No Damages from Horizon, Doc Says He’ll Go to Supreme Court

COURT HOUSE — The Superior Court found in 2007 that an insurance giant wrongfully terminated a local cardiologist, but said the doctor failed to prove any monetary loss and the appeals court agreed last week deciding not to award any damages.
“I am very disappointed in the court’s decision,” Dr. Suketu Nanavati told the Herald. “I don’t know how they could find I wasn’t impacted by the loss of the insurance carrier’s patients.”
“I guess I’ll have to take this to the Supreme Court,” he said.
In 1997, Nanavati, owner of the Cape Heart Clinic in Court House, was dropped from the roster of approved physicians by Horizon Blue Cross and Blue Shield. Horizon is this region’s largest insurance provider.
Nanavati was dropped from Horizon’s roles when he was charged by the state Board of Medical Examiners with writing too many prescriptions and not recording the reasons for writing them.
In 1998, Nanavati’s case was substantially dismissed with a smack on the wrist for improper record keeping. He was reinstated as a participating physician the same year with Horizon. In March 2000, Horizon again dropped Nanavati from its ranks.
In 2003, Nanavati filed a lawsuit against Horizon for wrongful termination and breach of contract. He won the lawsuit in 2007 and Horizon was forced to reinstate him, but the court said Nanavati failed to prove monetary damages.
Nanavati filed an appeal on the denial of damages noting that the trial court should have determined damages once it found Horizon had broken its contract. The court, however, found that the Nanavati’s business actually grew after being dropped by Horizon and his case was hurt because he didn’t file the lawsuit for three years after being dropped.
Nanavati told the Herald last year that he was forced to turn “so many” patients away while he was off Horizon’s books. He said he could only accept Medicare patients and those wealthy enough to pay out of their own pockets.
When he won the lawsuit against Horizon, Nanavati said it was “great news for doctors everywhere who are tired of fighting these insurance monopolies.”
In 2007, Nanavati told the Herald he wasn’t surprised that the court failed to award him damages when he won the lawsuit.
“The courts have given HMOs immunity from damages in cases where death has resulted even when it had been found they denied life-saving treatments, so I wasn’t expecting any money,” Nanavati said. “I’m just glad to be able to help more local heart patients who are covered by Horizon.”
Even then, Nanavati said he would continue to fight Horizon’s move in the appellate courts. He was forced to file a complaint when the insurance carrier failed to reinstate him last year after he won the lawsuit. He was finally reinstated six months later.
“The fight is not over,” Nanavati told the Herald. “We’ll see what the Supreme Court says next.”
“If Horizon thinks I’m finished with them after they’ve treated me in this way for over 10 years, they must not know me very well,” Nanavati said last year. “I’ll continue to fight until justice is done.”