CHARLESTON — A woman is suing Anthem Blue Cross Life & Health Insurance Company after she claims it breached its contract with her.
Tammy Allred, a Chapmanville resident, claims she is insured under her husband's employer, Ramaco Resources, with premiums deducted from his paycheck and sent directly to Anthem, according to a complaint filed in Logan Circuit Court on Sept. 9 and removed to federal court on Oct. 11.
Allred claims on May 23, she was rushed to Logan Regional Medical Center in Logan due to chest pains and pain in her arm. Tests were performed and she was then transported via ambulance to Charleston Area Medical Center Memorial Hospital, where she was admitted and then remained for three days due to a heart attack.
The plaintiff underwent multiple tests during her hospitalization, including an echocardiogram, an EKG and percutaneous coronary intervention (PCI) or angioplasty, according to the suit.
She claims she was also informed she would need to wear a wearable cardioverter defibrillator due to the low percentage heart function she was exhibiting and her additional risk factors of suffering from cardiac arrest and irregular heart arrhythmia.
A formal request was submitted by Dr. Adnan M. Nahla for the wearable, but that request was denied by Anthem and she was discharged and told that the device would not be approved and that further hospitalization would not be covered under her insurance policy, according to the suit.
Allred claims she was informed the following week by her doctor that her echocardiogram results showed her heart was functioning at only 28 percent and another formal request was made for the wearable, but it was, again, denied by Anthem.
Drs. Casey Hager and Nahla have submitted documentation to the insurance company regarding the need for the wearable, but Anthem continued to deny the requests, claiming it was not medically necessary.
Because of its refusal to approve the wearable device, Allred had to pay out of pocket for it and suffered medical bills, annoyance, inconvenience, stress and hardship, according to the suit.
Allred claims the defendant breached its contract and acted in bad faith.
Allred is seeking compensatory and punitive damages with pre- and post-judgment interest. She is represented by Michael M. Cary of Cart Law Office in Charleston.
Anthem removed the action to federal court, citing that since the complaint involves the Employee Retirement Income Security Act of 1974 (ERISA), which is a federal law, the lawsuit needed to reside in federal court.
"ERISA preempts the state law claims and remedies alleged in the Complaint and provides exclusive remedies for the resolution of claims by employee benefit plan participants and beneficiaries," the Oct. 11 notice of removal states.
Anthem is represented by Elise N. McQuain of Frost Brown Todd in Charleston.
U.S. District Court for the Southern District of West Virginia Case number: 2:19-cv-00741
