Florida Blue Agrees to Settle ERISA Lawsuit
Sacramento, CA: Florida Blue has agreed to settle an ERISA lawsuit, in a move that could have implications for a similar lawsuit filed in California. The lawsuit involves the insurer's refusal to cover Harvoni, a potentially life-saving drug that has been shown to successfully treat hepatitis C.
Florida Blue was one of multiple insurance companies - including Blue Shield of California and Anthem Blue Cross Life - that face lawsuits alleging violations of the Employee Retirement Income Security Act (ERISA) and/or other acts designed to protect patients and policyholders.
Harvoni has been proven successful at treating hepatitis C in up to 95 percent of cases, and with few side effects. But patients with hepatitis C say their insurance companies have denied them the treatment, finding their livers are not damaged enough to warrant the medication, or arguing that the treatment is too experimental.
Plaintiffs say the real reason claims for the treatment are turned down is the price. An eight-week treatment course costs around $63,000 while a 12-week course is around $99,000. So even though it is effective, it's also costly.
As a result of the denials - which policyholders say put their lives and their health in jeopardy - lawsuits were filed against multiple insurance companies. That's because hepatitis C is linked to permanent liver damage, liver cancer, and death. According to the lawsuits, up to 70 percent of patients with hepatitis C will develop chronic liver disease. Patients without liver damage are still reportedly at a higher risk of heart attack, joint pain, and arthritis. Lawsuits filed against insurance companies encompass both ERISA-covered plans and those that are not covered by ERISA.
Blue Cross and Blue Shield of Florida (doing business as Florida Blue) has now reportedly agreed to settle the ERISA lawsuit filed against it. According to court documents, plaintiffs in the lawsuit alleged Florida Blue's actions "increase the risk of developing liver cancer by 15%."
Bloomberg BNA (6/23/16) reports Florida Blue has now agreed to cover Harvoni for its policyholders with hepatitis C. Plans covered by ERISA and those not covered by it are included in the settlement, which was given preliminary approval by Judge Robin L. Rosenberg.
What effect this settlement will have on similar lawsuits remains to be seen.
The lawsuit is Oakes v. Blue Cross & Blue Shield of Florida, Inc., case number 9:16-cv-80028, in the US District Court for the Southern District of Florida. The Blue Shield of California lawsuit is Homampour et al v. California Physicians' Service, case number 3:15-cv-05003, in US District Court, Northern District of California.
Florida Blue was one of multiple insurance companies - including Blue Shield of California and Anthem Blue Cross Life - that face lawsuits alleging violations of the Employee Retirement Income Security Act (ERISA) and/or other acts designed to protect patients and policyholders.
Harvoni has been proven successful at treating hepatitis C in up to 95 percent of cases, and with few side effects. But patients with hepatitis C say their insurance companies have denied them the treatment, finding their livers are not damaged enough to warrant the medication, or arguing that the treatment is too experimental.
Plaintiffs say the real reason claims for the treatment are turned down is the price. An eight-week treatment course costs around $63,000 while a 12-week course is around $99,000. So even though it is effective, it's also costly.
As a result of the denials - which policyholders say put their lives and their health in jeopardy - lawsuits were filed against multiple insurance companies. That's because hepatitis C is linked to permanent liver damage, liver cancer, and death. According to the lawsuits, up to 70 percent of patients with hepatitis C will develop chronic liver disease. Patients without liver damage are still reportedly at a higher risk of heart attack, joint pain, and arthritis. Lawsuits filed against insurance companies encompass both ERISA-covered plans and those that are not covered by ERISA.
Blue Cross and Blue Shield of Florida (doing business as Florida Blue) has now reportedly agreed to settle the ERISA lawsuit filed against it. According to court documents, plaintiffs in the lawsuit alleged Florida Blue's actions "increase the risk of developing liver cancer by 15%."
Bloomberg BNA (6/23/16) reports Florida Blue has now agreed to cover Harvoni for its policyholders with hepatitis C. Plans covered by ERISA and those not covered by it are included in the settlement, which was given preliminary approval by Judge Robin L. Rosenberg.
What effect this settlement will have on similar lawsuits remains to be seen.
The lawsuit is Oakes v. Blue Cross & Blue Shield of Florida, Inc., case number 9:16-cv-80028, in the US District Court for the Southern District of Florida. The Blue Shield of California lawsuit is Homampour et al v. California Physicians' Service, case number 3:15-cv-05003, in US District Court, Northern District of California.
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