P. ex rel. Dept. of Ins. v. Symons Emergency Specialties CA4/2
Opinion
Opinion
BACKGROUND
In 2000, SIMNSA obtained a license from the California Department of
Corporations to operate as a health care service plan in the state. The department issued
the license under Health and Safety Code section 1351.2, which provides for the
licensure of Mexican prepaid health care plans under certain conditions. Specifically, the
license authorizes SIMNSA to sell “employer-sponsored group plan contracts exclusively
for the benefit of citizens of Mexico legally employed in California.” (Capitalization and
boldface omitted.) Under the license, SIMNSA provides health care services “wholly in
Mexico,” except that emergency and urgent care services are available outside of Mexico.
Defendants are Symons Emergency Specialties, Inc. (Symons); Symons Ambulance; Jeff T. Grange; and Jeff T. Grange, M.D., Inc.
2 (Capitalization and boldface omitted.) The license is effective until SIMNSA surrenders
it or the state suspends or revokes it.
In 2014, Symons provided emergency services in California to an individual
insured by SIMNSA. SIMNSA refused to pay Symons’s claim, so Symons sued
SIMNSA. The parties settled that lawsuit.