University officials, Western’s third-party administrator and employee Staci Nash reached a settlement yesterdat over the coverage of four-year-old Presley Nash’s bone marrow transplant.
The settlement requires Medical Benefits Administrators, Western’s third-party administrator, to provide an extra $3,000 for the Nash’s insurance consultation fees. It does not require Western to pay more.
“Nothing has changed,” said John Grise, Western’s attorney. “We have provided the same coverage – no more, no less – that was granted in early August.”
Nash and her husband, former Bowling Green City Commission candidate Brian “Slim” Nash, filed the suit in August after HCC Life, the university’s reinsurer who handles claims of more than $75,000, denied coverage of Presley’s transplant. HCC Life based its decision on the Food and Drug Administration ruling that the procedure was experimental.
University administrators, after hearing advice from the state insurance bureau, agreed to cover the procedure with the faculty and staff self-insurance plan.
Western will pay for the procedure, which university officials say could cost up to $500,000. It will also pay up to $10,000 for food and lodging expenses.
“I don’t believe anyone at this point could say how much this is going to cost,” Grise said, explaining that Presley is still in Minnesota undergoing treatment at the Fairview University Medical Center.
Human Resources Director Tony Glisson previously said the transplant claim will affect insurance premiums for employees next year.
The Nashes are responsible for an annual $400 deductible, a $1,000 co-insurance payment and any co-pay incurred from emergency room and medical office visit fees.
For three months, Western and the Nashes have gone back and forth, disputing exactly what the university will cover under Staci Nash’s insurance plan and if the lawsuit should be dropped.
Grise said the settlement documents the university’s coverage. He said he’s satisfied with the settlement.
“That’s a good thing for Western. They’re not going to incur any (more) legal fees on this case.”
When the suit wasn’t dropped, general counsel Deborah Wilkins expressed concern that the family intended to ask for punitive damages.
Now the only costs still up in the air are attorneys’ fees.
Wilkins said Grise will charge approximately $15,000. It is likely the fees will also be covered by the university’s self-insurance plan, but President Gary Ransdell will make the final decision.
Ransdell hasn’t made a decision about payment of legal fees.
“I just got a call that it’s been settled,” he said. “It’s not a discussion I had yet.”
A hearing scheduled for today to dismiss the lawsuit was dropped because of the settlement.
Instead all the parties will file an agreed order of dismissal, Wilkins said.
“We’re pleased that we’ve been able to resolve it,” Wilkins said.
Neither Staci and Brian Nash nor their attorney, Janice Weiss, could be reached for comment.