Abira Medical Laboratories v. Anthem Blue Cross Life and Health Insurance Company

CourtDistrict Court, C.D. California
DecidedJune 12, 2025
Docket2:25-cv-03220
StatusUnknown

This text of Abira Medical Laboratories v. Anthem Blue Cross Life and Health Insurance Company (Abira Medical Laboratories v. Anthem Blue Cross Life and Health Insurance Company) is published on Counsel Stack Legal Research, covering District Court, C.D. California primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Abira Medical Laboratories v. Anthem Blue Cross Life and Health Insurance Company, (C.D. Cal. 2025).

Opinion

8 UNITED STATES DISTRICT COURT

9 CENTRAL DISTRICT OF CALIFORNIA

10 ABIRA MEDICAL Case No. 2:25-cv-03220-WLH-RAO 11 LABORATORIES, LLC d/b/a GENESIS DIAGNOSTICS, ORDER RE PLAINTIFF’S MOTION 12 TO REMAND AND DEFENDANT Plaintiff, ANTHEM’S MOTION TO DISMISS 13 [17, 12] 14 v.

15 ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY,

16 et al.

17 Defendants.

19 20 The Court is in receipt of Plaintiff’s Motion to Remand (the “MTR”) (MTR, 21 Docket No. 17), as well as Defendant Anthem’s Motion to Dismiss (the “MTD”). 22 (MTD, Docket No. 12). No party filed a written request for oral argument stating that 23 an attorney with five years or less of experience would be arguing the matter. (See 24 Standing Order, Docket No. 11 at 16). Further, pursuant to Federal Rule of Civil 25 Procedure 78 and Local Rule 7-15, the Court finds this matter appropriate for decision 26 without oral argument. The hearing calendared for June 13, 2025, is VACATED, and 27 the matter is taken off calendar. For the following reasons, the Court DENIES the 28 MTR and GRANTS the MTD, dismissing the action in its entirety without prejudice. 1 I. BACKGROUND 2 A. Factual Background 3 Plaintiff Abira Medical Laboratories, LLC (“Plaintiff” or “Plaintiff Abira”) 4 brings the present action against Defendants Anthem Blue Cross Life and Health 5 Insurance Company and Blue Cross of California d/b/a Anthem Blue Cross 6 (“Defendant Anthem”)1 and California Physicians Service d/b/a Blue Shield of 7 California (“Defendant Blue Shield”) (collectively, “Defendants”).2 Defendants are 8 “insurance company[ies]” which are “authorized to do business” and “provide health 9 insurance services throughout California.”3 (Notice of Removal, Docket No. 1-2, Ex. 10 A-2, First. Am. Compl. (“FAC”) ¶¶ 7-9). Plaintiff is a “New Jersey limited liability 11 company” with its “principal place of business” in Pennsylvania and is “an out-of- 12 network provider of laboratory testing services to Defendants’ subscribers / members” 13 (the “Insureds”).4 (Id. ¶ 6). 14 1 The Court notes that while Anthem Blue Cross Life and Health Insurance Company 15 is a separate entity from Blue Cross of California, the two Defendants have filed their 16 motions as a singular entity, referred to as “Anthem.” (See Notice of Removal at 3; MTD at 1). Accordingly, the Court utilizes this naming convention for the sake of 17 consistency. 2 Plaintiff also bring this action against ABC Companies 1 through 100 and Does 1 18 through 100. For the purpose of these Motions, however, the Court refers only to the named Defendants. 19 3 Defendant Anthem, providing URLs to public government websites, requests 20 judicial notice of the fact that Anthem Blue Cross Life and Health Insurance Company is a “health insurance company licensed by the Insurance Commissioner and regulated 21 by the Department of Insurance,” and that Blue Cross of California is a “health care service plan regulated by the California Department of Managed Health Care[.]” 22 (Request for Judicial Notice ISO MTD (“RJN”), Docket No. 12-14 ¶¶ 1-2). A court 23 may take judicial notice of documents available on government websites. See Gerritsen v. Warner Bros. Entm’t Inc., 112 F. Supp. 3d 1011, 1033 (C.D. Cal. 2015) 24 (“Under Rule 201, the court can take judicial notice of ‘[p]ublic records and government documents available from reliable sources on the Internet,’ such as 25 websites run by governmental agencies.”); Daniels-Hall v. Nat'l Educ. Ass'n, 629 F.3d 992, 998-99 (9th Cir. 2010) (taking judicial notice of information on the websites of 26 two school districts because they were government entities). The Court finds these 27 facts appropriate subjects for judicial notice and GRANTS the Request. 4 For the sake of consistency and simplicity, the Court will refer to those individuals 28 who are insureds, members and/or subscribers of Defendants and received the 1 Plaintiff alleges generally that “Defendants refused to pay Plaintiff for 2 laboratory testing services [(the “Laboratory Testing Services”)] rendered to multiple 3 [Insureds] insured by Defendants.” (Notice of Removal, Docket No. 1-2, Ex. A-2, 4 First. Am. Compl. (“FAC”) ¶ 1). Plaintiff contends that Defendants “deprived 5 Plaintiff of millions of dollars to which it was rightfully entitled to receive[,]” by 6 providing “purported bases for denial of coverage [which] were entirely 7 groundless . . .” (Id. ¶ 4). More specifically, Plaintiff alleges that it “performed 8 clinical laboratory, pharmacy, genetics, addiction rehabilitation, and COVID-19 9 testing services on specimens submitted by medical service providers, on behalf of 10 Defendants’ subscribers / members, for numerous patients located throughout the 11 United States[.]” (FAC ¶ 14). Plaintiff contends that Defendants have “contractual 12 obligations . . . to pay for the Laboratory Testing Services that were provided by 13 Plaintiff to Defendants’ [Insureds].” (Id. ¶ 15). This is because Defendants’ Insureds 14 allegedly “assign[ed] all rights and benefits under [their] health plan[s] and direct[ed] 15 payments to be made to [Plaintiff] for laboratory services furnished to [them] by 16 [Plaintiff].” (Id. ¶ 16). As a result, with respect to these Insureds who had assigned 17 such rights and benefits and had received the Laboratory Testing Services, 18 “contractual obligations arose between the Plaintiff and Defendants . . .” (Id. ¶ 18). 19 Plaintiff contends that “Defendants – over an extended period of time – 20 blatantly disregarded, among other of their duties, express obligations to pay Plaintiff 21 for services rendered.” (Id.). To that end, Defendants allegedly “either failed to 22 respond at all to properly submitted claims or fabricated some other pretextual basis to 23 improperly refuse to make payment to Plaintiff.” (Id. ¶ 19). Some of the purportedly 24 “meritless reasons for refusing and neglecting to properly process a myriad of 25 Plaintiff’s claims for payment[,]” include “(i) lack of adequate claim information 26 provided by Plaintiff; (ii) untimely filing of claims; and (iii) lack of coverage by the 27

