California Surgery Center, Inc. v. Unitedhealthcare, Inc.

I. Background

23 Plaintiff California Surgery Center is an ambulatory surgery 24 center. (SAC ¶ 7.) Plaintiff California Spine and Pain Institute 25 is a medical group comprised of anesthesiologists and other 26 doctors. (Id.) Plaintiffs treated patient KES for spinal disease 27 and, after other unsuccessful treatments, recommended to KES that 28 she undergo spinal surgery. (SAC ¶ 13.) KES presented Plaintiffs with a card indicating that she was insured by United, a PPO. (SAC ¶ 14.) In late November 2016, Plaintiffs called United to discuss KES’ treatment. (SAC ¶ 15.) United told Plaintiffs that KES was a United insured and was eligible for coverage, and authorized the services Plaintiffs proposed to render to KES. (Id.) United specifically stated that it would pay up to 80% of its in-network allowed amount and that it would honor an assignment of benefits and pay Plaintiffs directly. (SAC ¶ 22.) Indeed, Plaintiffs had obtained similar verifications of coverage and authorizations for treatment prior to rendering treatment to KES on several prior occasions. (SAC ¶ 30.) On each prior occasion, United paid Plaintiffs…