Kaiser Won't Pay for Liver Transplant, Woman Says
BALTIMORE, Md. (CN) - Kaiser should have covered a woman’s liver-kidney transplant, she claims in the Circuit Court for Baltimore City.
Bonnie Fortner sued Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. and Mid-Atlantic Permanente Medical Group, P.C. for medical malpractice, breach of contract, intentional misrepresentation – fraud, negligent misrepresentation, and tort arising from breach of contract – actual malice.
According to Fortner’s lawsuit, she saw several Kaiser doctors over a period of two years for digestive problems. Although a doctor referred Fortner for a liver ultrasound, Fortner rescheduled because of a work obligation and no one followed up with her for almost seven months, according to the complaint.
Fortner says her lab work showed abnormal liver results, but they were not properly followed up.
According to the complaint, Fortner was in the habit of drinking about six glasses of wine a day, but she had liver damage before a doctor asked her how much she was drinking and informed her that it could cause liver damage. At that point, she stopped, according to the complaint.
After being transferred to her third non-Kaiser hospital, University of Maryland Medical Center (UMMC), Fortner’s UMMC doctor requested Kaiser’s authorization to do a surgical consultation about liver transplantation, according to the complaint.
Kaiser denied the request, saying it was not medically necessary, that it was contradicted by Fortner’s other medical conditions, and that Fortner had not been free from alcohol abuse for at least six months, according to the complaint.
“The negligence of Kaiser’s own healthcare providers resulted in Ms. Fortner’s liver disease and the cause of her liver disease being diagnosed less than six months prior to her need for liver transplant, therefore, it was impossible for her to have met Kaiser’s previously undisclosed criteria of remaining alcohol free for at least six months prior to transplant,” the complaint states.
Kaiser also did not want to pay for Fortner’s transplant at UMMC because it was not a Kaiser-affiliated provider, according to the complaint. Fortner contends she was too medically unstable to be transferred to the University of Pennsylvania Medical Center, a Kaiser-affiliated transplant center.
Fortner also contends that her Kaiser-affiliated gastroenterologist recommended a liver-kidney transplant, to be done at UMMC and that she meets the requirements for coverage under Kaiser’s Evidence of Coverage statement.
Ultimately, Fortner had a liver-kidney transplant at UMMC, but Kaiser did not pay for it.
Fortner seeks declaratory relief, damages exceeding $75,000 for breach of the insurance contract, punitive damages, pre-judgment interest and post-judgment interest. She is represented by Keith D. Forman and Christopher S. Norman of Wais, Vogelstein & Forman.