Dignity Health v. Blue Cross Blue Shield of Georgia, Inc.

• Court: District Court, N.D. California
• Decided: April 7, 2026
• Docket: 4:25-cv-07336
• Status: Unknown

Opinion

1 2 3 4 UNITED STATES DISTRICT COURT 5 NORTHERN DISTRICT OF CALIFORNIA 6 7 DIGNITY HEALTH, Case No. 25-cv-07336-JST

8 Plaintiff, ORDER GRANTING MOTION TO 9 v. DISMISS

10 BLUE CROSS BLUE SHIELD OF Re: ECF No. 19 GEORGIA, INC., et al., 11 Defendants.

12 13 Before the Court is Defendant Blue Cross Blue Shield of Georgia, Inc.’s (“Blue Cross 14 Georgia”) motion to dismiss. ECF No. 19. The Court will grant the motion. 15 I. BACKGROUND 16 Plaintiff Dignity Health owns and operates medical facilities in the State of California. 17 ECF No. 16 (“Am. Compl.”) ¶ 1. It provided medical care to members of Defendant Blue Cross 18 Georgia. Id. ¶ 3. Blue Cross Georgia has a principal place of business in Atlanta, Georgia, and is 19 organized under the laws of the State of Georgia. Id.; ECF No. 19-2 ¶ 2. Blue Cross Georgia sells 20 health insurance contracts to individuals living in its designated service area, which encompasses 21 all counties of Georgia. Id. ¶¶ 3–4. Blue Cross Georgia “does not sell [health insurance] contracts 22 to individuals living outside of its service area.” Id. ¶ 4. Blue Cross Georgia also acts as a third- 23 party administrator of self-funded health plans, but does not receive any insurance premiums from 24 the plans or its beneficiaries for those plans. Id. ¶¶ 5–6. Blue Cross Georgia is not licensed by the 25 State of California to conduct business in California, including operating a “health care service 26 plan” under § 1345 of the California Health and Safety Code. ECF No. 19-2 ¶¶ 7–10. Dignity 27 Health nonetheless argues that Blue Cross Georgia “markets and sells insurance policies in 1 Blue Cross Georgia participates in the nationwide “Blue Card” program. Am. Compl. 2 ¶ 16. “The Blue Card Program links patients and independent BLUE CROSS and /or Blue Shield 3 Plans, across the country and abroad, with a single electronic network for claims processing and 4 reimbursement.” Id. Through the program, participating plans and their members may access a 5 network of providers maintained by local BlueCard plans, such as California’s local affiliate, 6 Anthem Blue Cross. Id. ¶¶ 9–11, 13–14. When a patient covered by a Blue Cross Georgia plan 7 receives care outside of Blue Cross Georgia’s service area, “the Home Plan will reimburse the 8 provider at a rate which equals (at a minimum) the levels received for providers under the 9 provider’s contract with its Host Plan, i.e., the local Plan.” ECF No. 19 at 9 (citing In re Blue 10 Cross Blue Shield Antitrust Litig., 308 F. Supp. 3d 1241, 1255 (N.D. Ala. 2018)). In this case, the 11 contract in question is Dignity Health’s contract with Anthem Blue Cross. Am. Compl. ¶ 11. 12 “The Anthem Provider Contract refers to entities like Blue Cross as an ‘Other Payor,’ which term 13 is defined in relevant part as ‘persons or entities, utilizing the Managed Care Networks(s)/Plan 14 Programs pursuant to an agreement with Anthem or an Affiliate, including other Blue Cross or 15 Blue Shield Plans.” Id. ¶ 12. Dignity Health alleges that it is obligated to treat Blue Cross 16 Georgia members because of its provider contract. Id. ¶ 13. 