A Los Angeles jury has concluded that Anthem Blue Cross should cover the cost of an out-of-state liver transplant that a California man paid for after the insurer refused to pay. In addition, the jury ordered Blue Cross to pay the Plaintiff’s legal expenses, which could greatly exceed the $206,000 cost of the transplant. Blue Cross approved Nehme’s liver transplant in late 2006, and he was on the waiting list at UCLA Medical Center. But the company refused to pay when Nehme, gravely ill and fearing for his life, decided to have the operation in Indiana, where wait times are far shorter than in California.
The jury voted 10 to 2 that the company breached its contract with the Plaintiff. It voted 9 to 3 that the health insurer acted in bad faith by refusing to pay for the out-of-state operation. The Plaintiff’s lawyer will ask the trial judge to order Blue Cross to allow its California members to pursue organ transplants at hospitals nationwide that do business with its parent, Indianapolis-based WellPoint Inc., the nation’s largest health insurer. This request is under the state’s unfair competition law.
Interestingly, according to Blue Cross, it offered to settle the case with the Plaintiff several months ago for more money than the jury awarded. The Plaintiff, a 62-year-old produce merchant and grandfather, said the case was not about money. Before the trial began he pledged to donate any winnings to liver research. He saw the suit as a way to pressure Blue Cross to stop denying out-of-state transplants, adding that he was particularly concerned about patients who could not afford to pay out of pocket. The Plaintiff said before the trial started:
I’m trying to save lives. There are a lot of people who need liver transplants, and they should be able to get them wherever they need them.
The Plaintiff’s liver began to fail in 2006, and he was placed in line for a transplant at UCLA. Blue Cross readily approved the procedure at the hospital, which is part of its contracted network. But his condition rapidly deteriorated, and his UCLA physician urged the Plaintiff to go to the Clarian Transplant Center in Indianapolis, where he had sent other patients. At the time, the median wait time for livers at UCLA was more than two years. At Clarian, an Indiana University-affiliated hospital, the wait time was about six weeks. When Blue Cross refused to pay, the Plaintiff went anyway and paid the cost of the January 2007 operation. He recovered and returned to work as the owner of produce markets in the Simi and San Fernando valleys. The suit contended that Blue Cross denied the Indiana transplant to save money.
Source: Los Angeles Times
Contact us today for a free legal consultation with an experienced attorney.
Fields marked *may be required for submission.
If you would like to subscribe to the Jere Beasley Report digital edition, simply visit our Subscriptions page and provide the necessary information or call us at 800-898-2034.
Attorney Advertising - Prior results do not guarantee a similar outcome.