Complaint / review text:
I have been a subscriber to HealthNet insurance plan for 5 years. The insurance covers myself and my three year old and I am employed part time so my premiums are fully out of pocket at the rate of almost 13,000 per annum.
My son was diagnosed with speech and sensory problems (Aphasia and Spensory Porcessing Disorder) at age two. My state mandates that children receive early intervention from Birth to Three and that insurance also pay for those services. We paid on a sliding scale and Healthnet paid for the services my son received for speech and occupational therapy.
Healthnet paid this until the day my son turned three (when the state mandate expires) and refused all speech claims from the point he turned three. My son was seen by a Yale pediatric neurologist and diagnosed with Aphasia and was given a prescription for intensive speech therapy
Healthnet has refused to pay for any speech, using a fallout that my son would have had to acquire and then lose speech (for instance by having a stroke) in order to get speech therapy. My son never got the chance to acquire proper speech, hence the speech delay and the need for therapy.
I initiated an internal and an external appeal. I made numerous calls and was told everything from they only paid it when he was two because they had to by law, to just keep submitting claims and see what happens - a veritible dice roll with my son's claims.
My appeals were denied for the same clause that he had to have a stoke or accident in order to get the 30 promised speech therapy sessions in my handbook from Healthnet.
I started an appeal with the State Insurance Commissioner and was told that Healthnet was not consistent in their reasoning for the denial but that the Insurance commissioner was not optimistic about Healthnet coming through for my three year old.
Healthnet discriminates against children with disabilites - how else could we explain the fact they paid the claims for the year they had to as governed by the State and now refuses to honor their policy of paying for 30 speech sessions per year.
We are forced to pay 13k for insurance and 150 per hour for private speech. We are unable to do this. We are unable to help our child get the help he needs and we are completely let down by our insurance company who has no caring or concern what their loose interpretation of their policy does to the health and well being of a three year old child who needs speech therapy and occupational therapy as a medical necessity. We are considering moving, refinancing or anything in order to get our child what the doctors say that he needs.