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California Court of Appeal

Roberts v. United Healthcare Services, Inc., 266393

In a class action for unfair competition, unjust enrichment and financial elder abuse, brought by a plaintiff enrolled in a private health plan offering benefits to persons 65 and over as well as disabled persons under the federally funded Medicare Advantage program, 42 U.S.C. section 1395w-21 et seq., alleging that the plan's marketing materials misled him (and other enrollees) as to the availability of in-network urgent care centers (and their smaller copayments) and that the absence of any in-network urgent care centers in California rendered the plan's network inadequate, the trial court's dismissal of the action is affirmed where: 1) plaintiff's misrepresentation and adequacy-of-network based claims are expressly preempted by the preemption clause applicable to Medicare Advantage plans; and 2) plaintiff's claims, to the extent they challenge a denial of benefits, are subject to dismissal because he did not first exhaust his administrative remedies under the Medicare Act, 42 U.S.C. sections 405(g), (h) and 1395ii.

Appellate Information

  • Decided
  • Published 2016/08/05




  • California Court of Appeal


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