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Yeager v. Blue Cross of California

July 15, 2009

DEBORAH DUNN YEAGER ET AL. PLAINTIFFS AND APPELLANTS,
v.
BLUE CROSS OF CALIFORNIA, DEFENDANT AND APPELLANT.



APPEAL from a judgment of the Superior Court of Los Angeles County. Victoria G. Chaney, Judge. Affirmed. (Los Angeles County Super. Ct. No. BC353402).

The opinion of the court was delivered by: Rubin, Acting P. J.

CERTIFIED FOR PUBLICATION

Deborah Dunn Yeager appeals, for herself and as class representative for all others similarly situated, from the trial court‟s summary judgment dismissing her complaint against respondent Blue Cross of California. Her complaint alleges Blue Cross violated its statutory duty under Health and Safety Code section 1374.55 to offer coverage for treatment of infertility in the group health plan that Blue Cross provided to Dunn Yeager‟s employer. We affirm.

FACTS AND PROCEEDINGS

Appellant Deborah Dunn Yeager is employed by Westmont College. Dunn Yeager belongs to the college‟s group health plan with Blue Cross. Every year, Blue Cross gives the college an annual renewal package for the health plan containing, among other things, a checklist of legally mandated health insurance benefits that the plan must make available. Among those mandates, Health and Safety Code section 1374.55 obligates Blue Cross to offer to provide coverage for treatment of infertility.*fn1 In compliance with that statute, Blue Cross‟s renewal package with Westmont College offers to pay up to $2,000 a year for half the cost of each group member‟s treatment for infertility. The package states:

"Blue Cross of California... is required to offer coverage for certain health benefits to Applicants for a Group Benefit Agreement/Policy and to Groups renewing their Group Benefit Agreement/Policy with Blue Cross.... The optional benefits offered and their costs are set forth below.

"[Accept [ ] Decline [ ] Infertility Treatment]

"Coverage for diagnosis and treatment of infertility at 50% payment rate, benefit payments to $2,000 during a calendar year. The Calendar Year Deductible is waived. Coverage does not include laboratory medical procedures involving the actual in vitro fertilization process. [Insurance Code section] 10119.6/ [Health and Safety Code section] 1374.55 [¶] Cost: Single - $8.45 Two-Party - $17.75 Family - $25.35" (Boldface omitted.)

Westmont College declined to buy coverage for infertility treatment. One factor in the college‟s decision was the coverage‟s high price.

Appellant could not become pregnant without medical assistance. Able to afford only limited infertility treatment that proved ineffective, appellant sued Blue Cross in 2006, alleging causes of action for unfair competition and false advertising.*fn2 (Bus. & Prof. Code, §§ 17200, 17500.) Appellant sought recovery of her out-of-pocket expenses for the infertility treatment she received above Blue Cross‟s $2,000 annual limit, and for her pain and suffering from losing her chance to bear a child.

Blue Cross moved for summary judgment. It argued it had complied with Health and Safety Code section 1374.55 by offering coverage for infertility treatment. The motion disputed appellant‟s contention that section 1374.55 obligated Blue Cross to provide a certain amount of coverage at a particular premium. According to Blue Cross, section 1374.55 left the amount and cost of coverage to negotiation between Blue Cross and Westmont College. Agreeing with Blue Cross, the court entered summary judgment and dismissed the complaint. This appeal followed.*fn3

DISCUSSION

Section 1374.55 obligated Blue Cross to offer coverage for ...


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