Health Net Conflicting Information

Julie M.
on 3/8/07 7:19 am - Griswold, CT
I'm wondering if anyone else has had an issue like this....I have Health Net NorthEast, Charter plan.  I work as a Manager for Health Net Federal Services, another subsidiary of Health Net.  Before the surgery, I logged onto my insurance plan information and thoroughly researched what was required for this surgery.  I checked the dates on the plan updates to make sure I had the most recent information.  I followed all the preauthorization requirements.  My Dr submitted the request for the surgery and I received a denial stating that it wasn't covered under my plan.  They listed the exclusion information, but I could not find it anywhere under my account information.  I had put my heart and soul into preparing for this operation, and decided I was going to take the money out of my retirement and have it done anyway.  At the rate I was going, I wouldn't be around to see my retirement anyway, I may as well get some use out of it now!  In the meantime, when I received my denial letter, they sent a cc to a different doctor and a different hospital, with a different surgery date.  They sent it to the OB and the hospital where I delivered my baby, with the surgery date exactly 1 year after my baby was born, rather than my Bariatric Surgeon and the Hospital where he was doing the surgery.   Now the problem with this is that I work with both this hospital and OB on a daily basis in my job.  I am embarassed and feel this is a HIPAA violation.  I am awaiting a decision on my first appeal.  I feel that the odds are stacked against me, and the fact that these additional providers are now aware of a procedure that I had done that they have no business knowing about is a huge privacy violation.  Do I have any recourse in this matter?

Julie

Daniethegirl
on 3/11/07 4:16 am - Chicago, IL
Lap Band on 04/27/07 with
Absolutely a violation of HIPPA. I would call them and inform them of their violation...and then file a complaint. Actually, according to the law, they are supposed to notify you of the violation and act to rectify it themselves, but it doesn't look like they're going to do that...
Most Active
×