17 Blue Cross Georgia is not alleged to be a signatory to the provider contract with Dignity 18 Health, id. ¶ 14, but is referred to as an “Other Payor.” Id. ¶ 12. Under the relevant agreement, 19 Dignity Health is required to look solely to Blue Cross Georgia for payment, but Anthem “help[s] 20 either process the payments for [sic] facilitate the treatments, payments, and appeals.” Id. ¶ 15. 21 Between November 8, 2022 and August 20, 2024, Dignity Health provided care to thirteen 22 individuals, whom Dignity Health alleges are domiciled in California. ECF No. 25-2 ¶ 7. Dignity 23 Health alleges that the value of these services was $1,628,283.36, but that Blue Cross Georgia 24 paid only a fraction of that amount. Am. Compl. ¶¶ 24–27. 25 On July 8, 2025, Dignity Health sued Blue Cross Georgia in California state court to 26 recover the amounts owed. ECF No. 1-1. On August 29, 2025, Blue Cross Georgia removed the 27 action to this Court. ECF No. 1 ¶ 4. On October 2, 2025, Dignity Health filed an amended 1 quantum meruit. Am. Compl. ¶¶ 28–69. Blue Cross Georgia now moves to dismiss the amended 2 complaint for lack of personal jurisdiction and for failure to state a claim. ECF No. 19. Dignity 3 Health filed an opposition brief, ECF No. 25, to which Blue Cross Georgia replied. ECF No. 26. 4 II. LEGAL STANDARD 5 A. Rule 12(b)(2) 6 When a defendant objects to the Court's personal jurisdiction over it pursuant to Federal 7 Rule of Civil Procedure 12(b)(2), “the plaintiff bears the burden of establishing that jurisdiction is 8 proper.” Boschetto v. Hansing, 539 F.3d 1011, 1015 (9th Cir. 2008). Absent an evidentiary 9 hearing, however, the plaintiff need only make a prima facie showing of personal jurisdiction. Id. 10 “Uncontroverted allegations in the plaintiff's complaint must be taken as true,” and “[c]onflicts 11 between the parties over statements contained in affidavits must be resolved in the plaintiff's 12 favor.” Id. (quoting Schwarzenegger v. Fred Martin Motor Co., 374 F.3d 797, 800 (9th Cir. 13 2004)). “Where, as here, there is no applicable federal statute governing personal jurisdiction, the 14 district court applies the law of the state in which the district court sits.” Schwarzenegger, 374 15 F.3d at 800. “Because California's long-arm jurisdictional statute is coextensive with federal due 16 process requirements, the jurisdictional analyses under state law and federal due process are the 17 same.” Id. at 800–01. 18 III. SUBJECT-MATTER JURISDICTION 19 The Court has subject-matter jurisdiction. 28 U.S.C. § 1332. 20 IV. DISCUSSION 21 “Personal jurisdiction must exist for each claim asserted against a defendant.” Action 22 Embroidery Corp. v. Atl. Embroidery, Inc., 368 F.3d 1174, 1180 (9th Cir. 2004) (citation omitted). 23 Federal courts recognize two types of personal jurisdiction over a defendant: general and specific. 24 Bristol-Myers Squibb Co. v. Super. Ct., 582 U.S. 255, 261–62 (2017) (citation omitted). Blue 25 Cross Georgia argues that the Court lacks both specific and general jurisdiction over it. 26 A. General Jurisdiction 27 It is well-established that “[a] court may assert general jurisdiction over foreign (sister- 1 affiliations with the State are so ‘continuous and systematic’ as to render them essentially at home 2 in the forum State.” Goodyear Dunlop Tires Operations, S.A. v. Brown, 564 U S. 915, 919 (2011) 3 (quoting International Shoe v. Washington, 326 U.S. 310, 317 (1945)). Generally, corporations 4 are at home in the states where they are incorporated or have their principal place of business. 