Blue Cross Must Pay $4M for Dropping Patient-Advocate Doc
Yellow Pages
Written by TAC Staff: Yellow Pages   
Saturday, 25 May 2013 15:28 Read : 486 times

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A doctor who claimed health insurer  retaliated against him for being a strong patient advocate, has won a $3.8 million verdict against the insurer.
 
Jeffrey Nordella, a family-practice and urgent care doctor, used to be a preferred provider on the Anthem Blue Cross network, a unit of insurance giant WellPoint Inc. During that time, Nordella challenged the insurer’s decisions to deny his patients claims for coverage. He often protested Anthem’s denial of coverage because it wasn’t “medically necessary” and he even met with top Anthem officials in 2001.
 
When he applied to be a provider again in 2010, the insurer rejected his application.
 
Nordella sued Anthem, arguing that the reason he was not allowed in the network was in retaliation for sticking up for his patients.
 
Anthem claimed it did not need any more family practitioners because it already had 137 primary-care doctors in its network within 10 miles of Nordella, who was medical director of an urgent-care clinic and family medicine in southern California.

But at trial the insurance company could only name seven doctors, according to Nordella’s attorney, Theresa Barta. Barta argued that in order to lower costs and boost its profits, Anthem intentionally cuts doctors from its network to make it harder for patients to get care.
 
The jury found that Anthem denied the doctor’s right to a “fair procedure” with “malice, oppression or fraud,” and originally awarded Nordella $4.49 million. However, the jurors found he was 15 percent to blame for his loss of income and which cut down the award to $3.8 million.
 
The second phase of the trial began on Apr. 12. Barta argued that the jury should punish Anthem based on a portion of its profits of $525 million in 2010. If the jury agrees, Nordella’s award could be increased. 

Source: lawyers.com

 
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