The LA Times is reporting that Anthem Blue Cross lost its jury trial concerning its unwillingness to pay for an out of state transplant. Not only did the jury say that Anthem breached its contract but also acted in bad faith:
Blue Cross approved Nehme's liver transplant in late 2006, and he was on the waiting list at UCLA Medical Center. But the company refused to pay when Nehme, gravely ill and fearing for his life, decided to have the operation in Indiana, where wait times are far shorter than in California.
The jury, which included at least three members with Blue Cross medical coverage, voted 10 to 2 that the company breached its contract with Nehme. It voted 9 to 3 that the health insurer acted in bad faith by refusing to pay for the out-of-state operation. The panel deliberated for less than two days.
"The message here is that you can't take people's money, promise to protect them, and then leave them to die in their time of need," said Nehme's lawyer, Scott Glovsky.
Anthem was spinning hard after the verdict, saying they were pleased that they were not found responsible for acting with malice. Bad faith wasn't enough? They also implicitly accused Nehme of wasting court time by not taking the settlement they had offered. Of course, this loss is much worse for Anthem than it would have been if they had managed a settlement for more. They could have just paid the bill, too, and not had this problem. Sometimes it's good to see stubborn people who won't be bought off.
The insurer will now be paying the cost of the transplant and all legal bills and is facing the possibility of an order that they allow transplants anywhere the parent company does business. Must be fun working PR for these guys.
Also at Insurance Matters