San Joaquin Community Hospital v. PacifiCare of California, 2003 WL 122780 (Cal.App.4th Dist. 2003)

Harry J. Nelson

Practice Area:Health Care

Outcome:Prevailed on appeal

Description:San Joaquin Community Hospital v. PacifiCare was a significant victory in the Court of Appeals upholding the right of healthcare providers (in this case, a hospital) to recover payment from healthcare service plans for medically necessary services, even if they do not have a contract with the health plan or its contracting intermediary. Reversing a dismissal by the lower court, the Court of Appeals concluded that a noncontracting health care provider had a right to seek reimbursement directly from the health plan.