Document ID: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-cand-3_14-cv-03573/USCOURTS-cand-3_14-cv-03573-4/pdf.json

Parties Involved:
Theresa Antman
Plaintiff
Blue Shield Life and Health Insurance Company
Defendant

Document Text:

United States District Court

For the Northern District of California

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IN THE UNITED STATES DISTRICT COURT

FOR THE NORTHERN DISTRICT OF CALIFORNIA

THERESA ANTMAN,

Plaintiff,

 v.

BLUE SHIELD LIFE AND HEALTH

INSURANCE COMPANY,

Defendant. /

No. C 14-03573 WHA

ORDER FOLLOWING 

FEBRUARY 18 HEARING

For the reasons stated at oral argument, defendant’s motion for summary judgment is

HELD IN ABEYANCE. Blue Shield shall promptly turn over to Antman the schedule of allowable

amounts for preferred providers furnishing the same services in San Diego in the year 2013, and

make available a Rule 30(b)(6) witness who is prepared to explain how, if at all, the schedule was

applied in Antman’s case (and to walk through her bills). Antman in turn shall make herself

available for a deposition. Both sides shall cooperate and be reasonable. Fact discovery closes

on MARCH 27.

Both sides shall file supplemental briefs (each not to exceed ten pages) and declarations

by APRIL 1 AT NOON. Responsive briefs (each not to exceed five pages) are due by APRIL 8 AT

NOON. A hearing is hereby set for APRIL 23 AT 8:00 A.M. Please be sure to address the

following in the supplemental briefs:

1. Antman contends that Blue Shield Life’s reimbursement provisions are

unenforceable. What law governs (e.g., California law, federal common law, ERISA)? What is

the applicable standard and how has it been applied in similar situations? Has any court reviewed

the reimbursement provisions invoked herein and found them unenforceable? Has any court

Case 3:14-cv-03573-WHA Document 35 Filed 02/18/15 Page 1 of 2
United States District Court

For the Northern District of California

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ratified these reimbursement provisions? Please address all binding decisions from our court of

appeals. 

2. The following hypothetical was discussed at oral argument. Assume the allowed

amount was $200 and the bill was $1,000. Plaintiff appears to contend that she believed that she

should have been reimbursed for $500 but Blue Shield Life contends that it was proper to

reimburse her for $100. Does the plan ever state that Blue Shield Life will reimburse the insured

for 50% above the allowed amount? Does the plan ever state that Blue Shield will reimburse the

insured for 50% of the bill, even if it is significantly more than the allowed amount?

3. When did Antman first become aware of a discrepancy between how she believed

the reimbursements would be calculated and how Blue Shield actually calculated the

reimbursements?

4. Having read the entirety of the plan, how would a reasonably prudent person

construe the reimbursement provisions?

IT IS SO ORDERED.

Dated: February 18, 2015. WILLIAM ALSUP

UNITED STATES DISTRICT JUDGE

Case 3:14-cv-03573-WHA Document 35 Filed 02/18/15 Page 2 of 2