28 laboratory testing services at issue (the “Laboratory Testing Services”) as “Insureds.” 1 [Insureds] for the services provided.” (Id. ¶ 20). Plaintiff attached as Exhibit 1 to the 2 FAC “a spreadsheet [(the “Redacted Claims Spreadsheet”)] setting forth the [Insureds] 3 who were rendered the Laboratory Testing Services, the dates of service, the amounts 4 billed for those services, and their respective ascension numbers.” (Id. ¶ 17; see also 5 Id. at Ex. 1). That spreadsheet contains 1,326 claims alleged to be in dispute (the 6 “Disputed Claims”). (Id. at Ex. 1). Plaintiff “redacted the names” of the Insureds “to 7 ensure” compliance with the Health Portability and Accountability Act of 1996 8 (HIPAA).” (Id. ¶ 17 n.1). On or about March 13, 2025, Plaintiff provided a 9 spreadsheet containing all the same information, but with the Insureds’ names 10 unredacted (the “Unredacted Claims Spreadsheet”), along with a handful of claim 11 numbers. (Decl. of Jessamyn Vedro ISO Notice of Removal (“Vedro Decl. ISO 12 Removal”), Docket No. 1-3 ¶ 3). 13 Plaintiff brings claims for (1) breach of contract; (2) breach of implied covenant 14 of good faith and fair dealing; and (3) quantum meruit / unjust enrichment.5 (See 15 generally Id.). Plaintiff seeks: (1) “compensatory, direct, or actual damages in the 16 amount of not less than $4,373,182;” (2) “all legal, equitable, consequential, and/or 17 incidental damages as determined by the trier of fact;” (3) punitive and/or exemplary 18

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Abira Medical Laboratories v. Anthem Blue Cross Life and Health Insurance Company, Counsel Stack Legal Research, https://law.counselstack.com/opinion/abira-medical-laboratories-v-anthem-blue-cross-life-and-health-insurance-cacd-2025.