Insurance and Anthem and Health Care & Life Sciences and Health Care & Insurance

WellPoint affiliate ordered to pay $206K for transplant

March 16, 2010

Blue Cross of California, a subsidiary of Indianapolis-based WellPoint Inc., has been ordered to reimburse a man $206,000 after he paid for his own liver transplant.

Ephram Nehme (EH'-from NEH'-mee) sued his health insurer to pay for an out-of-state liver transplant, saying he would have died while waiting to have his surgery at a Blue Cross-approved hospital in California.

Blue Cross approved the liver transplant to be performed at UCLA Medical Center in 2006, but his doctor recommended he travel to Clarian Transplant Center in Indiana because the wait times there were much shorter. The 62-year-old paid for the transplant out of pocket in 2007.

Nehme was denied payment in three appeals to the company before Monday's award.

The court also found Blue Cross acted without malice in the denial of payment.

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