Barrett
Barrett v. Office of Personnel Management
Opinion
Lead Opinion
MEMORANDUM *
Bailey and Verena Barrett appeal the district court’s grant of summary judgment in their lawsuit against the Office of Personnel Management (“OPM”). We affirm. Because the parties are familiar with the factual and procedural history of this case, we will not recount it here.
The Barretts seek reimbursement for surgery Verena Barrett underwent in Switzerland after Kaiser Permanente (“Kaiser”), a health maintenance organization contracted by OPM to provide health insurance for federal employees, declined to provide her with surgical treatment for lung cancer.
Kaiser’s decision was justified by the plain language of the Kaiser Plan, which provides in relevant part that benefits “are available only from Plan providers except during a medical emergency,” and that “except in a medical emergency ... you must contact your primary care doctor for a referral before seeing any other doctor or obtaining specialty services.” A “medical emergency” is defined in the Kaiser Plan as “an injury or the sudden and unexpected onset of a condition requiring immediate medical or surgical care.” The Plan specifically excludes emergency care provided outside the service area “if the need…