Spanish-speaking family sues Blue Cross for dropping coverage

By Cecilia Green

Published on March 21, 2006

Maria and Raudel Rodriguez were glad they had signed up for health insurance when, a few weeks after their policy began, Raudel needed surgery to open his clogged arteries.

When Raudel, 53, needed the surgery, Blue Cross of California began an investigation into his medical records. The records showed that Raudel had complained of chest pain to his previous doctor, a condition that was diagnosed as heartburn. However, Blue Cross claims that Raudel failed to disclose this preexisting condition in the English-written policy form and that the condition would have made him ineligible for insurance coverage. As a result, the HMO cancelled the policy, returned the $1700 the Rodriguezes had paid in premiums, and left the couple with $130,000 medical bill for the surgery.

The couple insists that they spoke with a Blue Cross representative over the telephone in Spanish and answered all the questions honestly. However, in order to receive coverage, they also had to fill out an application on a form that was written only in English. The Rodriguez family claims that if something was incorrect on the application it was the fault of Blue Cross for making them fill out a form in a language they don't understand.

About 10 percent of HMO members in California are not fluent in English, but they are entitled to the same service English-speaking policy holders receive.

As language barriers are becoming more of a problem in healthcare, steps are being taken to improve the system. The California Department of Managed Health Care will finalize rules this year requiring HMOs to make forms available in several languages to meet the needs of its members.

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