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Ways We Have Helped Patients

Client Denied Wheelchair Replacement

Elizabeth represented a young college student who was immobile due to cerebral palsy but he had successfully utilized a power wheelchair for several years.

When the power wheelchair became inoperable and irreparable, his parents’ health plan refused to replace it with another power wheelchair. Instead, the health plan offered only a manual wheelchair which the client could not operate on his own and required a helper to get around.

Elizabeth filed a lawsuit and resolved the matter.

Cancer Patient Denied Treatment

Elizabeth represented a client who received a form of radiation therapy for treatment of lung cancer.

Despite the doctor’s support that the radiation therapy was medically necessary and the generally accepted standard of care for the patient’s lung cancer, the insurance company denied benefits as investigational.

Elizabeth filed a lawsuit on behalf of the patient and resolved the matter.

Narcolepsy Prescription Refill Denied

Elizabeth represented a client whose longstanding prescription for a narcolepsy medication was denied when his employer’s health plan changed claims administrators.

Elizabeth filed a lawsuit and the health plan reversed its decision.  

Mental Health Lawsuit Filed

Elizabeth represented a family whose teenage son who exhibited concerning symptoms of undiagnosed mental illness. The parents requested psychiatric testing through their HMO.

The HMO delayed testing for months and refused the parents’ request for a referral to another provider. Eventually, without recourse from the HMO, the parents admitted their son to an inpatient program for comprehensive testing and he was diagnosed with schizophrenia.

Elizabeth filed a lawsuit on behalf of the parents and resolved the matter.

Doe v. Blue Cross Blue Shield of Illinois, 492 F. Supp. 3d 970, 972 (D. Ariz. 2020)

Elizabeth achieved a win for her client in a lawsuit challenging Blue Cross’s denial of benefits for residential treatment for the patient’s multiple diagnoses of anorexia nervosa, generalized anxiety disorder, major depressive disorder, and post-traumatic stress disorder. 
The patient had a traumatic past that included multiple sexual assaults. Her mental illness manifested through eating disorder behaviors, panic attacks, self-harm, and intermittent suicidal ideation. Following an increase in behaviors, she was admitted to residential treatment. Her physician supported residential treatment as medically necessary because the patient routinely refused food, was reliant on staff support for meals, and thoughts of self-harm which progressed to urges which she acted upon while in treatment. Blue Cross denied benefits, claiming the patient could safely receive intensive outpatient treatment.
The Court disagreed. The Court found that a structured setting of residential care was “clearly required to facilitate Ms. Doe’s care.” The Court noted that even with this elevated level of care, the patient’s mental state deteriorated with “urges of self-harm and suicidal ideation eventually progressing to action.” When Blue Cross attempted to defend its decision by pointing to dates when the patient complied with treatment or agreed not to harm herself, the Court responded that the stark reality was that many such dates coincide with, or immediately preceded, dates when the patient self-harmed. When Blue Cross claimed the patient had occasional passes to leave the facility, the Court responded that the patient often regressed following passes to leave the facility as evidenced by restricting food, panic attacks, and self-harm.
The decision is important for holding Blue Cross accountable for its wrongful denial. The decision also recognizes the realities of residential treatment, that good days can be followed by bad and that recovery is not a linear trajectory. The decision also shows the ways in which multiple mental illnesses interact to create a more challenging course of treatment.