A woman had to have her hip, leg and pelvis amputated because an insurance company delayed by over a month an MRI that later uncovered cancer, new court papers allege.
Kathleen Valentini was told to get the MRI by a doctor Feb. 4, 2019, because of debilitating pain in her right hip that caused her to limp, a Manhattan Supreme Court lawsuit says.
But insurance company Group Health Incorporated and the claim reviewing company eviCore said the procedure was “not medically necessary” when they overruled the doctor’s recommendation Feb. 16, 2019, the suit from Tuesday alleges.
Instead, the insurance company said Valentini should receive six weeks of physical therapy first — despite the fact that she had just completed weeks of physical therapy that didn’t improve her pain and that “GHI had approved and paid for,” the court papers claim.
“The insurance company and its utilization review lapdog had not bothered to review their own records or follow their own procedures before rendering this illogical, dangerous, and ultimately life-threatening opinion,” the suit charges.
The doctor fought the denial and GHI finally approved the MRI 40 days later, with the March 14, 2019, procedure revealing that Valentini had a sarcoma in her right hip, the court documents say.
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The 51-year-old North Carolina mom went to Memorial Sloan Kettering in New York, where a doctor told her, “had you come to us a month sooner, we could have used chemotherapy,” claims the suit — which was filed in Manhattan because that is where GHI is based.
“Now we can’t. We have to amputate before we treat with chemo,” the doctor continued to tell Valentini, according to the court papers.
Valentini lost her leg, and cancer was also found in her right lung, the suit says.
“The amputations caused Kathleen extraordinary pain and suffering, and dramatically reduced her ability to conduct activities of daily living and provide for the care and education of her son, whom she had been home-schooling,” the court documents say.
Valentini is still battling cancer, her lawyers said.
“The loss of Ms. Valentini’s leg, hip and pelvis never should have happened,” her lawyer Jordan Merson said in a statement. “This is just a terrible, traumatizing injury and not only has Ms. Valentini suffered needlessly, but her husband and son have also been devastated by this experience.”
Valentini’s other lawyer, Steve Cohen, added: “Sadly, this practice of deny, delay, and defend by insurance companies is all too common.”
Valentini, her retired NYPD cop husband, Valerio Valentini, and her 17-year-old son are suing for over $2 million in damages.
GHI’s parent company, Emblem Health Inc. — which is also named in the case — said, “We are very saddened to hear of Ms. Valentini’s medical issues. The health and safety of our members is our top priority.
“We cannot comment further given our commitment to member privacy.”
Evicore did not immediately return a request for comment.