Defense Judgment Granted in ERISA Case
April 2, 2010
In an ERISA case by a Kaiser Foundation Health Plan, Inc. member against Kaiser, defensed by Casey Yim in Federal Court, the plaintiff sought recovery of $350,000 in medical services rendered by "out of plan" provider, Providence Hospital. Defendant Kaiser paid Providence only $31,000, representing the "self pay discount," which was actually billed by Providence to the plaintiff.
Kaiser was granted a Motion for Summary Judgment because, under California law, Providence could not seek the "balance" from the plaintiff.
"Balance Billing" to the patient is prohibited under a recent California Supreme Court case law (Prospect Medical Group v. Northridge). This is probably the first "Balance Billing" case in California since the Supreme Court's decision in the Prospect Medical Group case. If the case is published, it will serve as a landmark for future cases in the area.
Nancy N. Potter assisted in the case.
