A lawsuit out of Florida is challenging Anthem's decision not to cover an air ambulance trip, despite the patient's physician deeming it medically necessary.
In the lawsuit filed Oct. 6 by the unnamed patient and air ambulance company Jet ICU, the plaintiffs claim Anthem wrongfully deemed the flight medically unnecessary and "placed its own healthcare decision making over the Patient's doctor."
According to the lawsuit, Anthem suggested that the patient, who was suffering a myocardial infarction while on a cruise, receive emergency treatment at a local Dominican Republic hospital instead of a level 1 trauma center in Florida as recommended by the patient's physician.
Despite Anthem's alleged suggestion, the patient was airlifted back to a hospital in Florida for treatment.
While Anthem reimbursed the land ambulance in Fort Lauderdale, Fla., it did not reimburse any of the air ambulance bill, according to the lawsuit. The patient still owes nearly $240,000.
Jet ICU and the patient allege that not covering the air ambulance bill violates Anthem's coverage policy, which says it will cover air ambulance services when an individual is transported for a medical emergency to a hospital, according to the complaint.
Anthem has not responded to requests for comment at the time of publication. This story will be updated as new information becomes available.