Court told to retry widow’s claim against HMSA

The widow of a cancer patient who died in 2008 will get another day in court in her case against Hawaii Medical Service Association, the health insurer that denied her husband’s second stem cell transplant.

A lawsuit filed by Patricia Adams claiming that the state’s largest health insurer treated her husband Brent Adams unfairly and in bad faith when HMSA refused to cover a second stem cell procedure went to the Hawaii Supreme Court, which ruled that the case must be retried in a lower court.

In 2005, then 40-year-old Brent Adams was diagnosed with stage 3 multiple myeloma, a rare, aggressive bone marrow cancer. His doctors recommended he undergo back-to-back stem cell transplants for the best chance of survival: the first, a transplant of his own stem cells and the second, a transplant from a sibling donor several months later.

HMSA paid for the first procedure but denied coverage of the second. After a lengthy appeals process HMSA was ordered by the state Insurance Division to pay for the second transplant in 2007. Adams died about a year later after fighting the insurer for two years to cover his treatment. HMSA declined to comment on pending litigation.

“Had HMSA timely informed them that Adams’ plan did not cover the second-phase transplant, he would have undertaken a different treatment, entered a different clinical trial or raised money for the second-phase transplant,” said Tred Eyerly, director at Honolulu law firm Damon Key Leong Kupchak Hastert, representing Patricia Adams. “By the time HMSA did tell him, it was too late for an effective second-phase transplant.”

The Supreme Court kicked the case back to the First Circuit Court to reconsider Patricia Adams’ claim that HMSA failed to inform Brent Adams in a timely manner that the stem cell transplant would not be covered under his health plan and to determine if the duty of insurers to treat members in good faith “only applies after an insured person submits a claim.”

“Insurers should provide full information about coverage at all times, not just after a claim has been made,” Eyerly said. “Adams might have had a better chance of survival if HMSA had simply told him at the outset that his preferred course of treatment was not covered by his plan.”

HMSA paid for Brent Adams’ first procedure but denied coverage of the second. After a lengthy appeals process HMSA was ordered by the state Insurance Division to pay for the second transplant in 2007. Adams died about a year later after fighting the insurer for two years to cover his treatment.