Health Net

I've had Health net for four years now. At first I really liked it. Last year, odd things started happening with the coverage of my medical claims. My primary care doc wasn't paid for my 1st visit, the EOB stated it went to my deductible: I have NO DEDUCTIBLE for physician's visits. It took me 5 months, many phone calls, and finally a written appeal in order to get Health Net to pay. Three therapy visits were suddenly denied although I had pre-authorization for them; after 2 calls I wrote a formal appeal and then the cost was paid, WITHIN A WEEK! In January 2019, the pattern repeated, plus got worse. Labwork (no copay for me) wasn't paid. Billed for the full amount. No reason given on the EOB. An x-ray ($5 copay) wasn't paid for, I was billed $174 for it. EOB said it went to my deductible - I have NO DEDUCTIBLE FOR THIS OR LABWORK! It took 4 months, 6 or more calls, and finally filing a formal grievance to get H Net to pay the benefits I'm entitled to. I had imaging tests in the next 3 months; not one of those were paid correctly until I called and made a complaint. Currently, I'm appealing charges for physical therapy, which is SUPPOSED to have a co-pay of $35/visit. Instead, HNet shows I owe a co-insurance, owed by me for every single thing done at PT, instead of the$35 copay for the visit. Starting the appeal process tomorrow. In addition, they won't accept my expedited appeal for a medication I need that was prescribed by specialist, even though I'm allergic to the 2 drugs they require I trial before they cover the medication I need. It makes me wonder if Health Net is trying to drive me off so I will seek another plan. I've pretty much memorized the plan benefits and appeals process by now, and have even filed a grievance over how long some of these problems have taken to resolve. I spend about 4 hrs per week on the phone with the representatives, who are very pleasant, but they don't get things fixed. I will be filing a "Quality of Care" concern with the Medicare Oversight unit soon about Health Net's frequent failures to pay Do I pay anything for my Health Net Advantage Plan? No. Do I expect Health Net to cover my services as their Evidence of Coverage Book states I'm entitled to? Yes. I'm shopping for a better company this year.