NEW ORLEANS -- The U.S. District Court of the Eastern District of Louisiana has ruled against an argument filed by Karen S. Kovach and Isaac Soileau, owners of Soileau & Associates LLC, regarding an insurance claim.
Soileau and Kovach were forced to prepay $1,192 daily in hospital charges for the care of a child. According to the lawsuit, their medical insurance policy with Louisiana Health Service & Indemnity Company should have covered those charges instead.
On Aug. 15, U.S. District Court Chief Judge Nannette Jolivette Brown ruled in favor of Louisiana Health stating that, based on the Employee Retirement Income Security Act of 1974, "[Louisiana Health Service & Indemnity] "has established the policy is an employee welfare benefit plan under the Fifth Circuit’s three-part test. Therefore, because the policy is an employee welfare benefit plan under ERISA ... federal-question jurisdiction exists."
Federal Court to hear insurance claim
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The lawsuit was initially filed in December 2017. Kovach and Soileau alleged the policy provided for coverage by Louisiana Health Services was for their minor child, K.S. According to the lawsuit, K.S., "had been previously diagnosed with “traumatic brain injury, fetal alcohol syndrome, autism, pervasive developmental delays, ADHD-severe, PTSD, anxiety, and several other neurological conditions" In 2014, K.S.’s condition became so unsafe that both parents, "were essentially required to stay with her continually, almost 24 hours a day.”
Physicians referred K.S. for treatment at Cumberland Hospital for Children and Adolescents in New Kent, Virginia. She was admitted for inpatient treatment in January 2015. The lawsuit states that, "after her premature discharge from Cumberland Hospital, K.S.’s condition deteriorated, resulting in several voluntary and involuntary emergency department admissions between August 2015 and March 2016." By June 2017, after being denied further treatment and appealing that decision, Louisiana Health Services allowed for medical treatment of K.S. but, "asserted a policy exclusion for “custodial care” to deny impatient treatment effective April 19, 2017."
Kovach and Soileau say they were forced to prepay all charges to Cumberland Hospital, even though the policy doesn't state that prepayment of pre-authorized services is required.