Inter Valley Health Plan v. Blue Cross/Blue Shield of Connecticut
Opinion
Opinion
Sills, J.
The cost of Anjanette Farace’s bone marrow transplant and chemotherapy exceeded half a million dollars. Fortunately, she was covered by the health plans provided by each of her divorced parents’ respective employers.
In fact, both plans—to their credit—paid for the treatment, leaving Children’s Hospital of Orange County overpaid by some $511,000. The hospital deposited this money into the registry of the Orange County Superior Court, and the mother’s plan, Inter Valley Health Plan, sued the father’s plan, an employee medical plan administered by Blue Cross/Blue Shield of Connecticut (Blue Cross), to determine which plan was primarily responsible.
After a trial on stipulated facts and declarations submitted with the trial briefs, the court determined that the matter was governed by the federal employee benefits law known as ERISA, and, under ERISA, as interpreted by PM Group Life Ins. v. Western Growers Assur. Trust (9th Cir. 1992) 953 F.2d 543 (PM Group Life), the mother’s plan was primary because her birthday comes earlier in the calendar year than the father’s birthday (the birthday rule).