The Los Angeles County Medical Association and two patients have filed a lawsuit against Health Net of California (PDF), accusing the insurance company of implementing "a defective utilization management process" to deny payment for medical procedures it deemed unnecessary.
According to the complaint, Health Net considered the emergency radical prostatectomy recommended to plaintiff Robert Mendoza was not medically necessary, nor was the implant of a nerve stimulating device suggested to plaintiff Kalana Penner. Mendoza and Penner underwent the respective procedures, which effectively treated their conditions.
"Once again, we see a health insurance company putting profits ahead of patient health and lives," Rocky Delgadillo, CEO of LACMA and the former Los Angeles city attorney, said in a news release (PDF). "By deciding which medical treatments are necessary and which ones it will cover, Health Net is dictating medical care from the boardroom. Patient care should be decided by doctors, not business suits."