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Chan v. Pacific Gas and Electric Company Health Care Plan for Management and Administrative & Technical Employees

United States District Court, Ninth Circuit, California, N.D. California
Aug 20, 2014
3:13-cv-05379 LB (N.D. Cal. Aug. 20, 2014)

Opinion

          Kathleen Cahill Slaught, Michelle M. Scannell, SEYFARTH SHAW LLP, San Francisco, California, Attorneys for Defendant THE PACIFIC GAS AND ELECTRIC COMPANY HEALTH CARE PLAN FOR ACTIVE EMPLOYEES erroneously sued as THE PACIFIC GAS AND ELECTRIC COMPANY HEALTH CARE PLAN FOR MANAGEMENT AND ADMINISTRATIVE & TECHNICAL EMPLOYEES.

          Kurt C. Peterson, Kenneth N. Smersfelt, Junga P. Kim, REED SMITH LLP, Los Angeles, CA, Attorneys for Defendant Anthem Blue Cross Life and Health Insurance Company.

          LAURENCE F. PADWAY, LAW OFFICES OF LAURENCE F. PADWAY, Alameda, California, Attorneys for Plaintiffs VICTOR K. CHAN AND SHIRLEY IP.


          FURTHER JOINT STATUS REPORT; [PROPOSED] ORDER

          LAUREL BEELER, Magistrate Judge.

         As required by the Court's June 11, 2014 Order, Plaintiffs Victor Chan and Shirley Ip, and Defendants The Pacific Gas & Electric Company Health Care Plan For Active Employees (the "Plan") and Anthem Blue Cross Life and Health Insurance Company ("Anthem") (collectively the "Parties"), hereby submit the following Further Joint Status Report:

         Further Joint Status Report

         On March 5, 2014, the Court ordered Plaintiffs to submit their claim for reimbursement of a liver resection surgery and a liver transplant and related procedures (the "Procedures") to Anthem for a second level appeal as required by the Plan's Network Access Plan ("NAP Plan") coverage option. Docket No. 29.

         On about June 10, 2014, Plaintiffs filed a second level appeal with Anthem for coverage of the Procedures. By letter dated July 10, 2014, Anthem informed Plaintiffs that after review of information submitted with the second appeal, the liver transplant and related procedures were deemed covered under the NAP Plan, as medically necessary emergency services arising out of the failed liver resection surgery. However, Anthem upheld the denial of the liver resection surgery, on the basis that "the services were scheduled and your plan only covers emergent care outside of the United States." Anthem also informed Plaintiffs that their appeal rights with Anthem were exhausted, and advised Plaintiffs that if they wished to pursue a voluntary review of the denial with PG&E, as provided under the NAP Plan, they should request such a review within 90 days of receipt of the second appeal response. Anthem is currently processing payments for the covered services.

         As of August 19, 2014, the administrative process has not been concluded in its entirety. The parties are also informally attempting to resolve the entire matter, including the issue of Plaintiffs' demand for attorney's fees. Based on the foregoing, the Parties respectfully request that the Court continue the stay for 30 days, and order the Parties to file a further Joint Status Report by September 19, 2014.

         GOOD CAUSE APPEARING, IT IS SO ORDERED:

         1. The Parties shall file a further Joint Status Report by September 19, 2014.


Summaries of

Chan v. Pacific Gas and Electric Company Health Care Plan for Management and Administrative & Technical Employees

United States District Court, Ninth Circuit, California, N.D. California
Aug 20, 2014
3:13-cv-05379 LB (N.D. Cal. Aug. 20, 2014)
Case details for

Chan v. Pacific Gas and Electric Company Health Care Plan for Management and Administrative & Technical Employees

Case Details

Full title:VICTOR K. CHAN AND SHIRLEY IP, Plaintiffs, v. THE PACIFIC GAS AND ELECTRIC…

Court:United States District Court, Ninth Circuit, California, N.D. California

Date published: Aug 20, 2014

Citations

3:13-cv-05379 LB (N.D. Cal. Aug. 20, 2014)