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Pete Mackey
Pete Mackey
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Good Doctor $3.8M – Anthem Blue Cross 0

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On Monday, a Los Angeles jury awarded a doctor $3,800,000 in compensatory damages after it found that Anthem Blue Cross shut him out of its network for standing up for his patients:

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.

The reality is that doctors can not survive without a substantial portion of their bills being paid for by insurance companies or Medicare. Theresa Barta, the lawyer representing Dr. Nordella will introduce evidence at the punitive damage hearing Friday that appears to be compelling:

Barta said that at the hearing Friday over punitive damages, she will tell jurors that Anthem Blue Cross in California generated $525 million in profit in 2010 for the parent company, WellPoint, which also runs Blue Cross plans in 13 other states.

During closing arguments at trial, Barta said Anthem intentionally limits its physician roster to make it more difficult for PPO patients to get care, which reduces Anthem's medical costs and boosts its profits.

Thank goodness that there are doctors out there who put their patients over money. My hat is off to you good doctor – it's not easy standing up to an industry as powerful as this one.