LA TIMES: Trial begins over lawsuit targeting Anthem Blue Cross
Source: Los Angeles Times

Article Note: This article appeared February 23, 2010 in the Los Angeles Times as Jason Adams begins jury trial against California's largest for-profit insurance company Anthem Blue Cross and its parent, Wellpoint, Inc., for a wrongful denial of a liver transplant.

Insurance giant Anthem Blue Cross refused to pay for a California produce merchant to get a liver transplant in Indiana because the company wanted to save money, a lawyer for the patient told jurors Monday.

But a lawyer for the state's largest for-profit insurer argued that the patient, Ephram Nehme, was not sick enough to qualify for an exception to his policy's requirement that transplants be performed in Blue Cross-contracted hospitals in California.

The high-profile trial is expected to shed light on how Anthem Blue Cross, which covers about 8 million Californians, decides what medical care to cover -- and what to deny.

"People buy insurance hoping they are never going to need it," Scott Glovsky, the lawyer representing Nehme, said during opening arguments in Los Angeles County Superior Court. "And Blue Cross sells it hoping people will never need it. Why? Because they make more money."

Blue Cross lawyer William von Behren said there was "no dispute Mr. Nehme needed a liver transplant. The question is whether Mr. Nehme needed to go somewhere other than UCLA for that liver transplant."

Von Behren said the evidence would show that four physicians working for Blue Cross -- two full-time in-house medical reviewers and two contractors -- concluded that "there was nothing in" Nehme's medical records "to indicate that there was any reason for Mr. Nehme to go out of network for a transplant."

The case is unfolding just as the Obama administration is attempting to jump-start a healthcare overhaul. That effort aims to expand the number of people with health coverage, make it affordable and ensure that those with pre-existing conditions are able to buy and keep insurance.

Read the full text of the LA Times story.

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