Hartford Courant (Connecticut)
Health Net Inc., one of California’s biggest health insurers, is being sued by a consumer group for using a more restrictive interpretation of “medical necessity” than it stated in materials provided to California public employees.
The Foundation for Taxpayer and Consumer Rights asserts that a Health Net booklet provided to California Public Employees’ Retirement System members said the cost of treatment wouldn’t be considered when determining “medical necessity.” Health Net “covertly” changed the definition to cover only the least expensive therapies, the consumer group said in its lawsuit.
The suit seeks to reimburse union members who were covered under the Health Net plan, starting in 2000. The change especially affected mental health and substance abuse claims, where the choice of treatment options is often “highly personal,” the suit said.