He left Health Net in December and is now a consultant. We wanted to do a better job, and doing a better job means people are less likely to litigate. Health Net wants its members to know that decisions made by providers and the plan can be challenged. The reason the external review process was launched was to respond to the needs of our customers to improve trust in the quality of decision making and in the speed of decision making. Everything we do to make ourselves better is done for the business reason of being successful.
Some litigation revolves around allegations of poor management decisions.
Since the program was installed, there have been about 350 appeals a month, he says. Of course, the third parties are paid by Health Net. I guess that until there was a perception or realization that people wanted this, it wasn't done. But it doesn't take the place of liability for decisions that have an impact on consumers.