Hundreds of Massachusetts consumers have been helped by the good work done by HLA’s Pro Bono Legal Network. Here are some of their stories:
Kim Troland of Robinson & Cole, LLP successfully represented P.M. a 51 year old Boston man who lost his insurance coverage last Fall, fell ill and incurred substantial bills for a four day hospital stay including 2 days in the ICU. P.M. had been enrolled in an HMO but could no longer afford the premiums. P.M. also was eligible for secondary coverage in a government-sponsored plan because of a disability. P.M. had lost his government sponsored plan in the Fall as well because the state agency had made errors in a review of his eligibility. Attorney Troland represented P.M. before a state administrative appeals agency and won retroactive coverage in the government-sponsored plan so it will cover P.M.'s hospital bills and other out of pocket costs.
Elizabeth Sanghavi of Holland & Knight, LLP successfully represented S.K., a 34 year old Cambridge man who works in the health care sector. S.K.'s income level is low enough to make him eligible for a government-sponsored plan. However, he he had been deemed ineligible because a state agency believed he had access to insurance through his employer, which he did not. Attorney Sanghavi represented S.K. in communications with the state agency to demonstrate and his eligibility and expedite an eligibility determination for the publicly subsidized health plan. S.K. will now be able to enroll in the health plan.
Jonathan Anderman of Holland & Knight, LLP successfully represented D.H., a 54 year old Hadley resident who requires a prescription medication to treat grand mal seizures. When a generic version of the medication became available, D.H.'s health insurer decided it would only cover the brand name medication with a $165 copay every two weeks, up from the $20 copay D.H. had been paying. However, the medication's generic version was not clinically effective for D.H. Attorney Anderman advocated with D.H.'s health plan which agreed to cover the brand name medication with the original $20 copay and it will reimburse D.H. for amount he has paid in increased copays for several months.
Georgia Maheras of Health Care For All and Alfred A. Gray, Jr. of Bowditch & Dewey, LLP successfully represented P.K., a 25 year old Middleton man, and obtained retroactive coverage for health care services provided to him at an out of state skilled rehabilitation facility. P.K. sustained a traumatic brain injury in 2006 and came to HLA in the Fall of 2006 for help with both private and public insurance denials. HLA staff and HLA Legal Network attorneys partnered for over 2 ½ years to obtain a refund of extensive out of pocket expenditures made by P.K. and his family and friends.
Sam Leadholm, Esq. successfully represented L.B., a 62 year old Gardner woman who incurred $9,000 in medical debt after she underwent a surgical procedure at a Central Massachusetts hospital. L.B. was determined eligible for a State coverage program effective two weeks after the procedure. Attorney Leadholm successfully appealed the effective date of the State program to cover the surgical procedure and obtained a waiver of L.B.'s anesthesiology bill. Attorney Leadholm began representing L.B. as a Pro Bono Legal Network member and is now an HLA staff attorney.
Mark Bronstein of the Law Office of Mark Bronstein successfully represented M.T., a 60 year old Boston woman whose disability benefits had been terminated and who was being asked to repay some of her benefits because of an alleged overpayment. Attorney Bronstein won reinstatement of M.T.'s disability benefits and ended the insurer's collection efforts by proving its benefit termination was in error.
Alyssa Yenikomshian of Rosenfeld & Rafik successfully closed the case of A.K. a 48 year old Mansfield woman whose health insurer had denied coverage for a particular type of radiation therapy to treat breast cancer. After A.K.'s insurer denied coverage, she received a $26,000 bill for the radiation. Although a provision in A.K.'s health plan included a specific provision stating this type of radiation was invesigational and not covered, Attorney Yenikomshian successfully advocated for the coverage in an external review process based on documentation of the insurer's previous coverage of this type of radiation for another patient.
Alpana Kumar of Foley & Lardner successfully represented C.F. a 62 year old Haverhill man who is vision and hearing impaired and had lost his health insurance that he had through the MassHealth (Medicaid) program. Attorney Kumar advocated on C.F.'s behalf and helped him enroll in an alternative MassHealth insurance program that will also provide him with comprehensive coverage.
Andrew Dennington of Conn Kavanaugh Rosenthal Peisch & Ford, LLP had a very successful outcome in the case of G.A. G.A., a Hadley resident with a very limited health plan through his employer, accumulated over $30,000 in debt to a New Hampshire hospital after he required a hospital stay. Attorney Dennington succeeded in gaining full forgiveness of G.A.'s hospital bill of over $30,000.
