California Hospital Says Arkansas BCBS Breached Implied-in-Fact Contract, Owes Over $100K

On Friday in the Northern District of California, Stanford Health Care filed a complaint against Arkansas Blue Cross Blue Shield (BCBS) and other unknown defendants, alleging that Arkansas BCBS failed to pay Stanford Hospital a bill of more than $100,000 and thus has breached an implied-in-fact contract.

Pursuant to a written contract between Stanford Hospital and Anthem Blue Cross, according to the plaintiff, Stanford Hospital “agreed to render medically necessary care to individual enrollees of Anthem Blue Cross health plans, including out-of-state affiliates of Anthem Blue Cross,” like Arkansas BCBS. The contract also gave the affiliates access to “discounted rates” in exchange for reimbursement of the medically necessary services, the complaint said.

The complaint stated that between Nov. 6 and 27, 2018, Stanford Hospital provided “medically necessary” services to an unnamed patient, who reportedly was a beneficiary of an Arkansas BCBS health plan. Stanford Hospital then billed Arkansas BCBS for the services administered to the unnamed patient, which totaled $227,905.61, but discounted to $106,785; however, the plaintiff claimed neither Arkansas BCBS nor any of its agents have provided any payment for these services to date. The plaintiff said that “(w)ithin the past two years,” it has “demanded” payment from the defendants for the services,” but they have “refused.”

Regardless, the plaintiff argued full relief should be granted under quantum meruit, “should it be found no contractual relationship exists.” The plaintiff claimed that “by its words and/or conduct,” Arkansas BCBS “implied and/or express(ly) request(ed)” the provision of care to the unnamed patient, which led Stanford Hospital to “reasonably expect()” the defendants to reimburse for the medical care.

Stanford Hospital is requesting a $106,785 payment plus interest, or, under quantum meruit, a payment of $227,905 plus interest, among other reasonable relief.

The plaintiff is represented by the Law Offices of Stephenson, Acquisto & Colman Inc.