LOS ANGELES – A parent has filed suit against his insurance providers over allegations coverage of treatment for his minor son was wrongfully denied.
Ryan E. filed a complaint on April 30 in the U.S. District Court for the Central District of California against Entertainment Industry Flex Plan and Anthem Blue Cross Life and Health Insurance Co. citing the Employee Retirement Income Security Act.
According to the complaint, the plaintiff alleges his 9-year-old son has Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcus infections (PANDAS). The suit states the plaintiff's son's specialists have recommended therapy with intravenous immunoglobulin and that the defendants denied coverage of this treatment in February as not medically necessary.
The plaintiff holds Entertainment Industry Flex Plan and Anthem Blue Cross Life and Health Insurance Co. responsible because the defendants allegedly refused to pay for treatment that was necessary for plaintiff's son's health and safety, failed to consider medical evidence which showed treatment to be safe and effective, failed to provide explanations of the basis relied on for the denial of plaintiff’s claim, and failed to adequately investigate the merits of plaintiff’s claim.
The plaintiff seeks judgment against defendants, payment of health insurance benefits, restraining order and injunction, reimburse treatment paid with own funds, costs, attorneys’ fees, and further relief as the court deems just. He is represented by Russell G. Petti of Law Offices of Russell G. Petti in La Canada.
U.S. District Court for the Central District of California case number 18-cv-03646