Redmond

Plaintiff brought a bad faith action against defendant based on its initial denial of coverage and subsequent delayed payment of her claim for reimbursement of health care expenses covered under her Medicare-subsidized agreement with defendant. Defendant’s demurrer was sustained without leave to amend, and the action was dismissed on jurisdictional grounds. On appeal, plaintiff claims that (1) her claim did not fall within the exclusive review provisions of the Medicare Act because it did not arise under the act, (2) the exclusive review provisions of the Medicare Act should not apply because Congress did not so intend and these provisions offer no remedy for her claim, and (3) the court abused its discretion in failing to grant her leave to amend her complaint. We affirm.

Plaintiff’s Allegations

Defendant is a health maintenance organization which “arranges for the provision of’ medical services to its “Subscribers.” Plaintiff was one of defendant’s “Subscribers.” The agreement between plaintiff and defendant required that “[i]n determining whether a specific benefit is covered, [defendant] shall rely on Medicare guidelines . . . Plaintiff and defendant agreed that…