Monday, April 15, 2013

Insurance Company in California Ordered to Pay $3.8 million to Doctor They Retaliated Against

The Physician Was Guilty of Trying to Get Reimbursement for His Patients

The corrupt, mismanaged, inefficient, outdated (fill in your adjective here ________) U. S. health care industry got a nicet lesson when a jury in California awarded a physician $3.8 million in damages when an insurance company tried to exclude him from their preferred physician group.  The problem, according to the doctor and validated by a jury was this.

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.

Now juries are notorious for siding with doctors, so this case will go to appeal and the insurance company may yet prevail.  But here is one of the smoking guns in the trial.

The company rejected Nordella's application for its PPO network because he wasn't board certified in family medicine and because Anthem already had a sufficient number of primary-care physicians, Ng said. At the time, Nordella was medical director at Porter Ranch Quality Care, a walk-in clinic that offers urgent care and family medicine.
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.

Gee, seven instead of 137.  Well the company had an excuse.

Because of frequent changes in its list of physicians since 2010, Anthem said, it could not retrieve all of the requested information.

but of course there is another explanation as to why the company could not name the 137 doctors.  They didn’t exist.

 Oh, that.

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