Insurer pays patient $3,547 Maryland woman disputed MONY bill.

October 14, 1991|By Ross Hetrick | Ross Hetrick,Evening Sun Staff

After a two-year fight, Bonnie Schlenker has received $3,547 from the Mutual Life Insurance Co. of New York for five months of physical therapy -- a bill the insurance company at first refused to pay, saying the treatment was not medically necessary.

The case was an example of the type of disputes that can arise in the practice of "utilization review," a practice in which health insurance companies examine medical and psychological treatments to determine if they are medically necessary.

"I'm relieved to have finally got it," said Schlenker, a former Baltimore County schoolteacher.

"But I'm distressed that the facts have not changed over the last two years," she said.

The Mutual Life Insurance Co. of New York, known as MONY, had refused to pay for most of Schlenker's physical therapy from April through August 1989. However, MONY had been paying for the same treatments for the seven months before that period.

The Maryland Insurance Division had scheduled a hearing on the matter for tomorrow, but it has been canceled after the company offered to pay the full claim. Schlenker received the check Friday after signing an agreement that she would not pursue the case any further.

"The group health business is a business that we are no longer in and we simply wanted to settle this situation expeditiously," said Charles J. Wasilewski, a MONY spokesman. "We did talk to the insurance division and they did not find any wrongdoing and this is not an admission of liability."

In an Oct. 1 Evening Sun article, Schlenker said MONY began asking for information about her treatment in May 1989, but refused to say that her benefits were in jeopardy until Sept. 22 that year -- after she had taken the treatment.

In October 1987 she started physical therapy for lower back problems and for a year, the treatment was paid for by the Prudential Insurance Co. In October 1988, Schlenker's husband changed jobs and the new insurer, MONY, picked up payments After Sept. 1, 1989, Schlenker continued the therapy under another health insurer until December 1989.

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