In a Michigan First, Blue Care Network Settles Denial of Care Suit

A Michigan woman has settled a suit against an HMO for denying care, marking the first time in state history that a plaintiff has "successfully sued" an HMO for a business policy, the Detroit News reports. Plaintiff Cassandra Branch sued Blue Care Network, a subsidiary of Blue Cross Blue Shield of Michigan, over its "bad debt" policy that prohibits patients with outstanding debts from receiving care. In August 1990, Branch's doctor, who was part of the Blue Care Network, refused to care for Branch's 11-year-old daughter because Branch owed $40. Although the plaintiff offered to pay the bill at that time, she was told "she could neither pay nor see a doctor," according to the Detroit News. The plaintiff's daughter, Kim, was admitted to the hospital two days later with viral encephalitis, a condition that could have been treated if diagnosed earlier, the News reports. As a result, Kim suffered permanent brain damage and died five years later. The News reports though that most HMO lawsuits have been dismissed under ERISA. Earlier this year, the Michigan Court of Appeals ruled that Cassandra and Kim Branch were not "actual" HMO members, but instead had traditional Blue Cross insurance and subsequently had not agreed to the HMO's "bad debt" policy. Therefore, the state Court of Appeals determined that the Branch family had the right to sue, which prompted the HMO to negotiate an undisclosed settlement with the family. Ann Mandt, the plaintiff's lawyer, said the Branch case provides an example of "why patient protection is needed." Mandt said, "Every day of the week, people are denied necessary health care based on decisions made by non-medical people, which is exactly what happened in this case" (Webster, Detroit News, 12/1).