A 95-year-old World War II veteran is suing Blue Shield of California, alleging he has been wrongfully denied home care benefits even as basic daily tasks become more and more difficult for him.
“His health is deteriorating and he is in desperate need of the care he pays for and deserves,” according to the Los Angeles County Superior Court lawsuit filed by Ralph Yeomans, alleging elder abuse as well as breach of contract and the implied covenant of good faith and fair dealing. Yeomans seeks unspecified compensatory and punitive damages as well a court declaration that he is entitled to the benefits he seeks. A Blue Shield representative did not immediately reply to a request for comment on the suit brought Friday, June 30
Yeomans lives alone and is visually impaired, physically disabled, homebound and struggles to move around his house, according to the lawsuit, which also states he finds cooking, cleaning, shopping, taking medication and other basic daily tasks difficult. As a member of Blue Shield’s Advantage Optimum Plan, Yeomans is eligible for part-time or intermittent skilled nursing and home health aide services totaling no more than eight hours per day or 35 hours weekly, the suit states. Last August, Yeomans’ primary care doctor provided certification authorizing the Yeomans’ in-home care, which he was required to do in order to receive benefits, the suit states.
Blue Shield then contacted Allied Pacific of California IPA, a home health services medical group that provided Yeomans three visits by an in-home health practitioner for a maximum of 15 minutes daily, far less than what the plaintiff expected, the suit states.
“Frustrated and in desperate need of in-home assistance, Mr. Yeomans spent 14 months attempting to contact representatives of Blue Shield and Allied Pacific, only to be shuffled around and sent back and forth between each organization,” according to the suit. Yeomans filed a grievance with Blue Shield in February and the insurer responded the next month by telling him once again that a doctor must certify he is homebound, even though his primary doctor had provided that information, the suit states.
“To date, Mr. Yeomans has yet to receive any of the in-home health services to which he is entitled under his subscription to Blue Shield’s policy,” the suit alleges.
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TK says
Keep voting republican. and this is the garbage ‘for profit’ healthcare system we have in this po-s greedy corporate country.
Question Authority says
How’s voting Democrat in Chicago, San Fran and LA working for you?
KL Lehman says
He live in the democratic republic of california dummy
Rosie says
No private health insurance pays for this service. Only Medi-Cal so he needs to qualify for that. If he doesn’t qualify and he is a Veteran, the VA has a home health service he can apply too.
Jill Martinez says
If Mr Yeomans has medi-cal as well he should ask his social worker about the IHSS (In Home Supportive Services) program. It’s a great resource for the elderly and disabled to get the care they need and to be able to remain in their own homes!
Tray says
They’re waiting for him to die. So they will drag this out with their lawyers, making him spend all his money. They took his payments and now they refuse to authorize services, what a great way to treat a veteran.
Christine Ramirez says
Hope he wins….fight back….that’s what they do….give you the run around until you give up….