St. Joseph Hospital of Orange v. Newegg, Inc.

I. BACKGROUND

The following facts are alleged in the Hospitals’ complaint, originally filed in the Superior Court of the State of California for the County of Orange. See Dkt. No. 1, Ex. A. Newegg operates a self-funded health benefit plan that provides health care benefits to plan participants and beneficiaries. Compl. ¶ 2. The Hospitals provided expressly and/ or impliedly authorized hospital services for fourteen patients covered by Newegg. Id. ¶¶ 8–126. The total billed charges and reasonable value of the medically necessary services provided to the patients was $147,667.88, but Newegg has only paid or accepted responsibility for $20,916.87. Id. The Hospitals detail the services rendered to each of the fourteen patients. Id. ¶¶ 9–26. Some of the patients received emergency services, such as Patient 1, who received

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CIVIL MINUTES - GENERAL

Case No. SACV 20-1704 JVS (JDEx) Date October 20, 2020 Title St. Joseph Hospital of Orange v. Newegg, Inc. same day, the hospital1 sent a fax to Newegg’s automated system to determine eligibility. Id. ¶ 10. Authorization was not required because Patient 1’s…