Anthem Under Fire For Lack of Common Sense

Anthem Blue Cross insurance has been under fire lately. The White House wants Anthem to explains its premium increases, and has been hit by a jury in California for refusing to pay for a liver transplant.

Ephram Nehme was approved by Anthem for a liver transplant in California, but his doctor told him to go to Indiana for a shorter wait. He did so, and Anthem refused to cover the transplant in Indiana, citing its contract with Nehme that stated all transplants had to take place in California. Nehme paid for the surgery himself, then sued Anthem and received the cost of his transplant and attorneys' fees.

While Anthem could be seen as proper for sticking to its contract language, contract language such as this is why people hate insurance companies, and why Democrats think people will support their reforms. Consumers don't understand contract language like this, and don't understand why an insurance company can approve transplants in one state but not another. It was not as if Nehme wanted to have his transplant done in Zimbabwe, he wanted it done in Indiana, another state in which Anthem sells insurance! Anthem could clearly determine whether a provider in Indiana meets its standards for payment. So while Anthem will say that Nehme, and others with Anthem insurance in California, can't leave California for transplants, consumers will only get angry with insurance companies, and become putty for the Democrats.

Insurance companies need to pick and choose their battles with consumers. Hiding behind contract language is going to get Obama's Single Payer System, and insurance companies (as well as Americans) will be the big losers there.