Kaiser Gave Misleading Coverage Information, Sick Man Claims
SAN BERNARDINO, Calif. (CN) – Kaiser told the family of a sick man a ventilator would be covered under a certain plan, but after they bought the coverage, Kaiser claimed it was not covered, the man claims in San Bernardino County Superior Court.
Evan Brown sued Kaiser Foundation Health Plan, Inc. for breach of the implied covenant of good faith and fair dealing, breach of contract, negligent infliction of emotional distress and violations of the business and professions code for unlawful, unfair and fraudulent conduct.
Shortly after birth, followed by a close brush with death, Evan Brown was diagnosed with congenital central hypoventilation syndrome (CCHS), a disorder that causes him to stop breathing in his sleep, according to the lawsuit. Since he was two months old, he has used a mechanical ventilator at night, it says.
As Brown’s 26th birthday approached, when he would no longer be eligible for coverage under his father’s workplace plan, his mother began looking into individual plan options for him, according to the complaint.
A representative of the Kaiser National Sales Center told Brown’s mother the “Platinum 90 HMO Plan” would cover Brown’s ventilator and supplies, the complaint sates. She followed up with the Member Services Department and a Kaiser Senior Health Plan Representative confirmed that the plan in question would meet Brown’s needs, according to the complaint. Based on those representations, Brown enrolled in the Platinum 90 HMO plan instead of securing continued group coverage under COBRA, according to the complaint.
Seven months later, Brown called Kaiser to order replacement supplies and was told that his ventilator and supplies were not covered, according to the complaint. He is now afraid to request an overdue service visit for the machine, lest the manufacturer learn it isn’t covered and take it away, he says.
“Most people would think that being stricken with a devastating breathing disorder would be their worst nightmare. This case illustrates how the nightmare can actually be made worse – by a health insurer that unreasonably refuses to provide him with the care that he needs to survive, even thought that care is medically necessary and the insurer’s contract with its subscribers requires it to do so,” the complaint states.
Evan Brown seeks compensatory, punitive and exemplary damages, prejudgment interest, attorneys’ fees, costs of suit, injunctive relief and a jury trial. He is represented by Michael Bidart, Ricardo Echeverria and Danica Crittenden of Shernoff Bidart Echeverria in Claremont.