Filed: Aug. 20, 2014
Latest Update: Aug. 20, 2014
Summary: 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 Plai
Summary: 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 Plain..
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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.
