West Virginia Record

Sunday, October 20, 2019

Heart patient claims Highmark West Virginian wrongfully denied claims for emergency care

Federal Court

By Kyla Asbury | Aug 20, 2019


CLARKSBURG — A heart patient is suing Highmark West Virginia, dba Highmark Blue Cross Blue Shield West Virginia, for its alleged failure to pay his medical claims.

Karl J. Kolenich reported to St. Joseph's Hospital in Buckhannon on Sept. 24, 2018, where he was diagnosed with aortic dissection. He was taken to West Virginia University Hospital, according to a complaint filed in U.S. District Court for the Northern District of West Virginia.

Kolenich claims he discovered on Oct. 5, 2018, that his medical bills for the emergency air ambulance were not being paid by his health insurer through his policy because they were deemed not medically necessary. The plaintiff appealed the decision, which was denied as he was told the provider was out of network.

Kolenich also reported to St. Joseph's Hospital on Oct. 28, 2018, approximately three weeks after open-heart surgery and was diagnosed with atrial fibrillation, but because he had just had open-heart surgery, they refused to treat him, according to the suit. Ruby Memorial Hospital also refused to treat him and sent him back to Cleveland Clinic.

Kolenich claims he went to Cleveland Clinic, where he was admitted to ICU. He later discovered those medical bills were also denied by the defendant because they were out of network.

The plaintiff claims the defendant failed to comply with each and every request for information he requested and caused Kolenich damages. Kolenich claims the defendant wrongfully denied coverage for his medical bills.

Kolenich is seeking a declaration regarding the defendant's noncompliance and benefits payable under the plan along with pre-judgment interest. He is represented by Melissa Roman of Klie Law Offices in Buckhannon.

The case is assigned to Judge Tom Kleeh.

U.S. District Court for the Northern District of West Virginia case number 2:19-cv-00038

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U.S. District Court for the Northern District of West Virginia Clarksburg Division

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