5 Daimler AG v. Bauman, 571 U.S. 117, 137 (2014). Blue Cross Georgia is incorporated in and has 6 its primary place of business in Georgia, not California. ECF No. 25 at 13–14. 7 Plaintiff contends that “[i]f the non-resident defendant’s activities in the state are 8 ‘continuous and systematic,’ or ‘substantial,’ the court may assert general jurisdiction over a cause 9 of action, even if it is unrelated to the defendant’s forum activities.” ECF No. 25 at 13 (citing 10 Hirsch v. Blue Cross, Blue Shield of Kansas City (9th Cir. 1986). Hirsch is no longer good law. 11 After Daimler, a state other than one in which the defendant is incorporated or has its primary 12 place of business has general jurisdiction only in “exceptional circumstances.” Daimler, 571 U.S. 13 at 139 n.19. “Exceptional circumstances, as noted in Daimler, do not exist merely whenever a 14 foreign corporation’s in-forum contacts can be said to be in some sense continuous and systematic, 15 it is only whether that corporation’s affiliations with the State are so continuous and systematic as 16 to render [it] essentially at home in the forum State.” San Diego Cnty. Credit Union v. Citizens 17 Equity First Credit Union, 325 F. Supp. 3d 1088, 1095–96 (S.D. Cal. 2018) (quoting Daimler, 571 18 U.S. at 139 n.19) (citation modified). 19 Martinez v. Aero Caribbean, 764 F.3d 1062 (9th Cir. 2014) is illustrative. In that case, the 20 Ninth Circuit declined to find general jurisdiction where the defendant's contacts with California 21 included contracts with California companies worth between $225 and $450 million; attendance at 22 industry conferences; and promotion of products in California. 764 F.3d at 1070; see also Dormoy 23 v. HireRight, LLC, 23-cv-02511-EMC, 2023 WL 5110942, at *5–6 (N.D. Cal. Aug. 9, 2023) 24 (finding no general jurisdiction over the defendant when it had temporary headquarters and 25 employment in California, given that defendant operated in a variety of states, with offices and 26 executives spread across the nation). This Court has previously denied general jurisdiction when 27 every member of the defendant company’s leadership team worked from California, its mailing 1 Inc., No. 24-cv-0903-JST, 2024 WL 4261498, at *6 (N.D. Cal. Sept. 9, 2024). 2 Plaintiff asserts that Blue Cross Georgia members received “a significant number” of 3 treatments in California, including “a significant number” provided by Dignity Health, and that 4 Blue Cross Georgia, via the BlueCard program, is “likely a part of large contracts for services that 5 [Blue Cross Georgia] knowingly entered into.” ECF No. 25 at 14. Plaintiff also asserts that it 6 contacted Blue Cross Georgia regarding payment for the services it provided. Id. 7 The Court finds that Plaintiff has not met the high bar for alleging “exceptional 8 circumstances.” Even if Plaintiff’s disputed allegations were true, they would be insufficient to 9 establish that Blue Cross Georgia is at home in California. See, e.g., Walden, No. 24-cv-0903- 10 JST, 2024 WL 4261498, at *6. 11 B. Specific Jurisdiction 12 Specific jurisdiction “depends on an affiliation between the forum and the underlying 13 controversy, principally, activity or an occurrence that takes place in the forum [s]tate and is 14 therefore subject to the [s]tate's regulation.” Goodyear, 564 U.S. at 919 (quotations and citation 15 omitted). In determining whether the exercise of specific jurisdiction is consistent with due 16 process, courts are to consider:

