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Read Making a Killing

home / healthcare / patient stories

PATIENT STORY

Delayed Benefits Costs Man His Testicles

Frank Wurzbacher - Covington, KY
According to court documents:

Frank Wurzbacher, a retiree who had surgery for prostate cancer, was taking monthly injections of a drug called lupron to keep the cancer from returning.

In January of 1995, a new insurer took over as the third-party administrator of his retiree health plan. The new company announced it would pay only 80% of the allowable charges for Frank's treatment, rather than the 100% it had been covering.

The change would cost Frank $180 a month, a charge his attorneys say he could not afford. After several months, Frank's doctor said he could not continue to provide the injections without recovering his costs. The one alternative Frank's doctor gave him, and the one that would be covered in full, was castration, according to his attorney.

After making several calls to his insurer and having no luck getting the company to change it's mind about the injections, Frank took his doctors advice.

Frank had the surgery on September 18, 1995. When he got home, there was a notice waiting in the mail from his insurance company saying they would go ahead and pay the full cost of the injections.

According to court documents filed by Frank's attorneys, his insurance company had decided more than a month before that it would cover his injections in full. But administrative snafus, including failure to enter the information in the insurance company's computer, kept the information from Frank despite his repeated inquiries.

Frank asked for compensatory damages from his insurance company, alleging negligence, among other things, under state law. A federal district court dismissed the complaint, ruling that Frank's claims are preempted by ERISA. "The court finds that this case is based on a denial of benefits claims which is clearly preempted by ERISA" the court said.

Frank has no recourse and will get no compensation for this tragedy.




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