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Published: Friday, 1/27/2006

Couple files lawsuit over health-care coverage

A Sylvania couple who claim their health coverage was interrupted because of a contract dispute between United Healthcare and ProMedica Health System have filed a lawsuit in federal court.

Brian and Edna Yeager sued United and ProMedica yesterday in U.S. District Court in Toledo, claiming the recent cancellation of the health-care contract has disrupted their ability to receive certain medical treatment.

United, which serves 35,000 members in northwest Ohio, canceled its health coverage contract with ProMedica on Jan. 1, and added all Mercy Health Partner hospitals to its network.

The Yeagers receive health insurance from United through Mr. Yeager's employer, Home Depot, which also was named as a defendant in the complaint.

The Yeagers are asking the court to certify the complaint to class-action status to include all Home Depot employees and other United members whose coverage was affected by the cancellation.

Stephen Hartman, a Toledo attorney who represents the Yeagers, said the case could be argued as early as today before Judge David Katz on a request for a temporary restraining order.

The complaint said the Yeagers' primary care physician, who is in the ProMedica network, is not allowed to refer the couple to doctors and facilities in the Mercy Health Partners network. As a result, they cannot receive medical care for services covered by their health plan.

"When United and ProMedica were trying to negotiate a contact, they didn't think or care about the effects this would have on the people who are insured," Mr. Hartman said.

The lawsuit said Mrs. Yeager may have to undergo surgery for a medical problem and that her husband repeatedly has contacted United to find out whether the procedure would be covered, but United has failed to respond.

"She needs to see a specialist and a surgeon, but she can't be referred to a physician whose services will be covered," Mr. Hartman said.

"My client was told that the only way she could get the procedure done was if it was a medical emergency, and it would then be covered," he said.

Deborah Spano, a United spokesman, disagreed with the attorney's interpretation that members wouldn't have access to services.

"[The Yeagers] are allowed access to treatment under our new network agreement with Mercy Health Partners. I can only tell you there is access for care to people who were affected by the ProMedica disruption. There are procedures for transition in care. No one should be without care," she said.

The lawsuit seeks compensation for the Yeagers and other potential members of the class, including access to benefits and attorney fees.

Janet Galecki, a ProMedica spokesman, would not comment because of the pending litigation.



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