Kaiser Foundation Health Plan, Inc. v. Lifeguard, Inc.

This case is a dispute between two health care service plans over which must pay for emergency medical services rendered to a patient who was covered under both plans. Kaiser Foundation Health Plan, Inc., paid for the services and sued Lifeguard, Inc., for reimbursement. The trial court found that Kaiser was responsible for all of the costs in question and entered judgment for Lifeguard, from which Kaiser appeals. We conclude that each side is responsible for one-half of the costs and therefore reverse.

I.

The case was tried to the court on stipulated facts. Michael Bozzo suffered a heart attack in June of 1990. At the time, he was enrolled in Kaiser through his employer, and he was covered as a dependent by Lifeguard through his wife’s employer. He received emergency treatment costing $132,517.91 at hospitals unaffiliated with Kaiser. Kaiser proposed to Lifeguard that they split the costs of Bozzo’s treatment 50/50. Lifeguard responded that Kaiser was solely responsible for the costs; Kaiser paid for them; and Kaiser sued Lifeguard to recoup the payment.

II.

Kaiser and Lifeguard are health care service plans governed by the Knox-Keene Health Care Service Plan Act of…