Erika, Inc. v. Blue Cross & Blue Shield of Alabama

496 F. Supp. 786, 1980 U.S. Dist. LEXIS 13310
CourtDistrict Court, N.D. Alabama
DecidedSeptember 2, 1980
DocketCiv. A. 77-M-1601
StatusPublished
Cited by10 cases

This text of 496 F. Supp. 786 (Erika, Inc. v. Blue Cross & Blue Shield of Alabama) is published on Counsel Stack Legal Research, covering District Court, N.D. Alabama primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Erika, Inc. v. Blue Cross & Blue Shield of Alabama, 496 F. Supp. 786, 1980 U.S. Dist. LEXIS 13310 (N.D. Ala. 1980).

Opinion

MEMORANDUM OPINION

McFADDEN, Chief Judge.

This case arises out of a dispute between Erika, Inc., a Delaware corporation, and *787 Blue Cross-Blue Shield of Alabama (“Blue Cross”), a non-profit corporation organized for the purpose of operating various health care service plans. The court has jurisdiction under 28 U.S.C. § 1332.

The coverage at issue is Blue Cross “C-Plus” coverage which provides coverage supplementary to that provided by the Medicare program of the federal government. Erika, which provides hemodialysis supplies for use by patients at home, claims that Blue Cross owes it certain sums payable under C-Plus contracts owned by its customers.

The case was tried to the court without a jury and this memorandum opinion is issued in lieu of findings of fact and conclusions of law in accordance with Rule 52, Fed.R.Civ.P.

Prior to 1975, the processing of claims for supplies of hemodialysis patients in Alabama was handled by University Hospital. Under this arrangement, supplies were shipped directly to patients and the processing of the patients’ claims was done by University Hospital. Blue Cross has a practice of paying sums directly to providers of health care services who are residents of the state where valid assignments are executed by the subscribers. To accomplish this direct payment, Blue Cross had assigned a provider number to University Hospital. Pursuant to its standard procedures, Blue Cross then paid the amounts due under the various C-Plus contracts directly to University Hospital. In the summer of 1975, University Hospital decided to stop processing claims of its patients for supplies furnished by Erika. Thereafter Blue Cross paid the amounts due under the contracts for supplies furnished by Erika directly to its subscribers. Erika contends that this money should have been paid to it under one of two theories: (1) that á contract was formed between Blue Cross and Erika by which Blue Cross agreed to send the money directly to Erika; and (2) that the money should have been paid directly to Erika under “assignments” executed by the subscribers in favor of Erika. The court finds neither argument persuasive.

The contract alleged to exist is based on a series of communications between Erika and Blue Cross following the termination of billing service by University Hospital. On July 2, 1975, Aaron W. Barradale of Erika wrote to Andy Fox of Blue Cross and requested a provider number for Medicaid and Blue Cross. The relevant portion of the letter reads as follows:

We will require an Alabama Blue Cross and Alabama Medicaid provider number, and instructions on your billing requirements in order to participate in both programs.

Mr. Fox responded by letter of July 17, 1975, which states in relevant part:

Medicare beneficiaries may have Alabama C-Plus. File a copy of the SSA-1490 which was submitted to Prudential and attach a copy of the remittance statement from Prudential indicating Medicare’s allowed charges. Send these claims to “C-Plus Claims Department, Blue Cross and Blue Shield of Alabama, 930 South 20th Street, Birmingham, Alabama 35298.” (A provider number is not necessary since we intend to process these claims by special checks).

For a contract to exist between the parties based on these writings, the court must find that an offer was made, that the offer was accepted, and that there was consideration given. W. Jaeger, Williston on Contracts § 23 (1957). Professor Williston defines “offer” as follows:

An offer necessarily looks to the future. It is an expression by the offeror of his agreement that something over which he at least assumes to have control shall be done or happen if the conditions stated in the offer are complied with. Unless the statement gives the person to whom it is addressed an assurance that, on some contingency at least, he shall have something, the statement is not an offer.

Williston on Contracts, § 24A. Under Alabama law, to render the contract valid, the agreement of the parties as expressed in the offer and acceptance must be certain and explicit and their full intention as *788 certainable to a reasonable degree of certainty. Dillon v. AFBIC Development Corp., 420 F.Supp. 572 (S.D.Ala.1976).

Erika contends that the July 2 letter was an offer to continue providing medical supplies to Blue Cross subscribers, and bases its contention on the fact that Erika requested a “provider” number, a device used for paying providers directly. Although the plaintiff is correct in pointing out that a “provider number” is generally used by insurance companies to accumulate claims and pay by computer, there was no evidence indicating that a request for a provider is a customary manner of requesting direct payment. Even if the letter could be construed as an offer, Blue Cross’ refusal to assign a provider number constituted a rejection of that offer. Erika’s response is that Blue Cross’ agreement to pay the sums by “special checks” was in fact an acceptance of the offer. This argument cannot stand in light of the testimony that special checks were used for the payment of single claims both to subscribers and to providers. Indeed, the evidence indicated that Blue Cross used special checks more often in the case of subscribers than providers. The response of Blue Cross to the inquiry of Erika merely outlines procedures for the submission of claims and can' in no way be deemed to constitute an acceptance of specific contract terms.

Even if the exchange of letters can somehow be construed as containing the essential elements of the agreement, no contract was formed because there was no consideration. Consideration for a promise is an act, a forbearance, or the creation, modification or destruction of a legal relation, or a return promise, bargained for and given in exchange for the promise. Restatement of Contracts, § 75. In the instant case, there was no consideration to Blue Cross from Erika for any promise made by Blue Cross. Although legal detriment to the promisee is as valid consideration as benefit to the promisee, see Corbin on Contracts, § 122, that consideration must be bargained for, and in the instant case there is no evidence that the action of Erika in submitting bills in the form and manner set forth by Blue Cross and refraining from sending such bills to Blue Cross’ subscribers was in any way bargained for. The court finds that the exchange of correspondence did not form a contractual obligation on the part of Blue Cross to pay the money directly to Erika.

The plaintiff’s second argument is that it was entitled to receive direct payment from Blue Cross because of certain “assignments” executed by Blue Cross subscribers in favor of Erika. The form used by Erika read as follows:

I request that payment under the medical insurance program be made directly to Erika Distributors, Inc. on any unpaid bills for supplies furnished to me during the period --to--

Erika contends that the execution of such a form in favor of Erika vests in Erika the right to receive direct payment of insurance proceeds.

There is no required form in which an assignment must be made.

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Cite This Page — Counsel Stack

Bluebook (online)
496 F. Supp. 786, 1980 U.S. Dist. LEXIS 13310, Counsel Stack Legal Research, https://law.counselstack.com/opinion/erika-inc-v-blue-cross-blue-shield-of-alabama-alnd-1980.