Court allows insurer to deny continued nursing care services to quadriplegic
Kali Pung was paralyzed at her neck level in a diving accident in 2006. She carried health insurance with Blue Cross Blue Shield at the time, and under her contract the insurer was required to provide her with private nursing help. In 2014, changes in the law governing insurance policies contained apparently contradictory language about whether BCBS could cancel Pung's policy. She argued that if similar policies were written by BCBS, it was obligated to continue her policy; BCBS argued that a separate section of the law allowed BCBS to cancel her policy if it didn't write similar coverages for the "small group market."
Not surprisingly, since she drew a Court of Appeals panel with Henry Saad, the insurer's best friend, Pung lost her argument on appeal. The appellate judges ruled that the provision Pung relied upon was rendered inoperable by the provision BCBS relied upon, and that the case she cited as a precedent would apply only to pregnant insureds attempting to avoid cancellation--not disabled insureds. The judges ruled that the public policy limitations on cancellation should apply to women who had "chosen" to become pregnant during the policy period and who likely faced limited expenses, but not to insureds who suffered illness or disease and might represent "enormous" liability exposure to the insurer.