Woman Blames Kaiser Error for Increased Costs

DENVER, Colo. (CN) - A woman's treatment costs escalated because her health failed when Kaiser cancelled her policy in error for 2 months, she says in a Denver County District Court complaint.

Lamar Richardson is an employee of Colorado's Department of Corrections and receives health insurance through the state, which contracts with Kaiser Foundation Health Plan to provide medical services.

In 2011, the state informed its employees they needed to submit dependent coverage information to continue receiving benefits.

During that time, his wife, Jennifer Richardson, was being treated for an unspecified and permanent illness. The couple timely submitted the requested information, twice, but was told each time the information was not received.

Their coverage was cancelled as of Sept. 1, 2011.

As a result, the Richardsons hired an attorney to fight for a reversal of the state's decision to stop coverage, which ended with a reinstatement of the medical coverage. Department of Personnel & Administration Executive Director Kathy Nesbitt, who initially denied the coverage, sent a letter admitting her error, according to the complaint.

The state "affirmatively acknowledged that the benefits should not have been cancelled because materials and documents were received and faxed to the employee benefit unit."

Yet, Jennifer was denied critical treatments from Sept. 1, 2011 into December 2011, while the matter was being resolved. The Richardsons also incurred substantial medical expenses that had to be paid out-of-pocket.

If that was not enough, Kaiser refused Jennifer the proper medication once treatments resumed, the complaint states.

Additionally, upon resuming medical treatment with Kaiser, the previous medications were not effective and a more expensive medication was required, the complaint states. Kaiser initially refused to provide the required medication, claiming that the medication prescribed pre-termination of benefits was sufficient.

The plaintiffs are suing the State of Colorado, Department of Personnel & Administration and Kaiser Foundation Health Plan of Colorado for breach of contract. They want a court to rule that both the State of Colorado and Kaiser had a duty to provide Jennifer with proper medical treatment and that Kaiser should have covered the treatments.

"Kaiser's refusal to provide needed medication was a breach of its contractual obligations to the Richardsons," the complaint states. "The direct and foreseeable injuries to the plaintiffs is that Mrs. Richardson's medical expenses have substantially escalated and will continue to escalate throughout her life."

The plaintiffs are represented by William Finger and Andrew Newcomb of Frank & Finger, in Evergreen, Colo.

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