Are you paying Health Net high monthly premiums for a PPO policy now based on Medicare/Medicaid reimbursement rates? Are California's out-of-network addiction treatment facilities no longer willing to admit your loved one for help?
If so, please let Insurance Commissioner Dave Jones know your concerns by signing this letter.
You find information about how to also file an additional formal complaint directly with the California Department of Insurance by clicking the link below
ATAC's mission: To provide political and legal advocacy, education and consumer protection in the field of addiction treatment.
For more information, please visit www.atac.org
Dear Insurance Commissioner Dave Jones:
I am writing to better understand my rights with the insurance policy that I purchased with respect to substance use treatment. A policy that I purchased indicated one set of benefits for out-of-network substance use disorder treatment that now seem to be no longer valid.
I am being told that I am required to pay thousands of dollars for treatment already provided because there has been a change in reimbursement rates for my Health Net PPO policy. Can the substance use treatment facility actually charge me? Had I known that the out-of-network benefit had substantially changed, I might have sought another insurance policy during open enrollment but now I did not have that option until the next open enrollment period.
Should I have been notified by Health Net of a change in my benefits for substance use treatment? Why was the substance use treatment facility not aware of the change in reimbursement? Who was supposed to notify me? The substance use treatment provider is saying they were not notified of the reimbursement rate change and it is being implemented retroactively. Is that true? The substance use treatment provider also said Health Net is paying Medicare rates, if that is true why is my premium so high?
If my insurer did not notify me of this substantial change in substance use treatment benefits, with no corresponding reduction in premium, what is my recourse? I pay thousands of dollars a year in premiums each year and then when I want to use a particular benefit I discover it has been reduced? Worse, I cannot change policies until the new open enrollment period?
Clearly this situation is placing a financial hardship on my family. What can the Department of Insurance do to help me, or can you direct me to the appropriate entity for help.
Family Members of our loved ones