OAKLAND, Calif., Nov. 9 (UPI) -- A lawsuit filed by a California couple against Health Net has led the HMO to approve specialist care for their 4-year-old son for a rare spine condition.
Mark and Kimberly Zembsch said Health Net refused to let their son, Jack, see an out-of-network doctor they believe can treat his condition. The specialist practices in Delaware.
The boy suffers from metatrophic dysplasia, which causes the spine to twist as it grows, damaging internal organs, The Los Angeles Times reported.
A spokesman for Health Net, California's third-largest for-profit HMO, said the company believed there were local doctors who could treat the boy's condition. But after media coverage of the lawsuit, the company granted the Oakland-area family's long-standing request, the newspaper said. The suit alleged Health Net repeatedly denied the family's request for 14 months for permission to see the doctor.
A healthcare finance expert said the case helped highlight the issue of out-of-network care in a public way. A spokesman for an insurance trade group said insurers routinely refer patients out of their networks and that the Zembsch case is rare.
