Settlement allows Health Net CA members to seek refund for out-of-network claims of 2014 - Sovereign Health Group
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06-01-18 Category: Addiction

Settlement allows Health Net CA members to seek refund for out-of-network claims of 2014

California state residents registered for an individual or family Health Net Preferred Provider Organization (PPO) health plan in 2014 and still bore out-of-pocket expenses during the year for medical services provided by an out-of-network medical professional due to inaccurate information received from the insurer can submit a claim to seek reimbursements. The development comes following a recent class action, resulting in the settlement. The settlement will be valid only in the case of PPO plans purchased by individuals and families in 2014, and not employer-provided health care plans. It applies to charges incurred from out-of-network doctors, and excludes hospital, facility, or lab charges.

The settlement was the outcome of a lawsuit filed by class representatives (on behalf of others who have similar claims) Rebecca Lehman and Heather Womick against Health Net of California, Inc., in the Los Angeles County Superior Court in December 2014. The plaintiffs and Health Net entered into a settlement agreement to save time and money while addressing the concern over the uncertainty of litigation. Now, the court will hold a final fairness hearing on July 12, 2018 to decide whether to approve the settlement.

Insurance woes

Health Net often remains in news due to one controversy or the other or for causing inconveniences to people who opted for insurance coverage through it. There are numerous instances where Health Net refused to reimburse the claims presented by behavioral and substance abuse treatment providers, jeopardizing the ability of rehabilitation centers to continue providing professional care and treatment to the suffering and need, especially during their darkest hours.

In the wake of such a crisis in the federal health care system, the 2017 report of Mental Health America (MHA) suggests over 40 million individuals across the U.S. struggle with a mental health problem, out of which 56 percent still don’t receive any kind of professional support or treatment.

Ranging from behavioral problems such as bulimia nervosa, anorexia nervosa, gambling addiction, or sex addiction to dependence on illegal drugs, prescription opioids and alcohol, millions of Americans hit rock bottom each year. Their brains are modified by chemicals that trigger compulsive drug-seeking thoughts that force substance users to resort to any means to seek the forbidden substances.

Sadly, only less than 2 percent of victims seek help to regain control of their lives. Addiction leads to distinct thinking patterns in its patients, which enables them to continue abusing drugs despite the negative outcomes.

Coping with substance use disorders

Experts say physical and psychological cravings give rise to destructive thought patterns which are common to many who are dependent on drugs. As a result, they are unable to process long-term consequences that leads to distrust in relationships and social isolation which is aggravated by the ongoing cycle of addiction. Nevertheless, seeking professional services of a reputed treatment provider is critical to regain control of life and repair the drug-induced damage.

The stigma attached to addiction, particularly when it is capable of causing a great deal of harm, prevents people from seeking professional help. Studies show that mental and physical health hazards arising out of addiction tend to assume many forms, making it tough to ascertain how to collectively treat them with a single method. Many people have concerns over multiple manifesting health symptoms, but the complex nature of these conditions prevents them from expressing what they are going through due to the fear of being misunderstood or ridiculed. Unfortunately, there are so many people grappling with addiction and yet, they are not willing to disclose their conditions due to the attached stigma and shame.

If any misconceptions or myths surrounding addiction have prevented you or your loved one from taking addiction treatment, contact the Sovereign Health of San Clemente, which offers a variety of personalized therapies for addiction to treat patients holistically. The specialists at our state-of-the-art addiction treatment centers are trained to identify the underlying causes and prescribe the right treatment for addiction as well as group psychotherapy based on individual requirements.

Additionally, patients can also seek alternative therapeutic activities to embark on their journey to sobriety. If you or your loved one is battling depression, call our 24/7 helpline or chat online with our representatives who are available for your queries.

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