Rebecca Haffajee of Ropes & Gray successfully closed the case of W.L., a 61 year old Wareham man diagnosed with prostate cancer in January 2007. W.L. had been laid off in December 2006. His employer never informed the company's health insurer that W.L. should be taken off the health plan and he was not informed of his right to continue his coverage through a COBRA plan as required by law. W.L. needed extensive health care in early 2007. Several months into 2007, W.L. learned his health insurance was terminated retroactively to January 1, 2007. As a result W.L. became liable for $7,000 in medical bills. Attorney Haffajee successfully advocated for all of W.L.'s medical bills to be covered by his former insurer.
Kate Sullivan of Rosenfeld & Rafik, P.C. received a successful settlement in the case of O.A., a Nashua, N.H. man who was fired by his Chelmsford-based employer after seeking inclusion in the company's health plan that was offered to all other employees.
Lee Holland of Tarlow, Hart, Breed and Rodgers, P.C. successfully represented M.R. a Plymouth woman whose health insurer denied full coverage for a visit to an out-of-network specialist physician it had covered previously. Attorney Holland gained full coverage for the specialist's bill after the insurer initially only paid 50%.
Aron Boros, formerly of Foley Hoag and now of the Office of Medicaid, successfully represented G.K. a Quincy woman with Medicare. Several of G.K.'s doctor's visits were not covered by her insurance at first, but Attorney Boros secured coverage for her medical bills and helped G.K.'s husband sign up for state-subsidized health insurance.
Attorney Sabrina Rusnak of Proskauer Rose LLP successfully represented C.M., a 37 year old Holbrook woman billed over $1,000 by a dentist who provided services to C.M.'s three young children. The dentist asserted he accepted the family's insurance but did not disclose he was out-of-network and the family would incur costs. The dentist sued C.M. in small claims court. Attorney Rusnak successfully negotiated a settlement that eliminated nearly C.M.'s entire debt.
Attorney Ajay Zutshi of Proskauer Rose successfully represented the family of E.M., an 8-year-old Worcester girl. E.M. was enrolled in a private health plan and Mass Health (Medicaid), but her family was charged for several therapy appointments by a counseling agency because they assigned E.M. to a therapist who did not accept payment from her private health plan. Attorney Zutshi provided legal arguments to the agency that led to them ceasing collection efforts with E.M.’s family.
Attorney Leslie Cerio successfully represented F.T. a 35-year-old Chelsea man charged for an ambulance trip for his young daughter. F.T. was aggressively pursued by a collection agency for the debt, but Attorney Cerio was able to relieve F.T. of responsibility for the bill because the collection agency could not adequately verify the debt.
Attorney Rachel Ziegler successfully represented D.I. a 27 year old Boston graduate student needing breast reduction surgery. D.I.'s student health plan denied coverage although D.I.'s doctor had determined the surgery is medically necessary. Attorney Ziegler gained coverage for D.I.'s surgery from her health plan.
HLA Attorney Georgia Maheras and Al Gray Jr. of Bowditch & Dewey LLP successfully resolved the case of P.K. P.K. was recently approved for insurance coverage for skilled nursing services at an out-of-state facility effective May 1, 2007. After more than a year of advocacy, Attorneys Maheras and Gray convinced the payor to provide retroactive coverage for eight months of services after a series of wrongful coverage denials and misrepresentations by the payor
Jane Urban of DLA Piper US LLP successfully represented L.K. a 73 year old Buzzard's Bay woman charged $1,500 for an ambulance trip not covered by insurance. Attorney Urban confirmed that L.K.'s insurance properly denied the claim and ensured that L.K. received a refund of the portion she paid for the service as promised by the ambulance company.
Lisa Fleming of Bromberg & Sunstein successfully represented T.L. a teenage girl from Worcester County, living with several major disabilities arising from birth defects. She is deaf, blind and has defects in growth and development. T.L.'s health plan substantially cut the number of hours of personal care attendant (PCA) services it would cover. Attorney Fendell intervened with T.L's insurer, a substantial portion of her PCA hours were restored and a further evaluation for an additional restoration of hours will commence.
Matt Jill, Colin Sullivan and Mark Batten of Proskauer Rose successfully represented T.N., a 52 year old Peabody man who left his job as a teacher and requested Worker's Compensation benefits. T.N.'s confidential medical records from his Worker's Comp. claim were kept with his personnel file with his former employer and were accessible by many at his former workplace. Attorneys Jill, Sullivan and Batten successfully secured the privacy of T.N.'s medical records.
Susan Fendell of Mental Health Legal Advisors successfully represented T.K., a 9 year old Newton girl who sees a psychiatrist multiple times each week for substantial mental health care needs. T.K.'s new health plan was not covering her psychiatrist as her old health plan did because her psychiatrist is not in the new plan's provider network. Attorney Fendell successfully intervened with T.K.'s new health plan and it is now covering her psychiatrist's services.
