forever might be a cause of action pursuant to a loss of consortium. Poor me. Is the good woman at home listening ? **Grin LOL** He's invited me to be the lead class representative against the largest insurer in California and I agreed. Don't know if naming them is appropriate at this time so I won’t. No real downside to me here (or anyone else wanting to participate) as there is little to nothing I need do but sit and wait out the outcome) unless the unlikely event I am served Rogs and/or get Deposed. Call me crazy and I am, but I would love that opportunity. Case gets filed late next week and I have asked for copies of some of  the work product. Without the "medical necessity" issue, I GUESS my case is as good as any but for the questionable "Abnormal Structures" interpretation that likely will be key. You know, I have said before, but part of me feels you missed your calling as a litigator. But the fact that your expertise requires attention to the minutia that must be inherent in patent law structured in the highly technical area of the biosciences is probably why we're here. The fact that NO ONE seems to have found this obscurity in this 1999 statute but you is remarkable on it's face!!! I plan to look for myself, time permitting, but if and when you get the time. I would be interested in your analysis of the legislative Hx/ Intent of the statute. And to those of you who here in CA who were DENIED your reconstructive and plastic procedures based on a "Medical Necessity" requirement in recent years, (NOT, just with Health Net alone)  please contact Diana or myself so that we might help with this, your injustice, and get you on board. Its not at all too late but do so like NOW! Forever and deeply grateful, Diana  (How's that for total Saccharin sap.)  But heartfelt never the less! Rock          

I just had to buy a new personal laptop.  I was afraid to even TOUCH the MacBook Air -- afraid I would bend the case just by looking at it.  I regularly drop my laptop -- I need something made of reinforced titanium and steel, even if it's heavy.  Le Sigh. Largest insurer in CA?  Do I get three guesses, and the first two don't count?  And Woo HOO that case number 2 is being filed already!  I thought Rob was going to wait to see how the case against Health Net worked out first (make all the mistakes in that case ...) before going after the really big boys.  He must be REALLY confident of the outcome if he is ready to take on the Big Cash, Bad Scammers already! I agree that the insurance companies are HOSED if they try to stick with some type of limited construction of "medically necessary."  The statute and legislative history could not be more clear -- there is NO requirement for medical necessity in the CA statute AND the legislative history demonstrates that the phrase was added in and THEN REMOVED, demonstrating the legislative intent to EXCLUDE medical necessity from the analysis. Here is the site for legislative info: http://www.leginfo.ca.gov/index.html Here is the site for the bill: http://www.leginfo.ca.gov/cgi-bin/postquery?bill_number=ab_1 621&sess=9798&house=B&author=figueroa  Look specifically at the amendment of 8/5/98 (exactly 5 years to the day before I had my DS). Send me an email at my home address (I am currently working off a borrowed laptop and don't have access to my email address book) so I can tell you about something else entirely.