CHARLESTON -- A man is suing United Healtcare Services after he claims it wrongly denied coverage for a procedure he had done.
In early 2010, Steven Fields was having difficulty with his lower back and was set to Dr. Anthony M. Alberico, who advised him of an x-stop surgery procedure that would help him, according to a complaint filed May 3 in Kanawha Circuit Court.
Fields claims Alberico informed him he would check first with the insurance company to determine whether or not the procedure was covered.
The plaintiff advised Alberico that if the procedure was covered, he wanted to have it done, but he could not afford it if it was not covered by his insurance, according to the suit.
Fields claims Patricia Mollett from Alberico's office called the defendant and spoke with a woman who told her the insurance carrier did not require pre-certification for the procedure and that it would be covered under his health insurance.
Based solely on that representation, Fields was scheduled for the surgery and it was conducted, according to the suit.
Fields claims the procedure was successful, but afterward he began to receive bills from the defendant for payment because it had denied coverage on the basis that the procedure "was not a covered procedure."
The plaintiff appealed the decision three times, based upon his detrimental reliance on the representations by United to Mollett, according to the suit, however, in the first two appeals, United Healthcare ignored this issue.
Fields claims in his third appeal, through counsel, United Healthcare finally addressed the issue in one sentence.
Under the Doctrine of Detrimental Reliance, Fields is entitled to have coverage provided to him by United Healthcare for the procedure, according to the suit.
Fields is seeking compensatory and punitive damages. He is being represented by Michael J. Del Giudice.
The case has been assigned to Circuit Judge Jennifer Bailey.
Kanawha Circuit Court case number: 11-C-714