Insurance Company Promises to Pay $66K Medical Bill, Then Denies Claim |
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A class action has been filed against Kennecott Holdings Corporation for denying medical insurance benefits and refusing to allow access to claim information as required by the Employee Retirement Income Security Act (ERISA). The class seeks costs, interests and attorneys’ fees.
Specifically, the complaint alleges that Paul M. Oedekoven was insured under a self-funded employee welfare plan created and sponsored by Kennecott. Prior to April of 2003, he suffered from spinal disc problems and sought treatment at the Gulf Coast Orthopedic Center in Hudson, Florida. In February of 2003, prior to surgery, Blue Cross Blue Shield (BCBS), the administrator for the plan received a request from Gulf Coast to certify that BCBS would provide coverage for the plaintiff’s disc surgery. BCBS approved the request and Oedekoven had the surgery.
Shortly afterwards, BCBS informed Oedekoven that only half of the $66,000 medical bill would be paid. His request for further information on the claim was denied. He alleges that the defendants violated ERISA by denying a review of the claim denial.
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