City of Hope Nat. Med. Center v. PacifiCare of Cal. CA2/7

INTRODUCTION

The City of Hope National Medical Center (COH) filed a complaint alleging that PacifiCare of California had breached the parties’ health services contract by failing to reimburse COH for medical treatment provided to a PacifiCare plan member. PacifiCare filed a motion for summary judgment arguing that it was not contractually obligated to pay for the medical treatment because: (1) COH had failed to obtain PacifiCare’s authorization prior to providing the treatment; and (2) PacifiCare had entered into capitation agreements with third party medical providers that absolved it of financial responsibility for the services rendered by COH. The trial court granted the motion for summary judgment and awarded PacifiCare attorneys’ fees and costs. COH appeals the judgment and the award of attorneys’ fees and costs. We affirm.

FACTUAL AND PROCEDURAL BACKGROUND

A. Summary of Fact Preceding the Filing of the Lawsuit 1. Summary of the parties’ health services contracts City of Hope National Medical Center (COH) is a health care provider that specializes in the treatment of cancer. PacifiCare is a licensed health care service plan under California’s Knox-Keene Health Care Service…