Health Net and Angeles IPA’s Insufficient Networks Cause Permanent Injury to Member
By Scott Glovsky on October 17th, 2018 in Insurance, Insurance and Healthcare Denials, Insurance Bad Faith
Health Net and Angeles IPA’s Insufficient Networks Cause Permanent Injury to Member Causing Him to Lose Sight in One Eye, Law Offices of Scott Glovsky Lawsuit Alleges
CLAREMONT, Calif., October 16, 2018– Scott Glovsky of The Law Offices of Scott Glovsky filed a lawsuit in Los Angeles Superior Court on behalf of Jose Nunez accusing Health Net and its contracted medical group, Angeles IPA, of bad faith, negligence, and breach of contract.
In August of 2015, Jose Nunez needed urgent eye surgery and each time he had set up the surgery with in-network providers, Health Net and Angeles IPA would shift Mr. Nunez to a new doctor or refuse coverage for the doctor’s surgical center, he alleges in a new lawsuit. Health Net and Angeles IPA’s actions, he alleges, caused a nearly three month delay. As a result of the delay, Jose is now permanently blind in one eye, a result that was completely avoidable had Health Net and Angeles IPA not delayed care.|
Jose alleges that his problems getting care from Health Net are not an isolated occurrence but part of a larger systemic issue. Health Net knows and knew that it did not have sufficient specialists and surgical centers within it and its medical groups’ provider networks. In March of 2017, Medi-Cal performed an audit and found that Health Net “did not maintain an adequate number of specialists within its network.” It also found that “member grievances on referral for services and availability of appointments with specialists were among the highest complaints.” By keeping its network small, Jose alleges that Health Net has been able to record billion dollar profits for insurance plans like Jose’s. However, because of insufficient provider networks, Jose and other members have been unable to get medically necessary care in a timely fashion leading to severe injuries which in Jose’s circumstance has meant total and irreparable blindness in one eye.
It is Jose’s wish that through this case Health Net and Angeles IPA will begin to reform their system and put in place policies that will assure that Health Net members can access the medical treatment that they need in a timely fashion.
This case is Jose Nunez v. Health Net, Inc. et al. You can view the complaint HERE.
About The Law Offices of Scott Glovsky
The Law Offices of Scott Glovsky has spent over a decade protecting policyholders from insurance company abuse. In both individual and class actions, the Law Offices of Scott Glovsky has fought for consumers to protect their rights when insurance companies act in bad faith and put their own profits ahead of the rights and interests of their insureds.
