Navigation Links
Internal Anthem Blue Cross/WellPoint Document: Only Patients Who 'Push Back' Get Covered Out of State Liver Transplants
Date:2/25/2010

LOS ANGELES, Feb. 25 /PRNewswire-USNewswire/ -- Evidence uncovered this week in the Los Angeles trial of Anthem Blue Cross, subsidiary of WellPoint Inc., which denied a grocer payment for an out-of-state liver transplant, shows the insurance giant will only approve exceptions to its in-state transplant network if patients "push back."

Consumer Watchdog, which posted the internal Anthem Blue Cross protocol at http://www.ConsumerWatchdog.org/resources/BlueCrossPushBack.pdf, said Blue Cross/WellPoint's policy shows the need for national health care reform that includes greater legal leverage for patients to make demands on their insurers and a public option to the private health insurance market.

Grocer Ephram Nehme paid $205,000 out of pocket for a liver transplant in Indiana that saved his life after Blue Cross said he wasn't sick enough to receive the transplant anywhere but at one of its California-contracted hospitals.

Nehme paid for his health insurance as an individual, so he is able to sue Blue Cross. 132 million Americans who receive health insurance through a private employer-paid policy cannot recover damages no matter what harm a denial causes due to a 1981 Supreme Court decision. Nehme also noted his Blue Cross policy premiums recently jumped 50% to $1,500 per month.

The judge in the case barred television cameras from the trial this week, despite many requests for permission.

"Congress needs to push back against Anthem Blue Cross's 'push back' policy," said Jamie Court, Consumer Watchdog president.  "Patients on their death beds shouldn't have to be the squeaky wheel to get the treatment that can save their life. Not only is Anthem raising premiums by 50% on patients like Mr. Nehme, this document shows Anthem is forcing critically ill patients to push hard for medical care that is supposed to be covered in their insurance policies. Congress needs to give patients more legal leverage to fight insurers with a strong national health reform package." 

According to the lawsuit, Blue Cross denied Californian Ephram Nehme's time-sensitive liver transplant at Indiana University hospital even though Nehme's doctor told him that the medically necessary liver transplant would probably not be available in time in California. The transplant was necessary to save Nehme's life.  

According to the lawsuit documents, Blue Cross denied the procedure without speaking with any of Nehme's doctors or reviewing all of Nehme's medical files. A Blue Cross transplant nurse recommended that Blue Cross cover the Indiana transplant before the insurance company denied the claim.

Nehme, who was able to pay for the transplant himself and save his own life, said as the trial began: "I paid insurance all my life. When I got really sick they said no. I am going to make them change their practice."

Read a recent Los Angeles Times story about Ehpram Nehme herehttp://www.latimes.com/business/la-fi-transplant7-2009oct07,0,6616912.story

Download Consumer Watchdog's letter to Congress demanding new legal accountability of the health insurance industry here: http://www.ConsumerWatchdog.org/resources/PatientsBillofRightsHouseSenate.pdf 

Read about why 50 million Americans don't have the same rights as other patients to hold their health insurer accountable for denials of care here: http://www.consumerwatchdog.org/patients/EqualJusticeForPatients/

Consumer Watchdog is a nonpartisan consumer advocacy organization with offices in Washington, D.C. and Santa Monica, CA. Find us on the web at:http://www.ConsumerWatchdog.org

SOURCE Consumer Watchdog

Back to top

RELATED LINKS
http://www.consumerwatchdog.org

'/>"/>

SOURCE Consumer Watchdog
Copyright©2010 PR Newswire.
All rights reserved

Related medicine news :

1. Annals of Internal Medicine tip sheet for Aug. 21, 2007, issue
2. Pharmaceutical Manufacturing Quality: Optimizing Your Internal Process for FDA Compliance
3. Internal medicine physicians recommend key elements to guide state initiatives
4. Internal radiotherapy better than external for quality of life in endometrial cancer patients
5. Sunrise Provides Status Report on Special Independent Committee Investigation; Provides Updates on Managements Internal Control Review Efforts and on Legal Proceedings
6. Michigan Catholic Conference Launches Massive Internal Stem Cell Education Program
7. Annals of Internal Medicine tip sheet for Oct. 2
8. Barta joins Conseco as Senior Vice President, Financial Planning & Analysis; Barra named Senior Vice President, Internal Audit; Clarke to head Investor Relations
9. Pharmaceutical Manufacturing Quality: Optimizing Your Internal Process for FDA Compliance
10. Decision-makers seek internal balance, not balanced alternatives
11. BioHorizons Introduces Its New Tapered Internal Implants Featuring Laser-Lok(R) Microgrooves
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:2/12/2016)... ... February 12, 2016 , ... The Lymphoma Research ... lymphoma research and serving the lymphoma community through a comprehensive series of education ... Florida’s philanthropic community at its 10th anniversary Fashion Luncheon on Monday, February 8, ...
(Date:2/12/2016)... ... 2016 , ... As a former television executive, owner Tal Rabinowitz knows how ... to decompress, Rabinowitz found herself drawn to a casual meditation class while working at ... life, implementing a 20-minute-per-day meditation practice with her team. After her tenure at NBC, ...
(Date:2/12/2016)... ... 12, 2016 , ... Itopia, a leader in cloud services ... Intelligence Platform (CIP) into Cielo®, a discovery, migration and cloud orchestration engine. This ... small and medium business (SMB) clients. , In recent years, BI ...
(Date:2/12/2016)... Arlington, TX (PRWEB) , ... February 12, 2016 , ... ... Worth, and other communities across eastern Texas, is launching a cooperative charity drive with ... and families. , Serving more than 50,000 individuals and families in need, the Tarrant ...
(Date:2/12/2016)... ... ... Donor Network West, the organ procurement organization that heals lives through organ ... Regional Medical Center. Under the collaboration, the first of its kind, specific organ donors ... certain time frame for donor families for the recovery of organs. , Organ ...
Breaking Medicine News(10 mins):
(Date:2/12/2016)... -- Eli Lilly and Company (NYSE: LLY ) today announced ... vitamin regimen patent would not presently be infringed by Actavis ... , Italy and Spain ... dextrose solution.  --> --> ... held that Lilly,s patent would be indirectly infringed by Actavis ...
(Date:2/12/2016)... 2016  Apellis Pharmaceuticals, Inc., today announced ... Series D preferred stock financing, co-led by ... Group and venBio Global Strategic Fund, joining ... Investment, and Epidarex Capital. The proceeds of the ... clinical trials in the Company,s ongoing complement ...
(Date:2/11/2016)... , Feb. 11, 2016 The primary ... and future adoption patterns on the usage of liquid ... the following: - Timeframe of liquid biopsy ... ctDNA, cfDNA and Evs—by organization type - Sample inflow ... types: blood, saliva, stool, serum, and so on. - ...
Breaking Medicine Technology: