Sept 13 The group representing Los Angeles
doctors has joined with two patients to sue Health Net Inc
for denying claims based on the insurer's definition of
"They are denying these treatments because they are
expensive," said Rocky Delgadillo, chief executive at the Los
Angeles County Medical Association, which represents more than
The lawsuit, filed in Los Angeles Superior Court, accuses
Health Net of unfair and unlawful business practices. The
managed care plan operates mostly in the western United States
and has 2.3 million members in California.
"Medical care is complex, and sometimes there are differing
medical opinions as to what constitutes medically necessary
care," Health Net said in a statement on Thursday. "In these
instances, Health Net carefully follows the guidelines
established by the state of California's two regulators, the
Department of Managed Health Care and the Department of
One plaintiff in the lawsuit, Robert Mendoza, said he was
forced to raise $30,000 from funds set aside for income taxes
and proceeds from his wife's life insurance policy to pay for
surgery for a rare type of prostate cancer after Health Net
denied his request for coverage.
Kalana Penner, the other plaintiff, said she suffered from
debilitating back, neck and head pain for 10 years before being
treated with "occipital nerve stimulation."
The treatment was successful, but Health Net turned down the
33-year-old mother's request for a permanent device. That
decision was reversed last year after the California Department
of Insurance ruled that it should be covered.
"It's been life changing," said she said at a press
conference in Los Angeles. "I was crippled by this disorder."