Blue Shield of Cal. Life & Health Ins. v. Super. Ct. CA1/1

BACKGROUND

Real parties in interest Elvis Bokan, by and through his guardian ad litem Rebekah Bokan (his mother) and Rebekah Bokan, individually, filed a complaint against Blue Shield in May 2011, alleging causes of action for breach of contract, breach of covenant of good faith and fair dealing, and relief from asserted forfeiture. The complaint alleged

1 these facts: Rebekah purchased a contract of family health insurance (Policy) from Blue Shield, effective March 1, 2009, which provided benefits to her, her spouse and children for a range of medically necessary services; Rebekah’s son Elvis was born on January 25, 2010; on or about March 1, 2010, Elvis was admitted to Sutter Hospital for medical care and was discharged on or about March 13, 2010; Sutter Hospital issued a bill of charges for over $182,000 in medical services and other contractors at the hospital issued separate invoices; the type of services provided to Elvis at Sutter Hospital were covered under the Policy, but Blue Shield refused to pay for the care Elvis received at Sutter Hospital. The Policy contains a “Conditions of Coverage” section with a subsection entitled “Limitation [of] Enrollment.” Paragraph 3…