17 (1) The non-resident defendant must purposefully direct [its] activities or consummate some transaction with the forum or resident 18 thereof; or perform some act by which [it] purposefully avails [itself] of the privilege of conducting activities in the forum, thereby 19 invoking the benefits and protections of its laws; (2) the claim must be one which arises out of or relates to the 20 defendant's forum-related activities; and (3) the exercise of jurisdiction must comport with fair play and 21 substantial justice, i.e. it must be reasonable. 22 Schwarzenegger, 374 F.3d at 802. With regard to the first prong, “[a] purposeful availment 23 analysis is most often used in suits sounding in contract” and “[a] purposeful direction analysis . . . 24 is most often used in suits sounding in tort.” Id. The plaintiff bears the burden of proving the first 25 two prongs; the burden then shifts to the defendant to show that jurisdiction is unreasonable. Id. 26 Dignity Health attempts to establish specific jurisdiction through the declaration of David 27 Lambert, its Regional Vice President, California Revenue Cycle. ECF No. 25-1. Based on 1 residents by “market[ing] and sell[ing] insurance policies within the State of California, as the 2 Patients pay premiums to [Blue Cross Georgia], while also living in California. ECF No. 25 at 16. 3 But that is not what Lambert declared. He indicated that Dignity Health treated Blue Cross 4 Georgia beneficiaries who “presented with California residential addresses” and “presented 5 insurance cards with the [Blue Cross Georgia] logos,” which “instructed Dignity Health to call or 6 otherwise contact [Blue Cross Georgia].” ECF No. 25-1 ¶ 3. Lambert further stated that Dignity 7 Health communicated with Blue Cross Georgia, id. ¶ 5, received payment from Blue Cross 8 Georgia, id. ¶ 4, and that Blue Cross Georgia “approved, verified, denied services, and made such 9 requests of Dignity Health for clinical information and caused such information to be sent in 10 California.” Id. ¶ 6. 11 Nothing in Lambert’s declaration establishes that Blue Cross Georgia reached out to 12 California, that California residents paid premiums to Blue Cross Georgia, or that Blue Cross 13 Georgia sells or has sold health plans in California. ECF No. 26 at 6. Blue Cross Georgia notes 14 that “Plaintiff does not claim that the 13 patients are primary beneficiaries of any purported health 15 plan of [Blue Cross Georgia], nor does Plaintiff contend these patients are dependents of a primary 16 beneficiary who is domiciled in California.” Id. For its part, Blue Cross Georgia’s declarant 17 stated that it “does not contract with any physicians or medical facilities in California,” “does not 18 direct its members to seek treatment in California,” “does not call, email, correspond with, or 19 otherwise contact out-of-network providers in California proactively to confirm or solicit 20 information” and that “such communication . . . [is] almost always initiated by the provider.” ECF 21 No. 19-1 ¶¶ 12–13. Lambert’s declaration does not contradict any of those facts. ECF No. 25-1. 22 This record falls well short of showing that Blue Cross Georgia “purposefully availed [itself] of 23 the privilege of doing business in California.” Boschetto v. Hansing, 539 F.3d 1011, 1017 (9th 24 Cir. 2008). 25 Plaintiff also argues that Blue Cross Georgia’s participation in the BlueCard program is 26 sufficient to establish specific jurisdiction. Courts across the country who have considered similar 27 arguments have rejected them. See, e.g., Stanford Health Care v. CareFirst of Md., Inc., 716 F. 1 6720-HSG, 2022 WL 4021759, at *3 (N.D. Cal. Sept. 2, 2022); Healthcare Ally Mgmt. of 2 California, LLC v. Blue Cross Blue Shield of Minnesota, 787 F. App'x 417, 418 (9th Cir. 2019); 3 see also Craig Hosp. v. Empire Healthchoice, Inc., No. 18-CV-00794-WYD-STV, 2019 WL 4 10258608, at *4–5 (D. Colo. Apr. 1, 2019) (collecting cases). 