New Lawsuit Alleges Unitedhealth/Pacificare Deceived Cancer Patient

New Lawsuit Alleges Pacificare Set Course Of Deception To Avoid Claims and Cancel Policy of 34 Year Old Kidney Cancer Patient To Increase Company Profits.

Irvine, CA (PRWEB) November 18, 2006 -- UnitedHealth Group, the nations second largest health insurer, and its subsidiary Pacificare of California were named in a lawsuit yesterday for canceling the health insurance policy and refusing to pay medical bills after a cancer patient sought treatment. (D'ANNA vs PACIFICARE OF CALIFORNIA #GIN057028)

The lawsuit was filed in the Superior Court of San Diego by attorneys Robert K. Scott and Scott Mahoney of the Irvine-based Law Offices of Robert K. Scott. The lawsuit adds UnitedHealth Group and Pacificare of California to the growing list of California insurers who have been accused of revoking health care polices after patients get sick.

UnitedHealth Group Inc recently announced a 38% jump in its third-quarter earnings, aided by gains from last years PacifiCare acquisition. Recent revelations of a "conflict of interest" have been reported at the DMHC during hearings on the merger between UnitedHealth and Pacificare in California.

"I was repulsed when I learned that the CEO of UnitedHealth Group had 1.6 Billion in stock options while I am being harassed by collection agencies for the medical bills Pacificare refused to pay", said Salvatore D'Anna, the Plaintiff in the lawsuit.

According to the lawsuit filed yesterday, UnitedHealth Group and Pacificare of California allegedly failed to properly manage the patient's cancer treatment and withheld information that put his life in jeopardy to avoid the cost of a second surgery to remove his kidney because of remaining cancer reported in his Pathology report.

Pacificare allegedly withheld the coverage decision for the second surgery until the patient flew across the country for the procedure. Submitted documents indicate Pacificare informed the patient the day before the surgery that they were denying coverage which forced the patient to ask his parents to loan him $25,000 for a down payment on the surgery. When the patient returned home, instead of offering to pay for the surgery, Pacificare allegedly sent a letter that purported to cancel the policy.

For over thirty years, The Law Offices of Robert K. Scott has sued insurance companies on behalf of both individual consumers and businesses against the abuses of the insurance industry. This area of law is known as "insurance bad faith." Our goal is to vigorously fight to protect your rights and to achieve maximum results for you.

15. Plaintiff is informed and believes, and thereon alleges, that from the date of the Pathology report (April 4, 2006), defendants, Pacificare and the Sharp Community Medical Group collectively set upon a course of deception to deny plaintiff necessary and appropriate medical care, in derogation of their duty to properly manage plaintiff's health and uphold the medical standards they were entrusted to faithfully provide, for the sole purpose of avoiding the cost of an additional surgical procedure, a procedure that could save plaintiff's life.

16. When plaintiff awoke on April 21, 2006, he was looking forward to celebrating his 34th birthday, having just endured the most frightening experience of his life. Celebration quickly turned to fear and anger when members of the ACOR Kidney Cancer email list questioned the care plaintiff had been, and was, receiving and encouraged plaintiff to obtain a copy of the pathology report. After several hours and continued frustration, plaintiff received only one page of his pathology report. Plainti fr again requested the entire report from Dr. Anthony's office only to find additional important information withheld by those entrusted with his care. Plaintiff was informed by strangers on an email list that the 'Fuhrman Grade' in the Pathology report was all indication of a highly aggressive cancer, Plaintiff had a Fuhrman Grade 3 of 4 in addition to the POSITIVE MARGINS in his kidney.

17. Plaintiff alleges that from the date of the pathology report of April 4, 2006, Sharp Community Medical Group, knew of plaintiffs POSITIVE MARGINS and neglected to inform plaintiff of the proper care of such a condition. Plaintiff should not have had to find out from strangers on an email list that plaintiff s HMO and Medical Group were not providing proper care in large part because a second surgery would be costly and subtract from defendants' profit and money supplied by defendant PacifiCare.

SBD

Here's my story

My battle with cancer, an insurer that canceled my coverage because I got sick, and tens of thousands of dollars of debt started out as a compassionate joke.

My father was having health problems that his doctor didn’t understand, so I suggested that he go get a full body scan, something my mother had done a few years ago. Sometimes it finds hidden things.

Last Christmas, he said, OK, “I’ll do it if you do it.” He was more than a little nervous so I decided to humor him. I called the clinic where my mother had gone and they said it would be a couple of months, unless we would go Friday the 13th of January. We’re not superstitious, so that was fine with us. A friend and his wife went with us as well.

