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California Court of Appeal

Tenet Healthsystem Desert v. Blue Cross of Cal., 069057

In a suit by a hospital over defendants' refusal to pay approximately $1,996,265.50 for the cost of medical services it provided to an insured patient following extensive communications with insurer-defendant over a period of approximately 50 days regarding 'authorization' for the services, and the defendants ultimately denied coverage for the medical services based on an exclusion in the patient's policy for injuries sustained as a result of having a blood alcohol level over the legal limit, the trial court's judgment for insurer after sustaining, without leave to amend, insurer's demurrer to plaintiff's third amended complaint (TAC), is reversed and remanded for further proceedings where the TAC alleges facts with sufficient particularity to overcome a demurrer.

Appellate Information

  • Decided
  • Published 2016/03/17




  • California Court of Appeal


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