Health Insurer Loses In California

It would be interesting to see if what happened out west, would happen here in Texas, with a resident of Grand Prairie, Dallas, Arlington, Fort Worth, Mansfield, or Weatherford. It probably depends on your insurer.
The Los Angeles Times ran an article on March 15, 2010, about a health insurer in California. The title of the article is, “Anthem Blue Cross Should Reimburse California Man For Transplant, Jury Says”.
This article tells about a Los Angeles jury finding that Anthem Blue Cross (Anthem) should cover the cost of an out-of-state liver transplant that a California man paid for after Anthem Blue Cross balked at paying. The liver transplant cost $206,000.
The facts in the story said that the California man who needed the transplant, had already been approved for a liver transplant by Anthem, but he had been put on a waiting list by the UCLA Medical Center. While on the waiting list, the man became gravely ill and fearing for his life, decided to have the operation in Indiana, where the wait times are far shorter than in California.
The jury panel, which included at least three members who had Anthem medical coverage, voted that the company had breached its contract with the man by not paying for the liver transplant simply because he had the surgery out-of-state.
As a continuation of this verdict, there is a hearing next week where the man’s attorney will seek to broaden the jury’s verdict under the California’s unfair competition law, to allow Anthem’s members to pursue organ transplants at hospitals nationwide, that do business with Anthem’s parent company, Wellpoint Inc., the nations largest health insurer.
It is interesting that Anthem in a statement acknowledged that the transplant should have been approved despite the fact that the health insurance contract states that transplants must be performed only at California Centers of Excellence.
In the jury verdict, the California man was also awarded attorneys fees which could far exceed the $206,000 verdict. It is noteworthy that the man was offered an amount in excess of the verdict prior to the trial, which he turned down. The man and his attorney were seeking punative damages against Anthem, which the jury refused to find.
The man claims that the lawsuit was not about money. He pledged before the trial to donate any winnings to liver research. His goal was to get Anthem to stop denying out-of-state transplants.

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