Fwd: qotd: Physician awarded damages for being excluded from insurer's network

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-------- Original Message --------
Subject: qotd: Physician awarded damages for being excluded from
insurer's network
Date: Thu, 11 Apr 2013 06:29:11 -0700
From: Don McCanne <don@mccanne.org>
To: Quote-of-the-Day <quote-of-the-day@mccanne.org>



Los Angeles Times
April 10, 2013
L.A. jury sides with doctor in Anthem Blue Cross case
By Chad Terhune

In a rare case, a Los Angeles jury awarded $3.8 million in compensatory
damages to a Porter Ranch doctor who contended insurance giant Anthem
Blue Cross retaliated against him for being a strong patient advocate.

The jury ruled late Monday in favor of Jeffrey Nordella, 58, an
urgent-care and family-practice doctor who alleged that Anthem barred
him from its network in 2010, when he applied to be a preferred
provider. The damages could climb higher Friday, when the 12-person
panel reconvenes and considers punitive damages against Anthem, a unit
of insurance giant WellPoint Inc.

The jury found that Anthem, the state's largest for-profit health
insurer, violated Nordella's right to "fair procedure," and the company
did so with "malice, oppression or fraud." That latter finding prompted
the hearing Friday in Los Angeles County Superior Court to determine
punitive damages.

This case comes as health insurers, in a bid to hold down costs, are
increasingly dropping doctors and hospitals and promoting smaller
networks. Insurers typically try to negotiate lower rates with the fewer
providers left in the network, who get higher patient volume in return.

Theresa Barta, a Newport Beach attorney who represents Nordella, said
the insurance company contended it had 137 primary-care physicians in
its network within 10 miles of Porter Ranch. At trial, Anthem could name
only seven of those doctors, Barta said.

Because of frequent changes in its list of physicians since 2010, Anthem
said, it could not retrieve all of the requested information. The
company maintains that its doctor network was adequate when Nordella
applied.

During closing arguments at trial, Barta said Anthem intentionally
limits its physician roster to make it more difficult for PPO patients
to get care, which reduces Anthem's medical costs and boosts its profits.

http://www.latimes.com/business/la-fi-anthem-doctor-verdict-20130410,0,2796259.story


Comment: The intent of today's message is not so much to use this
opportunity to once again bash one of the nation's largest private
insurers (even if appropriate), but rather it is to demonstrate the
perversity of one more example of placing the business interests of the
insurer over the interests of patients.

Even though this court decision was in favor of a physician barred from
Anthem Blue Cross's network of physician providers, it confirms the
principle that private insurers should be improving patient access to
health care rather than impairing it, as in this now all too common
instance of limiting access by narrowing their networks of health care
professionals and institutions.

Once again, this demonstrates the irrationality of imposing expensive,
intrusive, private third party administrators between patients and their
health care professionals.

In a universal, publicly financed and publicly administered health care
system, such as a single payer national health program, the third party
- the government - covers all reasonable health care services and
products provided by any legitimate health care professional or
institution, with enough oversight to prevent deviancies such as fraud
or price gouging.

It is so obvious, yet...