California Court of Appeal
Children's Hospital Central California v. Blue Cross of California, F065603
In a dispute between plaintiff-hospital and defendant-health plan over the reasonable value of the post-stabilization emergency medical services provided by plaintiff-hospital to Medi-Cal beneficiaries enrolled in defendant's Medi-Cal managed care plan during a period of time when the parties did not have a contract, the jury's award to plaintiff-hospital of $6.6 million, the difference between the full billed charges and the $4.2 million defendant-health plan had already paid, is reversed and remanded, where: 1) the trial court incorrectly concluded that California Code of Regulations, title 28, section 1300.71(a)(3)(B) provided the exclusive standard for determining the reasonable and customary value of the medical services in this action; 2) because of this error, the evidence of the reasonable and customary value was improperly limited to plaintiff-hospital's full billed charges; and 3) this error was prejudicial.
Appellate Information
- Decided 06/10/2014
- Published 06/10/2014
Judges
- LEVY
Court
- California Court of Appeal