A 95-year-old World War II veteran has filed a lawsuit against Blue Shield of California, claiming that he has been wrongly denied home care benefits despite his deteriorating health and increasing difficulties with daily tasks. Ralph Yeomans, residing in La Habra Heights, alleges elder abuse, breach of contract, and a breach of the implied covenant of good faith and fair dealing.
Yeomans is seeking unspecified compensatory and punitive damages, as well as a court declaration affirming his entitlement to the benefits he seeks.
The suit, filed in the Los Angeles Superior Court, states that Yeomans lives alone, is visually impaired, physically disabled, and homebound. He struggles with basic daily tasks such as cooking, cleaning, shopping, taking medication, and moving around his house.
As a member of Blue Shield’s AdvantageOptimum Plan, Yeomans is eligible for part-time or intermittent skilled nursing and home health aide services, limited to a maximum of eight hours per day or 35 hours per week. Last August, his primary care doctor provided certification authorizing his in-home care, as required to receive benefits.
Blue Shield then contacted Allied Pacific of California IPA, a home health services medical group, for Yeomans’ care. However, he received only three visits by an in-home health practitioner, lasting a maximum of 15 minutes daily, which fell significantly short of his expectations, according to the suit.
“Frustrated and in desperate need of in-home assistance, Mr. Yeomans spent 14 months trying to reach representatives of Blue Shield and Allied Pacific, but was constantly shuffled between the two organizations,” the suit claims.
In February, Yeomans filed a grievance with Blue Shield. The insurer’s response the following month was to tell him once again that he must have a doctor certify that he is homebound, despite the fact that his primary doctor had already provided that information, the suit alleges.
To date, Yeomans has not received any of the in-home health services to which he is entitled under his Blue Shield policy, according to the lawsuit.
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