Aug. 20, 2001 — A class-action lawsuit was filed Monday against Blue Cross-Blue Shield Insurance Co., which carries the V.I. government’s group health insurance plan, alleging that the company is wrongfully rejecting claims of retired public workers.
The suit was filed in St. Thomas District Court by Maria Tankenson Hodge, a partner at Hodge & Francois, on behalf of Gloria Davis, Gerald Hodge Sr. and Lawrence Hodge, who is Tankenson Hodge’s husband. She said the action was triggered by Blue Cross’s refusal to pay claims to retired workers receiving Social Security, who are eligible for Medicare. That could amount to some 4,000 people aged 65 and older, including spouses.
One of those persons, it turns out, was Lawrence Hodge. Tankenson Hodge said that after her husband underwent outpatient surgery, "Blue Cross turned the claim down."
"We found that this was a policy they were pursuing across the board," she said.
According to the suit, Blue Cross allegedly refuses to pay any claims for medical treatment that would be covered by Medicare Part B, an optional program offered by Medicare that costs the elderly approximately $600 a year in additional premiums for extra coverage that retired workers are not required to take, under the government’s group health insurance policy.
Blue Cross officials couldn’t be reached for comment by Monday afternoon regarding the lawsuit.
Hodge said the suit seeks an injunction against Blue Cross to prevent it from denying coverage to the affected retirees. It also seeks monetary damages for them.
The complaint further alleges that the Blue Cross policy does not permit the insurer to refuse to pay these claims, and that the premiums the retired government workers pay to Blue Cross already cover these medical services.
The action also alleges that Blue Cross has been forcing retired government workers living on limited fixed incomes to choose between paying this extra premium or losing much of the insurance coverage for which they already pay Blue Cross.
Tankenson Hodge said the next step is for the court to decide whether there is a large enough group to justify a class action. That could take approximately two months.
Tankenson Hodge said announcing the lawsuit was uncommon practice for her firm. But she said there is a need for those people who may be affected to be informed.
"It just seemed like something that was a matter of importance to the community," she said.
The complaint states that the insurance company’s treatment of retired government workers "constituted an act of bad faith, deception, dishonesty and inequity" in "violation of the requirements of the Virgin Islands Insurance Code." The claims for damages include "embarrassment, emotional distress, financial harm to retired government workers’ credit and burdensome expense, both for payments made to health care providers from the retirees’ limited resources, for bills the insurance company should have paid, and for payments to doctors the retirees have not made, leaving them indebted to their doctors, with resultant harm to the retired workers’ credit and to their reputation, as well as possible deferred or forsaken medical care for conditions for which Blue Cross would wrongfully withhold coverage."
Repayment of excess insurance premiums some retired government employees have paid to Medicare for unnecessary coverage under Part B is also claimed.


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