Settlement Amount:
$245,527

Case Name:
Blossom and M. Gitterman v. Health Net

Case Number and Date:
San Diego Superior, Case No. 631230

Plaintiffs:
Blossom and M. Gitterman - Harris I. Steinberg, San Diego

Defendants:
Health Net - Steven Meadville, Encino; Timothy McFarland, San
Diego

Facts and Background:
In late 1989 plaintiff Mrs. Gitterman was diagnosed with terminal
end stage lung failure. Cedar Sinai found her to be an acceptable
candidate for a single lung transplant which had a 65%
possibility of saving her life. Verification of coverage was
sought from Health Net which denied the request indicating the
"lung transplant" procedure is still experimental and
investigative. Mrs. Gitterman died in April, 1990 before the
matter proceeded to arbitration. She had sought to obtain the
lung transplant in London, England where health insurance was not
required.

Plaintiff’s Contentions:
That plaintiff Mrs. Gitterman was an acceptable candidate for
lung transplant surgery and should not have been denied it by
defendant Health Net.

Defendant’s Contentions:
That the procedure was excluded from coverage and not within the
standard of care; that the plaintiff was too old and unacceptable
because of her age and her use of Prednizone which was used to
make her comfortable. Further, plaintiffs were limited to a
recovery of $16,000 out-of-pocket expense under ERISA.

Damages:
Death