This poor doctor if you read a little bit of his history outside the office had his wife killed by a violent former Air force Captain back in 2005 who then went to a Wal-mart store in the San Fernando Valley and continued his rampage. The man stole the a car from the pool maintenance man at the doctor’s house and beat up the doctor’s wife and his two kids and his wife ended up dying. He said this incident was part of his motivation to be such a patient advocate after having been a patient himself.
Anthem said they were considering an appeal and the damages could grow higher. The doctor went the extra miles to meet with officials at Anthem to resolve the claims as well in 2001, so this was a very longstanding dispute. Anthem rejected him from being a PPO in their network. His attorney argued that Anthem limits the number of doctors in the network to keep their care expense down. Perhaps this case will be an awakening here for insurance carriers as this is not the first battle of it’s kind out there, but might be the first victory of substance. Yesterday United Healthcare was ordered by a jury in Las Vegas to pay $500 million relating to a “low ball” reimbursement contract with a doctor who was evidently cutting corners to keep the practice going. Family practice doctors have really been hit the hardest and for all they do, they end up on the low end of the scale for payment. BD
In a rare case, a Los Angeles jury awarded $3.8 million in compensatory damages to a Porter Ranch doctor who contended insurance giant Anthem Blue Cross retaliated against him for being a strong patient advocate.
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.
Nordella said he was turned away because he had challenged the denial of hundreds of patient claims over the years when he was previously included in Anthem's network. He said he often protested Anthem's conclusion that care wasn't medically necessary and would not be covered. Nordella went so far as to meet with top Anthem officials in 2001.
Nordella said many doctors are unwilling to challenge powerful insurance companies because their incomes are so dependent on being in these provider networks. "Physicians are so afraid to come forward," he said, "and I hope this changes that."