Ohio doctor challeges denial of insurance coverage to disabled husband

PARKERSBURG -- An Ohio doctor is suing a West Virginia insurance company for its failure to pay medical bills her husband, who is also a doctor, incurred as a result of his ongoing hospitalization.

Dr. Teresita De Josef filed a breach of contract suit in Wood Circuit Court against Highmark Blue Cross Blue Shield of West Virginia. In her complaint filed Jan. 27, De Josef, 71, of Devola, Ohio, alleges Highmark last year refused to pay the bulk of medical expenses Dr. Aniano De Josef, 68, has accumulated since 2006 following his near-fatal brain injury.

Aniano is named as a co-plaintiff in the suit with Teresita serving as his power-of-attorney.

According to the suit, Teresita purchased a group insurance policy from Highmark that included Aniano as a member. The suit does not state when this occurred.

Formerly known as Mountain State Blue Cross Blue Shield, Highmark of West Virginia is based in Parkersburg. In 2004, it began a permanent affiliation with the Pittsburgh, Pa.-based Highmark, Inc., an independent licensee of the Blue Cross Blue Shield Association, and changed its name in January to reflect it.

Highmark of West Virginia's coverage area is all of West Virginia, and Washington County, Ohio.

On Sept. 13, 2006, Aniano "suffered a severe hypoxic brain injury during which he almost lost his life." A hypoxic brain injury is triggered by a lack of oxygen going to the brain.

Upon learning of Aniano's condition, Teresita had him admitted to Marietta Memorial Hospital where he "has been a patient ... since that time." In the suit, Teresita avers that in the last 4 ½ years Anianos's medical bills and expenses have exceeded $1 million.

On an unspecified date, Teresita submitted the bills to Highmark for payment. She alleges while they've paid some of them, Highmark on Aug. 31, issued a decision denying coverage for a "significant portion" of the bills.

The suit does not state the total of the remaining expenses.

Regardless, Teresita maintains since she purchased the policy, all premiums have been paid, and she has complied with all the terms and conditions. She says should Highmark's decision to refuse payment of the remaining bills stand it will place a heavy burden on her financially, and possibly force her into filing bankruptcy.

Prior to his injury, Aniano worked as a pathologist at MMH. Currently, Teresita, a general practitioner with a specialty in internal medicine, has a solo practice in St. Marys.

The De Josefs seek unspecified damages, interest, attorney fees and court costs. They are represented by Parkersburg attorney George J. Cosenza

The case is assigned to Judge Robert A. Waters.

Wood Circuit Court, case number 11-C-37