Health Net Health Net Ruby 4Medicare Advantage insurance Medical insurance company will rip you off, and they don't care! Nationwide
My Medicare Advantage insurance thru Health Net, canceled me for late payment AFTER I had called and let them know it was gonna be late, and was told that it was OK. I was canceled anyway, and upon calling was told that's just how it is. They were very nice on the my first call and very RUDE on the 2nd call. I found an old letter from them stating they would cover one of my meds, prior authorization, from 2015. But they haven't been, I've been paying for it. Luckily I have used discount cards (some I had to buy) due to this med is pretty expensive. There have been several months of each year that I DID NOT get it filled cuz I couldn't afford it. So I just went without it. When I contacted the company, HEALTH NET, I was transferred to several different people. The final person (who already knew the situation before speaking with me) stated it was covered, and had been covered the entire time. When I would get it filled, the pharmacy would always tell me it was NOT covered by my insurance, and did I still want it. HEALTH NET says it was covered, they don't know why I was told it wasn't, and if I went without it THAT WAS MY FAULT! Said I should contact my pharmacy and ask them why I was told differently. The final person I spoke to was VERY RUDE AND UNCARING. He offered no assistance at all. I wouldn't have been told, monthly, by the pharmacy that it was not covered when it was. The pharmacy "ran it" every time before filling, and every time I was told the same thing!! I'm disabled and on Medicare. But I'm not stupid!
2 Updates & Rebuttals
Health Net Ruby 4
#3Author of original report
Wed, July 05, 2017
My prior Auth is good from 3/30/2015 thru 12/31/2039. So I do not need to get a new one every year. Anytime I call any company about any issues, I always remain calm and I try to be pleasant but sometimes I'm a little short and curt. I do not cuss, yell, scream on the phone because it serves no purpose. I'm upset at the company, not the individual employees. So there was no reason for him to be rude. Yes my pharmacy ran my refill every month and told me the same thing every month. How would they get all of others correct and not just that one AS far as payment, payment was made for 1 month on the 28th of that month, and it was canceled 3 days later. It was not 2 months past due, I owed for 1 month only. Even after they saw it was thier mistake, the woman said oh well it can't be reversed. I called another person who told me that they would only accept a request for it to be redeterm if I payed for 2 months first... But she advised against it cuz she told me she had never seen them reinstate anyone. Unfortunately, I am back with them because I have no other affordable plans in my area. Which is why they think they can do whatever they want. I suspect you work for them. I don't need anyone to explain the policy to me, and I find that insulting. I prob have a higher education than you do. I do however expect if I talk to a company, for them to honor what I had been told... Correct or not.
Medi
Alabama,USA
How to file a Medicare Advantage Appeal or Greivance
#3Consumer Suggestion
Wed, July 05, 2017
Ok,
You need a broker or advocate, because you don't understand the process.
For a Medicare Advantage plan to disenroll you you must have not paid for 2 consecutive months.
You may have received a letter telling you they will disenroll you if you don't pay by the end of the second month. If you aren't there yet, pay and keep your coverage.
Your Healthnet plan in Cochise county is $29 per month. The only other option there with Drug coverage is $166. IF you can even get it because unless you have low income, under $1500 per month, you won't qualify got a special election.
They cannot disenroll you until the last day of the second month. Calling them and telling them you'll be late dosent matter, their grace period is 2 months, no longer.
In regards to your drug claim issues, it sounds like your pharmacy isn't calling into the PBM to verify your formulary exception. If your exception is from 2015, you must have your Doctor request it again, every year, if this hasn't been done, they won't pay.
If HealthNet member services is telling you the exception is active, the pharmacy is not doing the work to verify it, find a new pharmacy.
When calling Member Services, if you are angry, impolite or hostile and cursing, they can and will hang-up on you or be hostile right back and are well within their contract with Medicare to do so.
Stay calm, get names, dates and times and tracking numbers.
If you do indeed have an exception on file, you can submit all your receipts for your prescription for reimbursement. If they say no, you can file an Appeal. If they say they will pay, but will not you have a Greivance.
https://www.healthnet.com/portal/shopping/content/iwc/shopping/medicare/file_ag_med_adv.action