May 8, 2009
SBDE Partner Gregory L. Bentley Wins Nearly $1 Million Verdict on Behalf of San Bernardino Woman Denied Medical Care by Inland Empire Provider
A San Bernardino jury has awarded a local woman $875,000 after she was repeatedly denied medical treatment for "excruciating headaches" by the largest medical provider in the Inland Empire.
On May 8, 2009, the jury unanimously decided that Beaver Medical Group deliberately and intentionally prevented Mary Medeiros from receiving treatment for the severe headaches she experienced beginning in 2005. Beaver Medical Group is the largest medical provider in the Inland Empire.
"Consumers have the right to receive the medical care they need," said Gregory Bentley, a partner at Shernoff Bidart Darras Echeverria, who successfully tried the case. Mr. Bentley is also president of the Consumer Attorneys of Inland Empire.
"This verdict goes to show that medical providers won't be permitted to put profits before people," Bentley said.
The case brought into focus the odious fee arrangement between medical providers and insurance companies, known as capitation.
Under a capitation agreement, a medical provider is paid a pre-determined amount of money each month by the insurer for every policyholder who selects the provider as their primary medical provider. In exchange for the money, the provider authorizes and provides all medically necessary treatment.
What is troubling about capitation, Bentley said, is that the provider receives the same amount of money each month even if the policyholder does not undergo any medical treatment at all. This gives providers a financial disincentive to offer expensive medical care that cuts into their bottom line, Bentley said.
"It's a system that puts profits before patients," Bentley said. "It's horrible."
In the case of Ms. Medeiros, Beaver Medical had entered into a capitation arrangement with Health Net. In 2005, Ms. Medeiros repeatedly sought treatment from Beaver Medical for her headaches. Her physician steadfastly refused to refer her for an out-of-network MRI exam in spite of medical records stating that she was suffering from an anxiety disorder due to "excruciating headaches." Out-of-network referrals are more expensive than in-network treatment. Ms. Medeiros was eventually diagnosed with a brain tumor.
"It's reprehensible that Beaver would deliberately interfere with this poor woman's medical treatment," Bentley said. "Thank goodness we were able to make sure her legal rights were protected."
