Blues sued for allegedly refusing to pay for test Woman's aneurysm was not diagnosed

September 24, 1992|By Patricia Meisol | Patricia Meisol,Staff Writer

A University of Maryland employee sued Blue Cross and Blu Shield of Maryland and the state for $20 million Tuesday, charging that Blue Cross refused to pay for a medical test that could have diagnosed a brain aneurysm before it ruptured.

The woman, Nancy E. Biddison, who is in her 30s and an office worker in the animal sciences department at the University of Maryland College Park, suffered a stroke when the aneurysm burst on March 6, 1991. She lost vision in her right eye and movement in her left arm and leg, and walks only with the aid of a brace and a cane, according to the lawsuit and her lawyer.

Ms. Biddison returned to her job in June but is able to work only a few hours a day. As a result, she is considering retiring on disability, her lawyer said.

According to the suit filed in Baltimore County Circuit Court, Blue Cross refused to pay for a magnetic resonance imagery (MRI) test for Ms. Biddison, a Woodbine resident, after she complained of severe headaches. The company is under contract with the state to administer its employee health insurance program.

When the woman's primary doctor, Carl I. Margolis of Rockville, called Blue Cross on behalf of his patient, he was told "to mind his own business, that this was a matter between Blue Cross and the insured," according to Richard O'Connor, an Ellicott City jTC attorney who represents Ms. Biddison. Two other physicians also recommended the test.

Ms. Biddison, who earned about $20,000 a year at the time, never went ahead with the test because she couldn't afford the $1,200 cost. Six months later, with her condition still undiagnosed, the aneurysm ruptured and she had a stroke.

Ms. Biddison is expected to be a witnesses today before a U.S. Senate subcommittee which is opening two days of hearings to examine the management practices and financial condition of the Maryland Blues. She was asked to testify after investigators learned yesterday that the case had been filed, her attorney said.

Blue Cross is a direct insurer or administrator of insurance plans for 1.4 million Maryland residents. More than half its $1.3 billion in annual revenues comes from companies or government agencies that, like the state, are self-insured and hire the company to run their health insurance plans.

Blue Cross declined to comment.

"We have not been served papers, so it is very hard for us to comment and it would not be prudent to comment on it after we have it," said Linda Wilfong, a spokeswoman.

The lawsuit contends that an MRI was clearly covered under Ms. Biddison's policy. The suit claims that the test would most likely have revealed the aneurysm and resulted in successful surgery, and that Blue Cross did not consult medical professionals in refusing to pay for her treatment.

Ms. Biddison, who has a family history of high blood pressure and strokes, suffered from severe headaches beginning in 1989, the suit says. Over the next several years, she sought the advice of three doctors, who wanted her to undergo a MRI.

Knowing she could not afford the test, Ms. Biddison sought confirmation from Blue Shield that the procedure was covered, the suit says.

Blue Cross denied the test in September 1990 and never responded to Ms. Biddison's last letter to the company in October, her lawyer said.

The suit charges Blue Cross with negligence in failing to administer the state employees' health insurance according to the contract, and that it used or created guidelines that were not part of her coverage to deny Ms. Biddison the test.

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