Kaiser Won’t Honor Benefits Plan, Woman Says
PORTLAND, Ore. (CN) - A woman who needed surgery to remove cysts from her back claims a Kaiser hospital refused to pay out benefits to have it completed, she says in District Court.
Mary McCammon has a history of lumbar radiculopathy and low back pain. Radiculopathy is a condition affecting the nerves, causing them not to work properly.
On July 6, 2011 a lumbar spine MRI revealed large sacral Tarlov cysts that would need to be removed by a surgeon. She picked Dr. Frank Feigenbaum, a neurosurgeon in Kansas City, Mo. After several requests and subsequent appeals, however, Kaiser refused to grant plaintiff’s request for referral to Feigenbaum.
Without a referral, McCammon would be stuck footing the bill for the surgery.
“By email dated March 8, 2012, Dr. Robert House, Director Operations, Surgical Specialties, notified plaintiff that he was not able to authorize care by Dr. Feigenbaum and that plaintiff’s care was currently under active review to determine comparable care within the Kaiser system,” the complaint states.
McCammon, however, said she could no longer take the pain.
“Plaintiff notified Kaiser that her care had been under active review since July 2011 and that she could not continue to let her health deteriorate awaiting Kaiser’s response,” according to the complaint.
McCammon had the surgery performed, but Kaiser has refused to pay up.
She is suing for recovery of benefits under the Employee Retirement Income Security Act.
Megan E. Glor and John C. Shaw represent the plaintiff.