Erickson

Erickson v. Aetna Health Plans of California, Inc.

Good Law
1999 Cal. App. LEXIS 347·71 Cal. App. 4th 646·84 Cal. Rptr. 2d 76·99 Daily Journal DAR 3765·99 Cal. Daily Op. Serv. 2923
Court of Appeal of CaliforniaApril 21, 1999No. E021505California4,340 words

Opinion

Lead Opinion

Richli, J.

*649 Opinion

Aetna Health Plans of California, Inc., appeals from the denial of its motion to compel arbitration of claims arising from its alleged failure to provide timely cancer treatment to Donald Erickson under Aetna’s Medicare coverage plan. We conclude that: (1) although Aetna’s arbitration provision failed to comply with Health and Safety Code section 1363.1, that statute is preempted by the Federal Arbitration Act; and (2) the arbitration provision is not otherwise invalid under general principles of law. Accordingly, we reverse.

I

Factual and Procedural Background

Aetna is a federally qualified health maintenance organization. Pursuant to an agreement with the federal Health Care Financing Administration, Aetna offered replacement Medicare coverage to eligible individuals under a plan called Senior Choice. Mr. Erickson enrolled in Senior Choice in about April 1993.

Among other things, the Senior Choice handbook 1 set forth the options available to plan members in the event of a dispute. After explaining the procedure for filing a grievance, the handbook stated: “If you are not satisfied with the [grievance panel’s] proposed resolution, you may request binding…

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