Anthem to pay doc $3.8M for wrongful exclusion from network

A California court has decided that Anthem Blue Cross must pay a physician $3.8 million for wrongfully excluding him from its network.

Jeffrey Nordella, who practiced emergency and family medicine in the Los Angeles area, said Anthem blocked him from joining its network when he applied in 2010. He claimed Anthem was retaliating for his strong advocacy of patient rights when he was a previous in-network doctor, reported the Los Angeles Times.

In the past, Nordella challenged hundreds of Anthem's claims denials, particularly when the state's largest for-profit insurer said the care wasn't medically necessary and, therefore, wouldn't be covered.

"This verdict sends a message to doctors that they have a voice. They can stand up and fight back against insurers," Nordella's attorney, Theresa Barta, said in a statement. "This is a huge win, not only for my client, but for all physicians."

But Anthem claimed it barred Nordella from its network because he wasn't board certified when he applied. Plus, the insurer said there already were more than 130 primary care physicians like him in the surrounding area, according to the Northridge-Chatsworth Patch.

During trial, Barta accused Anthem of prioritizing profits over patient care by unlawfully excluding doctors to limit members' ability to receive care, which then lowers its own costs and boosts profits.

Nordella told the LA Times he hopes the verdict will make it easier for other doctors to challenge insurers when they're wrongfully turned away from a network.

Carol Lucas, a healthcare lawyer in Los Angeles who represents doctors and medical groups, agreed the decision could affect insurers' future decisions regarding provider networks. "Insurance companies will likely look at what happened here to Anthem, and they will make sure they can justify any exclusions from their networks," she told the LA Times.

After hearing the verdict, Anthem spokesman Darrel Ng said the insurer "is disappointed in the outcome and will examine our options in filing an appeal."

To learn more:
- here's the statement
- read the Los Angeles Times article
- check out the Northridge-Chatsworth Patch article