HMO SUITS: Prudential Case May Go To Trial
Reversing the decision of a Superior Court judge, three appellate justices decided last week that a 1996 suit brought by a cancer patient against Prudential HealthCare of California for "bad faith" conduct "raises issues worthy of a trial." The Santa Barbara News-Press reports that University of California-San Barbara scientist "Suzi Steinberg avoided death from ovarian cancer by undergoing a bone- marrow transplant that her insurance company refused to cover because it was an 'experimental treatment.'" Left with a bill for $60,000, Steinberg sued her insurer, Prudential HealthCare, for not making it clear that such experimental procedures were not covered in her policy. The appeals court said that "Prudential apparently never notified the university workers of" a policy change that took place in January 1995 that excluded "experimental or investigational" treatments. The suit will now go to trial in Santa Barbara Superior Court unless a settlement is reached. A Prudential spokesperson said, "We are disappointed in the court's ruling on the limited issue of whether Ms. Steinberg received official notification of the plan's terms." For her part, "Steinberg is also seeking punitive damages against Prudential that could amount to millions of dollars." She said of her suit, "My hope was to help other cancer patients as well to change their (insurance) company's behavior. ... I am looking forward to exposing the HMO's bad faith and their deceptive practices" (Schultz, 10/1).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.