Insurer denies out-of-network liver transplants, lawsuit filed

A trial beginning next week targeting the nation's largest health insurer and its California subsidiary for allegedly automatically denying requests for out-of-network liver transplants will help shed light on the need for stronger health reform than is currently being considered, according to Consumer Watchdog. The group urged President Obama, White House representatives, and the national news media to follow the trial.

Download the lawsuit filed in the Los Angeles Superior Court against WellPoint and Anthem Blue Cross of California by attorneys Scott Glovsky and Jason Adams: http://www.consumerwatchdog.org/resources/lawsuit.pdf.

"This lawsuit is a perfect example of the type of health care that Americans can expect under legislation pending in the U.S. Senate that would make private health insurance compulsory for every U.S. resident," said Jerry Flanagan, Health Care Policy Director for Consumer Watchdog. "Denials of life-saving, medically necessary care, is the MO of an industry that puts profits before patients and yet another example of why Americans need a public option to the private insurance market. When the nation's largest PPO is alleged to have automatically denied liver transplants at out-of-network hospitals it is clear that Congress must require more transparency when insurance company bureaucrats override a doctor's prescription, and greater legal accountability when they deny access systematically."

According to the lawsuit, Blue Cross denied 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 his life. As a result of Blue Cross' denial, Nehme paid more than $205,000 for the surgery. 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 insurance company denied the claim.

Read today's LA Times story about Ehpram Nehme here: http://www.latimes.com/business/la-fi-transplant7-2009oct07,0,6616912.story.

Leading health care legislation pending in Congress would require all Americans to have health insurance, but does not provide additional legal accountability over the industry or limit what insurance companies can charge for coverage. The House version of the bill does provide a Medicare-style public alternative to private insurance, however the bill passed by the Senate Finance Committee last week does not.

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