SAN FRANCISCO - A California woman sued CalPERS, Anthem Blue Cross Life and Health Insurance Company and Anthem UM Services for allegedly denying her sick father insurance coverage for a life-or-death procedure and ultimately causing his passing, according to documents filed Feb. 26 in the San Francisco County Superior Court.
Plaintiff Trisha Tyre says her father Ronnie Pruitt was insured by the defendants Anthem Blue Cross through CalPERS. Pruitt suffered from many heart conditions, including congestive heart failure and cardiomyopathy, as well as a long history of atrial fibrillation, hypertension and sleep apnea. Pruitt's cardiologist recommended a surgical procedure to help manage the decedent's conditions and improve his heart's ability to pump and circulate blood.
According to the suit, the defendants denied the insurance claim, citing the procedure as "not medically necessary," despite the insurance company being aware of and paying for many cardiology medications that the decedent took and despite strong recommendation from the decedent's cardiologist.
The surgery was scheduled for October 31, 2018, but was cancelled because the claim was denied, the suit says. Pruitt's health deteriorated, the suit adds, and he died in March 2019.
Tyre sued the defendants for breach of contract, breach of the covenant of good faith and fair dealing, negligence, wrongful death and survival. She is seeking judgements deemed necessary by the court.
The plaintiff is represented by DL Law Group and Mannion, Lowe and Oksenendler.