Health Net investigated for denying coverage to poor kids

November 19, 2007

Health Net of Connecticut is being criticized for sending misleading electronic messages to pharmacists that improperly denied coverage for low-income children

Connecticut officials are investigating whether Health Net improperly sent denial-of-care messages to pharmacists for medications for low-income children. According to a report in the Hartford Courant, state Attorney General Richard Blumenthal has started an investigation and is calling for sanctions against the managed healthcare company. The company provides health benefits to approximately 6.7 million people nationwide and is one of four companies that had contracted with Connecticut to provide benefits to Medicaid beneficiaries. According to the report, Health Net sent "not covered" messages to pharmacies that falsely led some pharmacists to believe the medications were not covered, when the medications only required prior authorization. The state HUSKY Medicaid program had previously asked two of the other providers, Anthem and WellCare, to cease sending the same type of message. Anthem stopped immediately, while WellCare expects to change the practice by Dec. 1.

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