Lawsuit Raises Questions on Administration of CalPERS PPO Plans
A lawsuit before California's Second District Court of Appeal centers on the question of whether public employees who get health benefits through CalPERS can sue insurers if they deny treatment, the Los Angeles Daily Journal reports.
The case arises from CalPERS' self-funded PPO plan, which it contracts with Anthem Blue Cross to administer. As such, Anthem Blue Cross contracts directly with CalPERS and does not maintain contracts with public employees who get coverage through CalPERS.
Anthem Blue Cross maintains that it has "no legal duty" to the public employees.
Lawyers for the patient said their appeal would focus on showing that third-party administrators of health plans, such as Anthem Blue Cross, are liable if they are contracted to review medical records and approve or deny coverage for public employees who get coverage through CalPERS.
The case is Mintz v. Blue Cross and was filed in Los Angeles Superior Court in 2007. A superior court judge dismissed the case in March (George, Los Angeles Daily Journal, 6/30).