Seriously Ill, MS Patient Sues Humana and its Sales Representative for Misrepresentations and Denial of Care

Seriously Ill, MS Patient Sues Humana and its Sales Representative for Misrepresentations and Denial of Care

WEST PALM BEACH, Fla. - Multiple sclerosis (MS) is a life altering neurological disease that in many cases disables the individual afflicted. In the case of Palm Beach County resident, Linda Flowers, the disease has left her medically disabled since late 1996.

As an active, vibrant, successful, working, woman, Linda Flowers achieved success. But things began to change in the mid 1980's when she was diagnosed with MS. Following that diagnosis the disease began seriously impacting her once full and active life. Hope, prayer, meditation, prescription medications, hospital stays, experimental treatments and non-traditional approaches to battle this life threatening disease have been used by Flowers in her fight to maintain balance in day-to-day living. Since 1992, Flowers has been under the care of William A. Sheremata, M.D., a professor of neurology at the University of Miami School of Medicine. Dr. Sheremata is one of the foremost authorities on MS in the United States. His research and work in the area of MS has helped Flowers and countless other patients who are fighting the disease.

Having been declared medically disabled, Flowers is able to receive benefits through Medicare. She received health services coverage, including full coverage for treatment by Dr. Sheremata, through a Medicare HMO plan administered through AV Med through the summer of 2000. However, in August of that year, AV Med withdrew from Palm Beach County. This departure left Flowers searching for health care coverage. "With a preexisting condition securing coverage can be difficult at times," said Flowers' attorney, Ted Leopold of Ricci~Leopold, P.A.. Flowers contacted Humana to inquire about coverage and scheduled a meeting at her home with Bill Torres, a sales representative and agent for Humana.

"Relieved is how Linda felt after meeting with Mr. Torres," said Leopold. "He informed her that Humana would be able to enroll her in their Gold Plus Plan. Linda was relieved to know through Mr. Torres representations as well as Humana's Provider Booklet, that Dr. Sheremata was in Humana's network, and that she would have 'no problems whatsoever continuing to treat with him' and that those treatments would be covered by the company," Leopold added. Linda Flowers relied upon the representations of Mr. Torres, Humana's agent, and enrolled in the plan.

"Most consumers who had been provided with the product and inducements of an authorized agent of a billion dollar plus insurance provider would believe those representations to be true and accurate," said Leopold.

Linda Flowers' MS was under control through the spring of 2001. However in April of 2001, she began suffering extreme weakness on the right side of her body. Flowers suddenly was loosing coordination of her right hand and some cognitive deficits. She contacted her primary care physician, Dr. Jeffery Dresener, a Humana contracted doctor to obtain the appropriate insurance referral for Dr. Sheremata. That is where the trouble began! Dr. Dresener's refused to authorize Flowers' referral for an appointment to see Dr. Sheremata. His reasoning in denying the referral was that Dr. Sheremata was not a Humana contracted physician.

"Linda immediately realized this was contrary to the representations made by Mr. Torres, Humana's agent during the enrollment meeting It was also in direct conflict with Humana's own Provider Booklet which listed Dr. Sheremata as part of the Humana plan." said Leopold. "Today as a result of Mr. Torres and Humana's misrepresentations Linda is without care for her medically necessary treatments for MS. It is clearly an enormous physical and emotional battle when fighting MS. This battle is exacerbated by an incredibly difficult situation with Humana denying life sustaining care that they represented and promised they would provide," said Leopold.

Leopold on behalf of Flowers has filed suit in state court in Palm Beach County against Humana, Inc., and Torres. In the three count complaint Flowers is suing for fraudulently inducing her to enroll in the Humana Gold Plus Plan, intentional infliction of emotional distress and civil conspiracy. In filing the complaint, Leopold will be asking a Palm Beach County jury to award monetary damages, including punitive damages to his client.

In February of 2002, Humana removed the case to Federal Court arguing that the case arose under the Medicare Act and thus Federal law applies. Leopold filed a motion to remand the case back to state court, arguing all of Flowers claims arouse out of Florida state law. On May 31, 2002, United States District Judge, Donald M. Middlebrooks, ruled in favor of Flowers and ordered that the case be remanded back to Palm Beach County Circuit Court. Judge Middlebrooks found Humana's position to be "erroneous" and stated that the case was "improperly removed from state court."

"It would seem that consumers, and in Linda's case a woman who is suffering from a grave medical condition-would be able to trust an insurance company the size of Humana. However, it is obvious that this is not the case. Humana and its agent Bill Torres, sold something that they knew they would not provide, all for an insurance premium. Let the buyer beware. This type of practice is fraudulent and we believe this should not and will not stand," concluded Leopold.