LA Doctors Say Health Net Denies Coverage For Sick Patients

Law360, New York (September 14, 2012, 2:54 PM EDT) -- A 6,000-member association of Los Angeles physicians on Wednesday sued managed care company Health Net Inc. for allegedly using an unlawful definition of medical necessity to deny coverage for individuals with aggressive cancer, neurological disorders and other ailments.

Highlighting the increasingly prominent tension between cost containment and patient well-being, the complaint brought by the Los Angeles County Medical Association accuses the insurer of ignoring recognized legal principles that state coverage can only be refused if it’s obvious that a physician’s recommendations are unreasonable or out of...
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