BCBS lawsuit regarding cranial molding
Rob Kistenberg
Description
Collection
Title:
BCBS lawsuit regarding cranial molding
Creator:
Rob Kistenberg
Date:
6/15/2001
Text:
Here's the article regarding the BCBS lawsuit from Business News.
Cook County sues Blues for fraud
CHICAGO—In what may be the first governmental lawsuit in Illinois
against a health maintenance organization for fraud, Cook County
State's Attorney Richard A. Devine sued Blue Cross & Blue Shield of
Illinois on Wednesday for denying coverage for a prescription
headband that corrects cranial malformities in infants.
The suit, filed in Cook County Circuit Court, charges that BC/BS of
Illinois is violating the Illinois Consumer Fraud Act by routinely
denying coverage for the Dynamic Orthotic Cranioplasty band.
In one case, according to the suit, the Blues plan refused to cover
the cost of the $3,000 headband by claiming first that it
was investigational, though the device is approved by the Food and
Drug Administration, and then that the band was solely for cosmetic
purposes. In two other cases, the suit charges, BC/BS of Illinois
claimed that the medical necessity of a DOC band had not been
established, despite doctors' prescriptions.
In a statement issued after filing the suit, Mr. Devine said that
Illinois Blues had committed fraud by violating its own stated
policies, which say it will pay for FDA-approved corrective devices.
The lawsuit seeks to prohibit BC/BS of Illinois from denying coverage
for prescribed DOC bands and to identify and make coverage available
to all policyholders who were wrongfully denied coverage for the DOC
band. The suit also calls for the insurer to pay $50,000 in civil
penalties.
A spokesman for BC/BS of Illinois said he still had not seen the suit
and could not comment.
Robert S. Kistenberg, CP, LP, FAAOP
O & P Clinical Technologies
Gainesville, FL 32605
352-331-4221
<Email Address Redacted>
Cook County sues Blues for fraud
CHICAGO—In what may be the first governmental lawsuit in Illinois
against a health maintenance organization for fraud, Cook County
State's Attorney Richard A. Devine sued Blue Cross & Blue Shield of
Illinois on Wednesday for denying coverage for a prescription
headband that corrects cranial malformities in infants.
The suit, filed in Cook County Circuit Court, charges that BC/BS of
Illinois is violating the Illinois Consumer Fraud Act by routinely
denying coverage for the Dynamic Orthotic Cranioplasty band.
In one case, according to the suit, the Blues plan refused to cover
the cost of the $3,000 headband by claiming first that it
was investigational, though the device is approved by the Food and
Drug Administration, and then that the band was solely for cosmetic
purposes. In two other cases, the suit charges, BC/BS of Illinois
claimed that the medical necessity of a DOC band had not been
established, despite doctors' prescriptions.
In a statement issued after filing the suit, Mr. Devine said that
Illinois Blues had committed fraud by violating its own stated
policies, which say it will pay for FDA-approved corrective devices.
The lawsuit seeks to prohibit BC/BS of Illinois from denying coverage
for prescribed DOC bands and to identify and make coverage available
to all policyholders who were wrongfully denied coverage for the DOC
band. The suit also calls for the insurer to pay $50,000 in civil
penalties.
A spokesman for BC/BS of Illinois said he still had not seen the suit
and could not comment.
Robert S. Kistenberg, CP, LP, FAAOP
O & P Clinical Technologies
Gainesville, FL 32605
352-331-4221
<Email Address Redacted>
Citation
Rob Kistenberg, “BCBS lawsuit regarding cranial molding,” Digital Resource Foundation for Orthotics and Prosthetics, accessed December 26, 2024, https://library.drfop.org/items/show/216683.
