Whittier : Dying School Employee’s Insurance Claim Denied

A last-ditch, unsuccessful treatment to save the life of a school employee has cost the Whittier Union High School District more than $100,000. In an April 17 meeting, the district board ratified a payment of $110,376.40 to Kenneth Norris Jr. Cancer Hospital and Research Institute at USC. The district says Blue Cross of California would not honor the district’s claim.

“We paid Norris up front to get the patient in the hospital,” Supt. Lee Eastwood said. “We were trying to save the life of an employee. We believed the surgery was covered. Blue Cross says the surgery was experimental, and they’re not going to cover it.”

Blue Cross confirmed that the claim had been denied. The company’s medical director said treatments that are not yet standard practice will typically be excluded from policies because they usually fail while driving up the cost of premiums.

“They should have been able to call us and get a policy determination,” said Brian Gould, the insurer’s medical director. “They should have had an answer within hours at most. If that didn’t happen, we would look into it. Then, something went wrong.”

“It is not unusual for employers and friends to come forward and say, ‘We can’t just let you die,’ ” said Gould, commenting on the school board’s action to pay a medical bill out of its general fund. “In other circumstances, we see neighbors taking collections or people going on TV and asking for contributions.”

Eastwood said the district is considering legal options for recovering the money. He declined to name the patient, who died shortly after the treatment.