Insurance Lawsuits Allege ERISA Violations
According to reports, a lawsuit was filed by Aram Homampour, who says his doctor prescribed Harvoni to treat hepatitis C. Hepatitis C is a contagious blood disease that can cause serious liver damage. The Centers for Disease Control and Prevention estimate 15,000 people in the United States die each year from hepatitis C-related liver disease. Harvoni, approved by the US Food and Drug Administration (FDA) in 2014, has about a 95 percent cure rate and comes with very few side effects. The problem, however, is the cost: a 12-week treatment program of Harvoni costs around $99,000.
Lawsuits filed against insurers allege the insurers are wrongfully denying Harvoni treatment to save money. The denials are reportedly given because insurers claim patients’ livers are not sufficiently damaged to warrant treatment with Harvoni.
In his lawsuit, Homampour alleges Blue Shield violated the Employee Retirement Income Security Act (ERISA) because it used internal policies to overrule a doctor’s determination of appropriate medical treatment. Homampour claims Blue Shield is forcing him to live with a serious health problem and related issues until his liver becomes sufficiently damaged enough to approve treatment.
Homampour’s lawsuit seeks class-action status for any patient whose Harvoni claims were denied by Blue Shield for reasons linked to medical necessity or experimental treatments.
A different lawsuit also alleging violations of ERISA linked to Harvoni treatment was filed in July against Anthem Blue Cross, as reported by Gordon Gibb for LawyersandSettlements. According to reports, Marina Sheynberg filed her lawsuit after her Harvoni treatment was denied because the treatment was not deemed medically necessary by the insurer. Sheynberg alleges she was told her test results showed that her liver damage was not significant enough to qualify for coverage of the Harvoni treatment. Sheynberg’s lawsuit also seeks class-action status and an injunction requiring Anthem to reevaluate denied Harvoni claims.
The Blue Shield lawsuit is Homampour v. Blue Shield of California Life and Health Insurance Company, case no 3:15-cv-05003, US District Court of California, Northern District.