Man Wants Co-Pay Back, Saying Kaiser Forced Him Out-of-Network
9-26-2014 23:54:00

WASHINGTON (CN) - Kaiser owes a man $5,000 he paid out-of-pocket to have a critical prostate surgery performed, he says in a federal, pro-se complaint.

Clifton Odell Bell sued Secretary of Health and Human Services and Kaiser Foundation Health Plan of the Mid-Atlantic States Inc. in U.S. District Court, District of Columbia.
The surgery was urgent and medically necessary.Clifton Odell Bell has prostate cancer and waited for six months for approval from Kaiser to have surgery performed, but was ultimately denied, according to his complaint. He says his Kaiser in-plan doctor, Roy Joseph, eventually ordered “urgent and medically necess[ary] Cyberknife prostate cancer surgery” and was forced to get the surgery outside the network, costing him $5,000.
He says that he was, “forced to pay the $5,000" co-payment because the Kaiser health plan had, for six months, "continually denied [him] network Cyberknife prostate surgery." Kaiser Permanente Medicare Plus (cost) Health Plan breached the health care contract, and the U.S. Department of Health and Human Services maintain a partnership with the health plan and approved the 2011 breach.
Bell is demanding a jury trial to prove his case and for reimbursement of the $5,000.

1:14cv1072