SAN FRANCISCO – A mother alleges that she has incurred $15,000 in medical expenses related to her daughter's care after her insurance company denied coverage of a prescribed infant formula.
Jennifer Batson filed a complaint on April 5 in the U.S. District Court for the Northern District of California against L-3 Communications Group Health Plan for Active Participants (501), L-3 Communications Funded Group Health & Welfare Plan for Active Participants (503), and Aetna Inc. citing violation of the Employee Retirement Income Security Act.
According to the complaint, the plaintiff alleges that in October 2015, her daughter's pediatrician wrote a prescription for an amino acid-based infant formula that is only available through special pharmacy order. The suit states the plaintiff contacted Aetna and was informed the formula was covered if considered medically necessary. The plaintiff holds L-3 Communications Group Health Plan for Active Participants (501), L-3 Communications Funded Group Health & Welfare Plan for Active Participants (503) and Aetna Inc. responsible because the defendants allegedly informed plaintiff that all of her claims were covered but due to a miscommunication by the defendants, she is now asked to pay for the formula. She alleges she incurred $15,000 in medical expenses.
The plaintiff seeks payment of benefits due under the plan, interest, prejudgment interest against the defendant at 10 percent per annum, attorney's fees of $150,000, and any other relief as this court deems just. She is represented by Laurence F. Padway of Law Offices of Laurence F. Padway in Alameda.
U.S. District Court for the Northern District of California Case number 3:16-cv-01707-JSC