“Whoever you are, whatever your health care needs – We are your Health Net,™” is precisely what one sees on the home page of the Los Angeles-based insurance provider, Health Net, Inc. Being one of the largest insurance providers in the state of California, Health Net is not only responsible for ensuring health coverage that is the right fit for its customers, but also, investigating several residential as well as outpatient treatment centers for possible fraud. This could involve scrutinizing referral practices and verifying medical necessity of services, besides determining if providers failed to collect the required out-of-pocket payments from patients.
However, experts say there are both right and wrong ways of handling patient payments while combating fraud. In recent years, with an explosion in the home care and hospice industry, owing to the Mental Health Parity Act of 2008 and the Affordable Care Act (ACA), which mandated the inclusion of substance abuse treatment within the scope of “minimum essential coverage,” enabling insurance reimbursement, Health Net and several other insurers have been engaging in acts of extracting money using confrontational means to curb what they perceive as fraudulent activity.
In the past, Health Net and its subsidiaries have been exposed in multiple lawsuits for their alleged involvement in unfair and deceitful business practices including deceptive advertising which violates California’s Unfair Competition and False Advertising laws. Multiple complainants have alleged that Health Net intentionally resorted to the use of fabricated and misleading marketing tactics to attract more members.
Further, the corrupt practices of Health Net were exposed by the former City Attorney of Los Angeles, California, Rocky Delgadillo, when he filed a civil lawsuit against Health Net for indulging in unlawful business practices including the creation of units entrusted with the task of finding ways to cancel insurance policies. In fact, research shows that California’s Department of Managed Health Care (DMHC) fined Health Net $1 million on Nov. 15, 2007, for not disclosing information about its program which paid bonuses to employees for rescinding policies. Additionally, in 2008, in what could have resulted in a major identity theft crisis, Health Net declared that it had accidentally posted the Social Security numbers of more than 100,000 doctors from 11 states on its website.
In yet another case of unfair practice, in August 2016, Health Net was busted for suppressing employees from speaking about the unjust company practices. Subsequently, a penalty of $340,000 was imposed on the company after the Securities and Exchange Commission (SEC) determined that it had linked severance payments to non-acceptance of whistle-blower awards. Moreover, even Sovereign Health, an addiction recovery center, in July 2016, filed a lawsuit against Health Net for $55 million, alleging that the insurer has attacked the industry by refusing reimbursements to behavioral health providers for services, impacting the care provided to people who need it.
In wake of the spike in frauds being perpetrated in California’s health insurance industry, it is disheartening that innumerable Californians live under the impression that they are insured when in reality they own policies which actually do not exist. And for the ones insured, the insurance company either won’t pay for their health care or may cancel their policies altogether. Sad, but true, several insurers today are solely interested in maximizing profits, even if it means using unlawful means at the expense of the patients.
Will California’s proposed single-payer health care system solve the problem?
Recently, led by Democratic Sen. Ricardo Lara, who believes that health care is a right for all citizens, the California state Senate passed a single-payer health care proposal authorizing the state to cover the healthcare costs of all Californians without the out-of-pocket costs. The move has infuriated business interests, fascinated liberal activists and overturned the political landscape of the country. If the bill ever comes into force, California would become the first state in the U.S. to enact universal health care coverage. The government seeks to replace private insurance companies, paying doctors and hospitals under a single-payer plan.
The single-payer plan differs from a public option, where the government offers an alternative to the existing insurance plans available in the market. In this case, the government would effectively step into the shoes of the insurance companies, paying all the health care bills. “Despite the incredible progress California has made, millions still do not have access to health insurance and millions more cannot afford the high deductibles and co-pays, and they often forgo care,” argued Lara while debating in favor of the proposal.
Worldwide, several countries such as Canada and the United Kingdom, have a robust single-payer system catering to the health care needs of their citizens. However, in the U.S., despite repeated calls for a similar system in the past, the cause gained momentum during the 2016 presidential campaign of Vermont Sen. Bernie Sanders, who insisted on a health care system, on the lines of the existing program, for senior Americans aged 65 and older.
The recent proposal echoes the sentiments of Sanders’ campaign as well as the California Nurses Association (CNA), who have long rallied in favor of a single-payer plan. Nevertheless, the proposal is a step forward for those seeking a broader blanket of medical coverage, even though it might be contrary to President Trump’s agenda. Although, the fate of Lara’s proposal is undecided, it will be forwarded to the State Assembly for further action. But, Republicans in California have opposed the bill citing reasons such as unaffordability.
“We simply cannot afford it,” said the Republican Sen. Tom Berryhill in the California state Senate. “Healthcare belongs in the private sector and should remain out of the hands of the government. I absolutely don’t trust the government to run our health system.”
Addiction is a public health crisis in America
There is no doubt that times are changing but, unfortunately, there is still a huge stigma attached to addiction particularly when it is capable of causing a great deal of harm. Addiction has long been viewed as a sign of moral weakness or a flaw; in fact, many people still see it that way. However, evidence-based scientific research tells us that addiction is a chronic disease similar to asthma, high blood pressure and diabetes with comparable relapse rates. When diabetic patients have a relapse, doctors do not hesitate in updating and reinforcing treatment. The same should be done in the case of addiction treatment, as well.
Unfortunately, most individuals fall prey to an addiction more quickly than they might ever realize. The only way to break free from the clutches of deadly substances is to undergo a specialized treatment for addiction at a professional drug addiction rehabilitation center.
Sovereign Health understands the plight of someone who is unable to discontinue the use of harmful substances despite its negative impacts on his or her life. Our customized addiction treatment services at Sovereign Health of San Clemente are designed to treat the person holistically.
If you or your loved one is battling an addiction to any kind of drug or alcohol, call our 24/7 helpline number or chat online with one of our representatives to know about the most effective drug addiction programs at our ultramodern centers.