Monday, March 1, 2010

Anthem Blue Cross Sued For Breach of Contract over Out-of-State Liver Transplant

Insurance companies are not your friend.

That is the first thing you should learn when dealing with insurance adjusters.

Sure they will try to be friendly with you at first but you should remember that when doing their job, their primary duty is to make money for their company.

I’m not saying that they are bad people; I’m just saying that they are doing their jobs.

Take this latest lawsuit against Anthem Blue Cross.

Ephram Nehme claims that Anthem Blue Cross committed a breach-of-contract for not paying about $205,000 of medical costs related to the out-of-state liver transplant he undergone.

However, Blue Cross denied any wrongdoing since the operation was done outside the coverage territory of the company.

The real battleground lies in proving whether Nehme would have died if he waited to have his surgery in UCLA.

Nehme claims that is the case while Blue Cross believes that there are not enough evidence to support that.

The trial is still ongoing and who knows how the jury will decide.

Many people, including me, would of course sympathize with Nehme.

Morally, we all believe that it is the insurance company’s duty to cover those expenses.

However, insurance companies are private companies who, of course are looking to make profit.

Less claims covered also means greater profit.

And Insurance companies have denied coverage to cases with fewer reasons than this one.

And they actually have valid legal arguments to support their defense.

Most insurance policies state the terms of their coverage explicitly.

Hopefully, Nehme will win, but I will not be surprised if he doesn’t.