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Judith O. Hollinger v. California Physicians' Service D.B.A. Blue Shield of California et al

December 11, 2012

JUDITH O. HOLLINGER, PLAINTIFF,
v.
CALIFORNIA PHYSICIANS' SERVICE D.B.A. BLUE SHIELD OF CALIFORNIA ET AL., DEFENDANTS.



The opinion of the court was delivered by: Honorable Ronald S.W. Lew Senior, U.S. District Court Judge

STATEMENT OF UNCONTROVERTED FACTS AND CONCLUSIONS OF LAW

Re: Defendant Good Samaritan Medical Practice Association, Inc.'s Motion for Summary Judgment and Motion for Attorney Fees [26]

After consideration of Defendant Good Samaritan Medical Practice Association, Inc.'s ("GSMPA") Motion for Summary Judgment and Motion for Attorney Fees [26], this Court makes the following findings of fact and conclusions of law:

UNCONTROVERTED FACTS

1. Plaintiff Judith Hollinger ("Plaintiff") is the widow of Dr. Glen Hollinger ("Dr. Hollinger"), who died on August 17, 2010, after battling cancer. Compl. ¶¶ 1, 8.

2. Dr. Hollinger was the Chief Medical Officer of GSMPA, which is an Independent Physicians Association. Administrative Record ("AR") at 501.

3. As a physician with Good Samaritan Hospital, Dr. Hollinger received health coverage under a Blue Shield Large Group HMO Plan ("the Plan"). AR at 806-869.

4. Dr. Hollinger selected GSMPA as his primary medical group under the Plan. AR at 770.

5. In February 2010, Dr. Hollinger was referred to Excel Diagnostics in Houston, Texas, for cancer treatment involving high dose Indium-III Octreotide therapy. AR at 1005.

6. Excel Diagnostics began administering treatment in March 2010. Id.

7. Initially, Dr. Hollinger paid in cash for the first round of treatment, but then asked sometime in June 2010 that GSMPA assist him with obtaining approval and payment for subsequent treatment from Blue Shield. AR at 501, 1048.

8. Under the Plan, coverage was only available for "medically necessary services," which are defined as:

[T]hose which have been established as safe and effective and are furnished in accordance with generally accepted professional standards to treat an illness, injury, or medical ...


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