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WALKER v. GROUP HEALTH SERVICES, INC.

No. 94,380.

37 P.3d 749 (2001)

2001 OK 2

Cynthia A. WALKER, an individual, Appellant, v. GROUP HEALTH SERVICES, INC., a corporation, d/b/a/ Blue Cross/Blue Shield of Oklahoma; and GHS Health Maintenance Organization, Inc., d/b/a BlueLincs HMO, Appellees.

Supreme Court of Oklahoma.

As Corrected on Denial of Rehearing April 23, 2001.

Attorney(s) appearing for the Case

Steven S. Mansell, Mark A. Engel, Steven S. Ashmore, Oklahoma City, OK, for Appellant.

Harvey D. Ellis, Kevin D. Gordon, Tamela R. Hughlett, Oklahoma City, OK, for Appellees.

Paul C. Duncan, Kathy Austin, Oklahoma City, OK, for Amicus Curiae, Oklahoma State & Education Employees Group Insurance Board.

KAUGER, J.:

¶ 1 We retained this cause to determine: 1) whether a health maintenance organization (HMO)1 may be liable to a state employee for bad faith breach of an insurance contract; and 2) whether, when an insured has received payment for disputed medical expenses, the requirements for exhaustion of administrative remedies of 74 O.S. Supp.1999 § 1306(6)2

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