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■ Coast Plaza Hosp v Blue Cross B205892

In California, health care providers are statutorily required to provide emergency care to a patient without regard to the patient’s ability to pay for such care.  (Health & Saf. Code, § 1317.)[1]  If a patient who receives emergency care is an enrollee of a health care service plan, section 1371.4, a provision of the Knox-Keene Health Care Service Plan Act of 1975 (Knox-Keene), requires the plan to reimburse the provider for the cost of the emergency care, barring certain exceptions inapplicable here.

            In this case, Coast Plaza Doctors Hospital (Coast Plaza) provided emergency care to Patient X, an enrollee of a group health plan insured by Blue Cross of California (Blue Cross).  When Blue Cross did not reimburse Coast Plaza for the cost of the emergency care, Coast Plaza sued Blue Cross in superior court, alleging a number of state law claims derived from section 1371.4.  Because Patient X’s group health plan qualified as an employee benefit plan subject to the Employee Retirement Income Security Act of 1974 (ERISA), the trial court sustained Blue Cross’ demurrer on the ground that Coast Plaza’s state law claims were subject to ordinary preemption under ERISA.

            We conclude that section 1371.4 is a state law that regulates insurance within the purview of ERISA’s saving clause.  Therefore, we reverse the judgment in favor of Blue Cross and remand for further proceedings. . . .

DISCUSSION

I.  Standard of Review

            “We review a trial court’s ruling on a demurrer independently.  [Citation.]”  (Liska v. Arns Law Firm (2004) 117 Cal.App.4th 275, 281.)  Our task in reviewing a judgment of dismissal following the sustaining of a demurrer is to determine whether the complaint states a cause of action.  (Crowley v. Katleman (1994) 8 Cal.4th 666, 672.)


■ Held:

In an action seeking reimbursement for the cost of emergency care, trial court judgment sustaining defendants' demurrer to plaintiff's complaint is reversed where Health & Saf. Code sec. 1371.4 is not subject to ordinary preemption under ERISA, as it is a state law that regulates insurance and thus falls within the scope of ERISA's saving clause.
Coast Plaza etc.-B205892- Hosp. v. Blue Cross 5/11/09 CA2/1
Coast Plaza etc.-B205892- Hosp. v. Blue Cross 5/11/09 CA2/1-pdf

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