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:10/13/2017)... ... October 13, 2017 , ... While it’s often important to ... Fortunately, an inventor from Austin, Texas, has identified a solution. , She developed a ... or restricted lighting. As such, it eliminates the need to turn on a light ...
(Date:10/13/2017)... ... October 13, 2017 , ... ... Hannah Randall, PharmD ‘17, and Jennifer Huggins, PharmD ’17, along with clinical ... the primary prevention of cardiovascular diseases during the 15th Annual Women’s Health ...
(Date:10/13/2017)... , ... October 13, 2017 , ... The Visiting Nurse ... Market. Featuring a collection of specialty vendors and unique items from across the nation, ... quality-focused health and wellness services offered by the VNA. The boutique will be ...
(Date:10/13/2017)... ... ... Talented host, actor Rob Lowe, is introducing a segment ... of "Success Files," which is an award-winning educational program broadcasted on PBS Member ... with passion and integrity. , Sciatica occurs when the sciatic nerve in the ...
(Date:10/12/2017)... ... October 12, 2017 , ... First Healthcare ... program management, will showcase a range of technology and learning solutions at the ... Convention and Expo to be held October 14–18, 2017 at the Mandalay Bay ...
Breaking Medicine News(10 mins):
(Date:9/22/2017)... -- As the latest Obamacare repeal effort moves is debated, ... and Lindsey Graham (R-SC) medical device market ... is in an odd place.  The industry wants repeal ... on medical device sales passed along with the Affordable ... visits and hospital customers with the funding to invest ...
(Date:9/18/2017)... , Sept. 18, 2017  PMD Healthcare of ... Pharmacy of Kalamazoo, Mich. , have ... service that expedites and streamlines patient and provider access ... 2.0, and wellness management services.  ... used to measure lung function for a variety of ...
(Date:9/12/2017)... , Sept. 12, 2017  Consumer reviews on the independent review ... as the number one company for hearing aids, ranking it higher ... other brands. ... Named #1 by Consumers For Hearing Aids ... Embrace Hearing is an online store that provides high performance, state-of-the-art, ...
Breaking Medicine Technology: