Blue Shield of California Denied Costly Yet Medically Necessary Rehabilitation Coverage
Blue Shield of California Denied Costly Yet Medically Necessary Rehabilitation Coverage For a Los Angeles Mother Who Recently Suffered Catastrophic Spine Injuries, Law Offices of Scott Glovsky Lawsuit Alleges
Scott Glovsky of The Law Offices of Scott Glovsky filed a lawsuit in Los Angeles Superior Court on behalf of Bobbie Candler Buyalos against California Physicians Services dba Blue Shield of California for bad faith, unlawful business practices and breach of contract.
On December 30, 2017, Bobbie was involved in a skiing accident when another skier struck her causing catastrophic injury to her spinal cord and leading to quadriplegia, the partial or total loss of use of all four limbs. She was admitted and treating at an acute rehabilitation unit (“ARU”) which provides intensive therapy and medical oversight but her doctors there deemed it appropriate for her to step down in care to a transitional care unit (“TCU”), a residential care facility that can still provide intensive rehabilitation therapy but with less medical oversight.
Despite its contractual obligation to provide coverage for the medically necessary service, Blue Shield denied coverage for plaintiff to be admitted in a TCU and instead has told Bobbie that she should get treatment at home, which is impossible given her homes geography and unsafe, or in a skilled nursing facility, a facility that offers a much lower level of care and service. If Bobbie were to go home then she would irreparably lose the opportunity to progress and gain daily life activities in treatment. The facility in which she currently resides therefore has nowhere safe to discharge her and she has as a result had to pay out of pocket for the continued care. As a result of Blue Shield’s denial, Bobbie has suffered emotionally and economically during an extremely difficult time when she is dealing with the reality of her injury and care of her three children.
It is Bobbie’s wish that through this case Blue Shield will accept responsibility for its actions, begin to reform its system and put in place policies that will assure that its members can access the medical treatment that they need in a timely fashion.
This case is Bobbie Candler Buyalos v. California Physicians’ Services dba Blue Shield of California, Los Angeles Superior Court Case No. BC706472.
You can read the complaint HERE.
About The Law Offices of Scott Glovsky
The Law Offices of Scott Glovsky has spent over two decades protecting policyholders from insurance company abuse. In both individual and class actions, the Law Offices of Scott Glovsky has fought for consumers to protect their rights when insurance companies act in bad faith and put their own profits ahead of the rights and interests of their insureds.