Jury finds health insurer discriminated against patient-advocate doctor

The LA Times reported today on a verdict against a health insurance company that discriminated against a doctor for being a patient advocate. The doctor’s wife was murdered and his children assaulted in 2005, which gave him an appreciation for the patient side of the medical profession.

The doctor challenged hundreds of health insurance claim denials in his provider network when the insurance company contended his treatment “wasn’t medically necessary and would not be covered.” According to the doctor, “many doctors are unwilling to challenge powerful insurance companies because their incomes are so dependent on being in these provider networks. ‘Physicians are so afraid to come forward,’ he said, ‘and I hope this changes that.’” 

A healthcare lawyer interviewed about the case believed it would send a message to insurance companies about the need to be able to justify claim denials and exclusion from provider networks. The loudness of that message will be determined tomorrow, when the jury decides the issue of punitive damages — punitive damages are designed to deter intentionally abusive conduct.