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L.A. County Medical Association sues Health Net over payment denials
Modern Healthcare

The Los Angeles County Medical Association and two patients have filed a lawsuit against Health Net of California, 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.