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A 17-year old football player has been a patient at the Palomar Medical Center in San Diego, California since a football injury left him in a coma nearly four months ago. The hospital’s grounds have turned into a gathering for this popular teen’s friends and family. However, they haven’t gathered there simply to comfort each other; they are there to protest the way that Blue Cross is handling his treatment.

Rushed to the hospital

According to several news sources, the teen was rushed to the hospital after he collapsed at a September football game in which he was playing. After being in a month long coma, he was gradually taken off his ventilator. According to his family, friends and his doctors, he continues to make improvements in the hospital’s acute rehabilitation unit.

His insurance company, Blue Cross, doesn’t think he’s making enough improvement to warrant the cost of remaining in the acute rehabilitation unit and wants to move him to a lower level nursing center. His family has appealed Blue Cross’s decision to the state level where an independent doctor will review his case – even though his own doctors have told the insurer that he needs to stay where he is. Coincidentally, or not, this isn’t the only recent case in which Blue Cross has been chastised for its claims decisions.

Not ‘medically necessary’?

In another recent case, Blue Cross seems to have looked for ways to stop providing treatment. After telling another California family that in-home nursing care was ‘medically necessary’ for their severely disabled son, and routinely paying for the care, Blue Cross simply stopped covering the expenses. At first, the insurer told the family that coverage would not continue because they had reached their policy limits. This wasn’t true.

Soon afterwards, they told the family that coverage would not continue because the in-home health care was no longer ‘medically necessary’. Also not true according to the boy’s doctors. The family has filed a lawsuit against the insurer and has since had to rely on MediCal.

Don’t accept denials

Policyholders should not accept an insurance company’s denials without first consulting with an expert. An attorney experienced in bad faith insurance matters may be able to help. For a free, no-obligation consultation, please click here.