Ramon Samano v. Kaiser Foundation Health Plan

MEMORANDUM

Ramon Samano appeals the district court’s grant of summary judgment in favor of Kaiser Foundation Health Plan, Inc., Southern California Permanente Medical Group, and Kaiser Foundation Hospitals (collectively, “Kaiser”). We have jurisdiction pursuant to 28 U.S.C. § 1291 , and we affirm in part and vacate in part.

1. The district court properly awarded summary judgment in favor of Kaiser on Samano’s claims for ERISA benefits. It is undisputed that Kaiser paid Samano’s $31,000 discounted bill and reimbursed Samano for related out of pocket expenses he was charged for emergency medical services provided by Providence Holy Cross Medical Center (“Providence”). It is also undisputed that once Providence applies the discounted rate to a patient’s bill, that sum is the maximum amount the patient owes Providence. Thus, the district court correctly concluded that Samano has received all the benefits owed under his ERISA plan and is not entitled to reimbursement for the original, nonbilled, amount of benefits that Kaiser might have owed Providence had it originally recognized that Samano was entitled to coverage. Under the circumstances, such an award of benefits to Samano would…