Newsnow Woman sues insurer over Texas-sized hospital bill

Burnaby-based Pacific Blue Cross taken to court after denying US$51,012 claim for Houston treatment fee

CorneliaNaylor cnaylor@burnabynow com

A woman who fractured her femur during a vacation inTexas is suing a Burnaby-based insurance company that denied her claim for a US$51,012 hospital bill

Chuan Chao, a Surrey resident, bought an insurance policy from Pacific Blue Cross for a trip to Houston from June 4 to July 2, 2022, according to a notice of civil claim filed in B C Supreme Court last week.

Twenty days into her vacation, however, she tripped on a sidewalk and fractured her femur

She was taken to a Houston hospital for surgery

After her release on June 26, she was unable to walk, and her surgeon advised her not to travel, according to the lawsuit

Chao says she contacted Pacific Blue Cross and notified them of the incident, saying she would need to stay inTexas until August because of her injury.

But she did not incur any more medical expenses after her policy ended on July 2, according to the notice.

“At no point did (Pacific Blue Cross) ever advise (Chao) that she would be required to extend her insurance coverage under the policy for the duration of her mandatory stay,” states the notice.

Chao returned to B.C. in mid-August and was told at the end of November that the insurance company was denying her US$51,012 claim.

She is now suing for damages, a declaration that she is entitled to the full amount, and a judgment against Pacific Blue Cross for the money.

She says the insurance company breached its contract by acting in bad faith, failing to tell her she had to extend her policy or face denial of her claim.

She claims Pacific Blue Cross didn’t fairly evaluate the evidence and circumstances involved in her claim and used a provision in the contract to “take ad- vantage” of her health restrictions “to avoid payment for the surgery”

“(Chao) was in a vulnerable position, and she relied on the knowledge and information of (Pacific Blue Cross) when she reported her claim,” states the notice “The actions of (Pacific Blue Cross) are significantly improp- er and egregious, and there is not rational justification for failing to advise (Chao) that she would be required to extend the policy.”

Chao said the prospect of having to pay the fees out of pocket despite believing they’d be taken care of by insurance has caused her “mental distress.”

The claims in the lawsuit have not been proven in court Pacific Blue Cross has not yet filed a response to Chao’s notice.