Prior to policy period, Plaintiffs' son fell and injured his knee while playing at school. Plaintiffs later obtained an individual health insurance policy with Blue Cross & Blue Shield of Mississippi (BC/BS). After the effective date of the policy, Plaintiffs' son begins to complain of pain, which is ultimately diagnosed after extensive testing to be related to a congenital condition in the boy's hip. BC/BS denied claims for payment associated with the hip condition on the basis of the Company's pre-existing condition exclusion, claiming that he had received treatment for it when he went to the doctor for his injured knee.
BC/BS settled shortly after filing suit for $19,800 - an amount which exceed twice the amount of unpaid claims.