Soba Living LLC v. California Physicians Service

I. Background

A. Facts The following facts are drawn from Plaintiffs’ Complaint (Dkt. 1-2). Plaintiffs provide treatment services to individuals recovering from alcoholism and substance abuse. Compl. ¶ 10. These individuals were insured under health plans or health insurance policies administered by Defendants. Id. ¶ 11. Defendants issued these

CIVIL MINUTES – GENERAL

Date: March 2, 2021 Page 2

enrollees benefits documents, referred to as Evidence of Coverage (“EOC”) or Insurance Policies, which provide that the insureds have coverage for out-of-network drug and alcoholism treatments like those provided by Plaintiffs. Id. ¶ 12-13.

Plaintiffs investigated the health coverage of Defendants’ enrollees prior to providing treatment. Id. ¶ 15. Plaintiffs contacted Defendants to obtain verifications of benefits and authorization to treat the individuals. Id. Defendants consistently verified that the patients were enrolled and that the requested treatments were covered benefits. Id. ¶ 16. Defendants further confirmed, by telephone and other means, that they would reimburse Plaintiffs for the treatments provided, pursuant to the applicable EOC or Insurance Policy.…