KHN Morning Briefing

Summaries of health policy coverage from major news organizations

Trial For Lawsuit Against Anthem Blue Cross Begins In California

The trial begins on a lawsuit targeting Anthem Blue Cross today in California.

The insurer "refused to pay for" customer Ephram Nehme "to get a liver transplant in Indiana because the company wanted to save money, a lawyer for the patient told jurors Monday," the Los Angeles Times reports. "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."

The Times points out that the trial is starting just as President Obama is attempting to rejuvenate health reform at the federal level. "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. Nehme's case is 'Exhibit A' of another problem: insurers refusing to pay for or denying care that treating physicians order, Jerry Flanagan, healthcare director for the Consumer Watchdog advocacy organization, said at a news conference outside the courthouse. 'Denials of life-saving, medically necessary care is the M.O. of an industry that puts profits before patients and yet another example of why Americans need a public option to the private insurance market,' Flanagan said."

According to the Times, "Blue Cross said it has approved more than 98.5% of all liver transplant requests since July 2004 and makes exceptions to its in-state requirement when its physician reviewers believe there is good reason" (Girion, 2/23).

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