Mala Rafik of Rosenfeld & Rafik successfully represented F.L., a 42 year old woman who required coverage for infertility treatment. F.L.'s health plan denied coverage, indicating that she did not meet their standards for coverage of this service. After F.L. attempted an unsuccessful internal appeal with her health plan, Attorney Rafik indicated to the plan F.L.'s willingness to litigate the matter and the parties settled in lieu of litigation.
Attorney Kate Sullivan of Rosenfeld & Rafik represented A.C., a 27 year old Pepperell woman who was denied coverage for a specialized treatment for a neurological disorder. A.C.'s matter was resolved to the mutual satisfaction of the parties.
Andrew Dennington of Conn Kavanaugh Rosenthal Peisch & Ford, LLP successfully represented D.R., a 57 year old Maine man who was flown to a Boston hospital for emergency medical care after he lost several fingers in a carpentry accident. Because he lacked health insurance, D.R. ended up with over $130,000 in medical bills. Attorney Dennington successfully negotiated a full waiver of one hospital bill for over $100,000 and negotiated for the reduction of a physician group bill from almost $33,000 to $6,000.
John Pint of Proskauer Rose successfully represented E.R., a 37 year old Quincy man who incurred a $2,500 debt to an in-home infusion provider when he was not aware that his insurance had been cancelled but continued receiving services. Attorney Pint negotiated a reduction in the debt to under $1,500.
Laura Godine of Steffensen, Herman and Doggett successfully represented O.O., a Malden man who had lost his Medicare Part D prescription coverage for failure to pay premiums and had an outstanding bill from an eye doctor. Attorney Godine was able to retroactively enroll O.O. in his Part D plan and gain him the premium assistance from Medicare that he had been entitled to all along. Attorney Godine also successfully negotiated for a payment plan for O.O. to pay off his eye doctor bill.
George Thompson of Unum Provident successfully represented R.M., a Westfield man whose employer-based health plan denied coverage for inpatient psychiatric services following a suicide attempt. R.M. ended up with about $24,000 in medical bills. With the help of the human resources department at R.M.'s employer, R.M. was released from liability for his medical bills.
Lisa Fleming of Bromberg and Sunstein successfully closed the case of A.A., a 37 year old Walpole woman who is severely disabled and enrolled in MassHealth (Medicaid). MassHealth cut A.A.'s coverage of hours for a personal care attendant (PCA) who helps A.A. with nearly all her daily living tasks. A.A. succeeded in obtaining a new MassHealth evaluation for A.A. and coverage for a significant portion of her PCA hours were restored.
Kevin Kelley, Attorney and Counselor at Law and Christian Holt, Esq. successfully closed the case of G.B. a 58 year old Belmont woman with health coverage only though the state's Free Care program which does not cover most ambulance services. G.B. had two uncovered ambulance bills, one for $592 and another for $644. Attorneys Kelley and Holt successfully advocated for full waivers of both ambulance bills.
Ron Gregson, Esq. closed the case of S.C. a 47 year old Plainville woman who stayed on her ex-husband's health plan after a 2003 divorce. The health plan later notified S.C. that she should have been removed from the plan after the 2003 divorce. The health plan then sought reimbursement from S.C.'s health care providers for services the health plan covered after the divorce. In turn, S.C.'s health care providers sought payment from her. Attorney Gregson successfully arranged for MassHealth coverage of most of the health services that became uncovered and a waiver of her remaining costs.
Mary Olsson of The Olsson Law Firm closed the case of A.C. a 16 year old Greenfield boy diagnosed with depression, anxiety and Asperger's disorder. A.C. was receiving outpatient counseling and he had insurance through a private health plan and MassHealth (Medicaid). However, A.C.'s health care provider refused to accept payment from multiple insurers. Attorney Olsson successfully advocated with A.C.'s health care providers and they are now accepting payment from both of his insurers.
Susan Fendell of the Mental Health Legal Advisors Committee closed the case of P.H. .a 58 year old Falmouth woman needing a prescription medication to treat her chronic mental health needs. P.H.'s health plan denied coverage for her medication. Attorney Fendell advised P.H. on the health plan's prior authorization process and now P.H. is receiving coverage for her medication.
Rick Cahaly of Massachusetts General Hospital closed the case of B.D., a 53 year old Wakefield woman, who incurred medical bills after she had an interruption in her coverage through the State's Medical Security Plan. Attorney Cahaly advised B.D. on how to resolve her medical debt with a hospital. Based on Attorney Cahaly's advice, B.D. negotiated a waiver of her debt.
Nancy Lorenz of Greater Boston Legal Services closed the case of R.V. an East Boston man with AIDS. R.V. is enrolled in a private health plan and MassHealth. MassHealth was supposed to cover R.V.'s copayments for his prescription medication, but R.V. paid the copays for several months. R.V. requested reimbursement from MassHealth but was denied. Attorney Lorenz represented R.V. and got MassHealth to reimburse R.V. for his entire $863 expenditure for the copays.