Health Net's 'Medical Necessity' Definition OK'd By Judge

Law360, Los Angeles (July 9, 2013, 9:55 PM EDT) -- Health Net Inc. on Tuesday won a victory in a suit by Los Angeles physicians who allege the insurer illegally deprives them of control over patient care, when a California judge ruled that the definition of medical necessity it uses to deny insurance coverage is lawful.

Los Angeles Superior Court Judge John Shepard Wiley rejected the Los Angeles County Medical Association's argument that Health Net's definition of medical necessity unlawfully allows it to deny coverage for individuals with aggressive cancer, neurological disorders and other ailments even...
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