Bell v. Blue Cross of California

Blue Cross of California is a health care service plan within the meaning of the Knox-Keene Health Care Service Plan Act of 1975, Health and Safety Code section 1340 et seq. Mark R. Bell, M.D. (a board-certified emergency room physician who is obligated to treat all emergency room patients without regard to whether they are insured or able to pay (§ 1317, subd. (b)), has not contracted with Blue Cross or otherwise agreed to accept the fees Blue Cross pays to its contracting providers. But Dr. Bell’s duty to render emergency services to everyone, including Blue Cross’s enrollees, means that Blue Cross is required by statute to “reimburse” Dr. Bell for those services. (§ 1371.4, subd. (b).) “Notwithstanding the statute,” claims Dr. Bell, “Blue Cross has a practice of paying non-participating emergency care providers arbitrary amounts that are substantially below the cost, value, and common range of fees for the services ... the providers render.”

To remedy this situation, Dr. Bell filed this class action against Blue Cross, seeking declaratory and injunctive relief, disgorgement, and damages under the unfair competition law (Bus. & Prof. Code, § 17200 et seq. [the UCL])…