Health Net 2000 Annual Report Download - page 15

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It’s no secret. From time to time, some doctors decide to stop working with managed health care plans. Regardless of why a doctor
leaves the network, Health Net does everything it can to ensure continuity of care for its members. That’s where Rebecca
Baughman comes in. A registered nurse for  years and a case manager for 10 years, Becky is one of many nurses who works in
Health Net of California’s Transition of Care Unit. Her job:To ensure that members undergoing an “active course of treatment”
continue to be treated by their physician, regardless of the physician’s contractual relationship with the health plan. “The doctor-patient
relationship is important, and we do all we can to ensure continuity of care for our members,”says Becky.
Fostering A Dialogue - Together, Health Net subsidiaries employ thousands of doctors, nurses,
care managers and customer service representatives. On a daily basis, these individuals interact with members, beneficiaries,
physicians and other health care practitioners from all over the country to ensure that more than five million members
get the services they need, when they need them.
There are times, however, when members dispute a coverage decision made by either the member’s medical group
or the health plan.When this happens, consumers want to know that there are safeguards in place to ensure a fast and
fair resolution.That’s why all Health Net health plans use a third-party, independent review process.This process, which
allows for independent oversight by specialty-matched physicians not affiliated with the health plan, gives consumers
confidence in the system and ensures a quick resolution for both the member and the health plan.
Health Net of California led the charge for third-party, independent review as the first California health plan to
voluntarily adopt the program in May of 1998.Today, non-emergent disputes in California are resolved within 30 days,
with urgent cases resolved in less than 72 hours. In January of 2000, third-party, independent review became law in
California, as it now is in most states.
Health Net subsidiaries have made significant progress over the last several years, yet more is being done to foster
better relationships with physicians, hospitals and members. For example, in late 2000 Health Net health plans launched
an initiative to decrease the inappropriate prescribing of antibiotics in an effort to control the emergence of drug resistant
bacterial strains. Physicians have reacted positively to this program, requesting additional information from Health Net
to distribute directly to their patients.
By talking candidly with members, providing information, improving the flow and speed of communications and
working collaboratively with partners, Health Net is adding value to health care. In addition, a sensible Patients’Bill of
Rights law that maintains quality, access and affordability as its basic tenets - and provides consumers with a quick and
fair process for resolving disputes - will help increase consumer confidence in the industry and in the good work
performed by 11,000 Health Net associates.
2000 Annual Report HEALTH NET 13