I thought I was there just to support my Dad. Unlike him, I didn’t even order a consultation with the doctor afterward. This was his appointment, not mine. About a week later, we went in to go over his results, and the doctor said my dad was fine but that she needed to talk with me. She said there was something odd, and that she wanted me to do an abdomen scan that would provide more detail.

We did that on Jan. 31. I got the results on Feb. 3 over the phone. They said there was a definite tumor on my right kidney and they thought I should get right to my doctor. There was no discussion yet of cancer. At that moment, I was certainly grateful that my new insurance with PacifiCare had kicked in. They approved it on Jan. 24, taking effect Feb. 1. It wasn’t until a good deal later that I learned that I had an aggressive form of kidney cancer and that one of my kidneys would have to be removed. This was done May 12.

I had first visited with my insurance broker in November, and after some back and forth he persuaded me to go with PacifiCare. I filled out the application Jan. 10, but on Jan. 18 he told me I had to submit an updated 2006 form. But he told me just to fill out the authorization pages and
he’d fill out the rest from my previous application.

On Aug. 13, I got a cancellation notice from PacifiCare. It said that I knew when I applied that I had kidney cancer, and accused me of fraud. If they had called the agent they would have learned I started the enrollment process in November, and the agent knew I was going to have the scan.
But I wasn’t diagnosed with cancer until after the coverage actually started. If I’d known I was ill, wouldn’t I have bought something better than a crummy HMO?

At the end of August, I received my regular monthly premium notice for the month of September. I sent the payment certified mail with return receipt and they cashed the check right away. When I did not receive the October premium notice, I sent the October payment to them
certified mail with return receipt. I know they received it but have not received confirmation if they had cashed this payment yet.

Also in August, I received two certificates from Pacificare. The first certificate was for HIPAA coverage which is useless since I need 18 months of prior coverage for HIPAA to apply. The second certificate was proof of previous prescription drug coverage so that I won’t get a penalty when I apply for Medicare Plan D coverage. This seemed odd since I won’t be eligible for Medicare until the year 2037. Since I signed up for coverage with Pacificare, I have also received an AARP card and a letter from Liberty telling me how they can deliver my Medicare drugs right to my home. Why they think I am eligible for Medicare is beyond me.

In addition, not only have I had to put with PacifiCare’s illegal, arbitrary cancellation of my policy, but my doctors failed to accurately diagnose my cancer, delaying the correct treatment and wasting precious time. As if that wasn’t enough, PacifiCare refused to pay the bills for my
kidney surgery by the experts at the Cleveland Clinic because it was not in the company’s network. PacifiCare didn’t tell me that it wouldn’t cover the surgery until the day before the operation, waiting until after I had already traveled across the country, and contradicting the recommendation of my in network doctor.

I also found out that since I didn’t have the PacifiCare insurance for 18 months, all other insurers could deny me coverage for having a preexisting condition. Now I am impossible to insure. Brokers tell me I’ll “never be covered.”

I have paid out of pocket for lung and abdomen scans and I’m supposed to have them every six months—for life. Together, they are $1,000 each time. I still have to figure out how to deal with $25,000 I owe my parents for a loan they gave me to partially pay for the $60,000 surgery that
PacifiCare denied. I don’t know what the future will hold.

I’m self-employed, and still not working as much as before all this. The only good thing about this story is that my Dad saved my life. My chances of survival are much better with the early detection. For that I’m grateful. The question now is how can I afford to stay healthy?

SBD

Pacificare knew that I should have another surgery right away to remove my kidney. I sent them an appeal for coverage on May 4, 2006 which said that they had 72 hours to give me a decision. They gave me their decision by phone the day before the surgery when I was already in Cleveland.

Here is the letter that was sent to my PCP the same day I sent my appeal for coverage.

CANCER CENTER ONCOLOGY MEDICAL GROUP EAST COUNTY

May 4, 2006

Kyle Seeley, D.O.
5565 Grossmont Center Drive
Bldg. 1, Suite 210
La Mesa, CA 91942

RE: D'Anna, Salvatore

Dear Kyle,

We had the pleasure of seeing Salvatore D'Anna in the office.

As you know, he had a Lifescan done which showed a right kidney tumor. He ultimately had a right partial nephrectomy and unfortunately had positive surgical margins. The initial advise from his urologist was to wait three months and repeat a scan, however, he was anxious in that regard.

I told him that I felt that he should definitely be re-operated on as soon as possible. He has already made arrangements to go back to Cleveland Clinic to be operated on there, and I agree with that. I do not think it would be prudent at all to wait any time.

Thank you very much for allowing me to participate in his care.

Sincerely,

John O. Clune, M.D.

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