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Case No. 18-0922

Estate of Kwan Rim
v.
Wellmark, Inc. d/b/a Wellmark BlueCross and BlueShield of Iowa and Wellmark Health Plan of Iowa, Inc.

Appellant

Estate of Kwan Rim

Appellee

Wellmark, Inc. d/b/a Wellmark BlueCross and BlueShield of Iowa and Wellmark Health Plan of Iowa, Inc.

Attorneys for Appellant

Rebecca A. Brommel

Attorneys for Appellee

Mitchell R. Kunert

Court of Appeals

Court of Appeals Opinion

Opinion Number:
18-0922
Date Published:
Jun 19, 2019
Summary

            Appeal from the Iowa District Court for Polk County, Douglas F. Staskal, Judge.  AFFIRMED.  Heard by Vaitheswaran, P.J., and Potterfield and Tabor, JJ.  Opinion by Vaitheswaran, P.J.  (5 pages)

The estate of Kwan Rim seeks further review from a district court decision that upheld the denial of health coverage for a large portion of an extended hospital stay in South Korea.  The estate argues (1) it was erroneous not to apply the strictures of Iowa Code chapter 17A (2016) to the external review process, (2) Rim’s insurer, Wellmark, Inc., had a duty to provide translated medical records to the independent review organization, and (3) the decision of the independent review organization should not have been affirmed.  OPINION HOLDS: Because the independent review organization is not an agency and Rim does not contest any action of the agency, the standards governing review of agency action are inapplicable.  Also, because the medical records were sufficiently intelligible to an English reader to render a coverage decision, we need not determine who should bear the costs of translation, if translation is required.  Finally, we conclude the independent review organization did not err in denying coverage for the bulk of Rim’s hospital stay.  Accordingly, we affirm the district court ruling on judicial review of the IRO’s decision.

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