Anthem Blue Cross of California has been ordered to reimburse a Los Angeles man the $206,000 he spent on a liver transplant despite having been insured by the company at the time he was diagnosed as a transplant patient-candidate. Ephram Nehme 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. A Los Angeles jury concluded March 15 that Woodland Hills-based Anthem Blue Cross should cover the cost of the transplant as well as Nehme’s court costs and legal fees. Although the insurer had approved Nehme’s liver transplant, the long waiting list at UCLA Medical Center prompted the 62-year-old business owner to seek a transplant—paying for the procedure out of his own pocket—in Indiana. His doctor is said to have recommended he do so, fearing Nehme would not live long enough for his name to reach the top of the waiting list in Los Angeles. Anthem’s parent company Wellpoint refused to pay when it was told he would go to Indiana. The case Nehme recently won comes on the heels of multiple appeals, which he lost. The cost of legal fees is expected to far exceed the cost Anthem will also have to pay to reimburse Nehme for his new liver.
