A doctor and the spouses of two dockworkers at the Los Angeles Port have filed a class action lawsuit against Zenith American Solutions, the Pacific Maritime Association and Cigna Inc, alleging that the port’s health care plan is subject to unacceptable backlogs and health care insurance denials.
Kristen Andrich, Loren Armijo and Dr. Ralph Mayer are claiming that thousands of policyholders and dependents have not had their claims repaid, despite the treatment being both a covered benefit under the plan and deemed medically necessary. The backlog has had a dramatic snowball effect that has seen doctors and hospitals go unpaid, medical providers seeking payment from plan participants, policyholders not being reimbursed for their payments and many patients not seeking medically necessary treatment because they cannot rely on their insurance plan to pay for it.
Ms. Andrich claims she received treatment for diabetes and a spinal cord injury, and was given approval to have the medical care covered. After incurring more than $380,000.00 in medical expenses, Ms. Andrich’s treatment was denied or unpaid.
The claims state that in 2013, Zenith American Solutions became the third party administrator for the health care plan, and that is about the time complications with the insurance plan began. Furthermore, the suit alleges that Cigna, who was the administrator prior to Zenith taking over, stopped processing claims a month before it was supposed to and that some 89,000 claims went unprocessed at the beginning of 2013. By the Summer of 2013, there were allegedly 286,000 unprocessed claims because “Zenith lacked adequate trained personnel to administer the Plan,” the lawsuit claims.
If you have unpaid claims and believe you have been wrongly denied or they have simply not been paid, call Kantor & Kantor for a free consultation on 888-569-6013.