Kaiser Won’t Pay for Amputation, Man Says

12-26-2013 23:59:00

     LOS ANGELES (CN) - Kaiser Foundation Health Plan refuses to pay for over $60,000 in medical expenses a man incurred after almost cutting off one of his fingers, he claims in a Los Angeles County Superior Court complaint.
     Bruce Joseph almost completely cut off his index finger in a lawn mowing accident in June 2011. He was rushed to Loma Linda University Medical Center where the majority of the finger was amputated. Joseph said he would have been transferred to a Kaiser hospital, but that a Loma Linda doctor said he should stay.
     “Scott Herron, M.D., the doctor who treated plaintiff wrote that plaintiff required emergency orthopedic surgery and that any ‘transfer of the patient would have put him outside of a safe window of opportunity to minimize infection and osteomyelitis for the open fracture,’” the complaint states.
     Joseph says Kaiser’s health coverage is limited to Kaiser facilities, except in the case of an emergency. The lawn mowing accident constitutes an emergency, but Kaiser still refuses to pay the $63,000 bill from Loma Linda, he claims.
     “California law requires that all health insurers provide emergency care coverage regardless of the facility where the care takes place,” according to the complaint.
     Joseph says Kaiser failed to investigate his claim before it denied his coverage and is illegally withholding payments owed him under his policy.
     Joseph adds that, "defendants purposely and despicably devised a plan to mislead insureds into thinking that emergency care a non-Kaiser facilities is not covered."
     He is suing for breach of contract, and breach of the covenant of good faith and fair dealing. He seeks economic, special, general, consequential and punitive damages.
     The plaintiff is represented by Christian J. Garris of Los Angeles.