VAN NESS v. BLUE CROSS OF CALIFORNIA

Nos. A088368, A088539.

104 Cal.Rptr.2d 511 (2001)

87 Cal.App.4th 364

Richard VAN NESS, Plaintiff and Appellant, v. BLUE CROSS OF CALIFORNIA, Defendant and Respondent.

Court of Appeals of California, First District, Division Four.

Review Denied May 16, 2001.


Attorney(s) appearing for the Case

John M. Riestenberg, Law Offices of John M. Riestenberg, Sacramento, Counsel for appellant.

Kurt C. Peterson, James C. Martin, Denise M. Howell, Stuart Shanus, Crosby, Heafey, Roach & May, Los Angeles, Counsel for respondent.


REARDON, Acting P.J.

In 1991 appellant Richard Van Ness purchased health insurance from respondent Blue Cross of California under its prudent buyer program. That program established a two-tiered benefit schedule— the negotiated fee schedule for participating providers and the limited fee schedule for nonparticipating providers. Benefits under the negotiated fee schedule were greater because network providers agreed to cap their fees for Blue Cross subscribers...

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