5 Plaintiff argues that the Court should reject those authorities and instead follow the 6 Northern District of Alabama’s decision in In re Blue Cross Blue Shield Antitrust Litig., 225 F. 7 Supp. 3d 1269 (N.D. Ala. 2016). Although Blue Cross Georgia does not address or distinguish 8 this case, the Court nonetheless finds Plaintiff’s argument unpersuasive. Claims brought under the 9 Clayton Act—like those at issue in Blue Cross Blue Shield Antitrust—are subject to a 10 jurisdictional provision that permits suit to be brought “in any district wherein [a corporation] may 11 be found or transacts business; and all process in such cases may be served in the district of which 12 it is an inhabitant, or wherever it may be found.” Id. at 1291 (quoting 15 U.S.C. § 22). The 13 present case does not involve the Clayton Act. 14 In short, Plaintiff’s allegations regarding Blue Cross Georgia’s contact with this district are 15 insufficient. And “[w]hile [Blue Cross Georgia] could certainly anticipate that its insureds would 16 travel out-of-state and need medical treatment, there is no reason for them to anticipate being sued 17 in the forum where they received treatment.” Alaska Reg'l Hosp. v. Amil Int'l Ins. Co., No. A03- 18 177 CV (JWS), 2003 WL 24085347, at *4 (D. Alaska Nov. 5, 2003); see also St. Luke's Episcopal 19 Hosp. v. Louisiana Health Serv. & Indem. Co., No. CIV.A. H-08-1870, 2009 WL 47125, at *8 20 (S.D. Tex. Jan. 6, 2009) (“merely providing out-of-state health coverage to insureds does not 21 subject an insurer to personal jurisdiction in every foreign state in which an insured happens to 22 obtain medical services”). 23 The Court finds that Plaintiff has not shown Blue Cross Georgia has “purposefully availed 24 [itself] of the privilege conducting activities in the forum,” and therefore has failed to establish 25 specific jurisdiction. Schwarzenegger, 374 F.3d at 802. 26 C. Jurisdictional Discovery 27 Dignity Health asks for an order permitting jurisdictional discovery. ECF No. 25 at 17. 1 Prestige Royal Liquors Corp., 183 F. Supp. 3d 996, 1001 (N.D. Cal. 2016) (citation and quotation 2 omitted). “[D]iscovery should be granted when . . . the jurisdictional facts are contested or more 3 facts are needed.” Laub v. U.S. Dep’t of Interior, 342 F.3d 1080, 1093 (9th Cir. 2003). In this 4 district, courts have held that “a plaintiff need not make out a prima facie case of personal 5 jurisdiction before it can obtain jurisdictional discovery.” Calix Networks, Inc. v. Wi–Lan, Inc., 6 No. 09-cv-06038-CRB (DMR), 2010 WL 3515759, at *4 (N.D. Cal. Sept. 8, 2010) (citation 7 omitted). A plaintiff must merely present “a ‘colorable basis’ for jurisdiction, or ‘some evidence’ 8 constituting a lesser showing than a prima facie case.” Id. (citation omitted). But “[w]here a 9 plaintiff's claim of personal jurisdiction appears to be both attenuated and based on bare 10 allegations in the face of specific denials made by defendants, the Court need not permit even 11 limited discovery.” Terracom v. Valley Nat'l Bank, 49 F.3d 555, 562 (9th Cir. 1995) (citations 12 omitted). 13 Dignity Health has failed to produce even “some evidence” that tends to establish personal 14 jurisdiction. Hawaii Med. Serv., No. 21-cv-6720-HSG, 2022 WL 4021759, at *5. Even taken as 15 true, Plaintiff’s allegations do not establish personal jurisdiction, and Blue Cross Georgia’s 16 declaration makes the lack of jurisdiction even more clear. 17 When presented with similar pleadings addressing similar issues, judges in this district 18 have denied requests for jurisdictional discovery. CareFirst of Md., 716 F. Supp. 3d at 817; 19 Hawaii Med. Serv., No. 21-cv-6720-HSG, 2022 WL 4021759, at *5. Plaintiff “has not met its 20 burden to demonstrate which pertinent jurisdictional facts are disputed or how further discovery 21 might ‘demonstrate facts sufficient to constitute a basis for jurisdiction.’” CareFirst of Md., 716 22 F. Supp. 3d at 817 (quoting Laub, 342 F.3d at 1093). 23 Dignity Health’s request to conduct jurisdictional discovery is denied. 24 CONCLUSION 25 For the foregoing reasons, the Court grants Blue Cross Georgia's motion to dismiss. 26 Although it seems unlikely that Dignity Health can amend its complaint to allege facts sufficient 27 to confer personal jurisdiction over Blue Cross Georgia, the Court grants such leave out of an ] Any amended complaint shall be filed within 21 days of the date of this order. 2 If no amended complaint is timely filed, the Court will dismiss this case. 3 IT IS SO ORDERED.

4 ||} Dated: April 7, 2026 5 JON S. TIG 6 United States District Judge 7 8 9 10 1] a 12

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