Olivia Reyes v. Blue Cross Blue Shield of Florida, Inc.

• Court: District Court of Appeal of Florida
• Decided: November 5, 2025
• Docket: 3D2024-0273
• Status: Published

Opinion

Third District Court of Appeal State of Florida

Opinion filed November 5, 2025. Not final until disposition of timely filed motion for rehearing.

________________

No. 3D24-0273 Lower Tribunal No. 20-CA-745-K ________________

Olivia Reyes, Appellant,

vs.

Blue Cross Blue Shield of Florida, Inc., et al., Appellees.

An Appeal from the Circuit Court for Monroe County, Timothy J. Koenig, Judge.

Wasson & Associates, Chartered, and Roy D. Wasson; Open Book Appeals and Erin Pogue Newell; Health and Medicine Law Firm, and Maria T. Santi, for appellant.

Johnson, Anselmo, Murdoch, Burke, Piper & Hochman, P.A., and Christopher J. Stearns and Selena A. Gibson, for appellee Florida Keys Aqueduct Authority.

Before GORDO, BOKOR and GOODEN, JJ.

GORDO, J. Olivia Reyes (“Reyes”) appeals from a final summary judgment

entered in favor of Florida Keys Aqueduct Authority (“FKAA”). We have

jurisdiction. Fla. R. App. P. 9.030(b)(1)(A). We affirm.

I.

FKAA is a governmental entity that operates a self-funded health

insurance plan and serves as a self-insurer for its employees. Reyes, an

FKAA employee, participated in the self-funded plan.

In August of 2019, Reyes underwent elective cosmetic procedures,

including liposuction and abdominoplasty. FKAA’s health insurance plan

excludes coverage for cosmetic surgery and any complications arising from

such procedures. 1

Twelve days after the procedure, Reyes developed complications

related to the surgery. She was hospitalized for over a month and treated

for an infection at the site of the abdominoplasty. Reyes submitted medical

bills for payment under her health insurance plan. FKAA denied coverage,

determining the expenses were complications of a noncovered service under

the plan.

1 Reyes concedes that her surgery was not covered under the plan.

2 Reyes filed the underlying action against FKAA, asserting claims for

breach of contract, breach of fiduciary duty, and third-party beneficiary

breach of contract. FKAA moved for summary judgment. Reyes filed a

response in opposition. Following a hearing, the trial court granted FKAA’s

motion for summary judgment, finding no genuine dispute of material fact.

Reyes moved for rehearing, which the trial court denied. This appeal

followed.

II.

“Our standard of review of an order granting summary judgment is de

novo.” Ottey v. Citizens Prop. Ins. Corp., 299 So. 3d 500, 501 (Fla. 3d DCA

2020) (quoting White v. Ferco Motors Corp., 260 So. 3d 388, 390 (Fla. 3d

DCA 2018)). “The court shall grant summary judgment if the movant shows

that there is no genuine dispute as to any material fact and the movant is

entitled to judgment as a matter of law.” Betancourt v. Citizens Prop. Ins.

Corp., 406 So. 3d 1011, 1013 (Fla. 3d DCA 2025) (quoting Fla. R. Civ. P.

1.510(a)). “The court shall state on the record the reasons for granting or

denying the motion.” Id. “A party asserting that a fact cannot be or is

genuinely disputed must support the assertion by citing to particular parts of

materials in the record, including depositions, documents, electronically

stored information, affidavits or declarations.” Id. (quoting Fla. R. Civ. P.

3 1.510(c)(1)(A)). “When seeking summary judgment, the moving party must

identify ‘each claim or defense-or the part of each claim or defense-on which

summary judgment is sought.’” Romero v. Midland Funding, LLC, 358

So. 3d 806, 808 (Fla. 3d DCA 2023) (quoting Fla. R. Civ. P. 1.510(a)). “Once

the party moving for summary judgment satisfies this initial burden, the

burden then shifts to the nonmoving party to come forward with evidence

demonstrating that a genuine dispute of material fact exists.” Id.

III.

Reyes argues the trial court erred in granting summary judgment for

FKAA because a genuine dispute of material fact exists as to whether her

hospital treatment resulted from complications of her elective cosmetic

surgery. The subject hospital records, however, specifically document that

she was treated for a post-operative infection at the incision site resulting

from the cosmetic surgery. 2 Because the undisputed evidence establishes

2 While Reyes submitted an affidavit from her cosmetic surgeon, Dr. Jason Altman, in opposition to summary judgment, it failed to identify any admissible evidence creating a genuine dispute of material fact. See Passariello v. Bank of New York Mellon, 347 So. 3d 446, 448 (Fla. 3d DCA 2022) (“[A]ffidavits opposing summary judgment must identify admissible evidence and not be based on mere supposition or belief[.]” (citing Gonzalez v. Citizens Prop. Ins. Corp., 273 So. 3d 1031, 1036 (Fla. 3d DCA 2019))); Citizens Prop. Ins. Corp. v. Zamanillo, 388 So. 3d 912, 914 (Fla. 3d DCA 2024) (“If the evidence presented by the nonmovant is merely colorable, or is not significantly probative, summary judgment may be granted.” (quoting

4 that Reyes’s hospitalization stemmed from complications of the cosmetic

surgery, FKAA was entitled to summary judgment as a matter of law. See

Tarkoff v. Schmunk, 117 So. 2d 442, 444 (Fla. 2d DCA 1959) (“We have held

that affidavits on motions for summary judgments should set forth admissible

evidence.”); Gonzalez v. Citizens Prop. Ins. Corp., 273 So. 3d 1031, 1035-

38 (Fla. 3d DCA 2019) (“Summary judgment is designed to test the

sufficiency of the evidence to determine if there is sufficient evidence at issue

to justify a trial . . . . [A] party should not be put to the expense of going

through a trial, where the only possible result will be a directed verdict. . . .

[T]he affidavits opposing summary judgment must identify admissible

evidence that creates a genuine issue of material fact. The purpose of this

requirement is to ensure that there is an admissible evidentiary basis for the

case rather than mere supposition or belief. The focus is on whether the

affidavits show evidence of a nature that would be admissible at trial . . . .

The [Appellants’] affidavits opposing summary judgment did not create a

genuine issue of material fact to defeat [Appellee’s] summary judgment

motion. Accordingly, summary judgment was properly granted.” (internal

quotation marks and citations omitted)); Chowdhury v. BankUnited, N.A.,

In re Amends. to Fla. Rule of Civ. Proc. 1.510, 309 So. 3d 192, 193 (Fla. 2020))).

5 366 So. 3d 1130, 1134 (Fla. 3d DCA 2023) (“Our new summary judgment

standard mirrors the standard for a directed verdict such that the inquiry

focuses on ‘whether the evidence presents a sufficient disagreement to

require submission to a jury or whether it is so one-sided that one party must

prevail as a matter of law.’” (quoting In re Amends. to Fla. Rule of Civ. Proc.

1.510, 309 So. 3d 192, 192 (Fla. 2020))).

IV.

Reyes further argues she received emergency medical services and

that federal law mandates coverage for such services. The Patient

Protection and Affordable Care Act identifies ten “general categories” of

mandatory “[e]ssential health benefits,” including “[e]mergency services.” 42

U.S.C. § 18022(b)(1)(B). Self-funded plans maintained by government

entities, however, are exempt from this requirement. It is undisputed that

FKAA is a governmental entity that operates a self-funded health insurance

plan. Because no genuine dispute of material fact exists regarding FKAA’s

exemption from covering emergency medical services under federal law, the

trial court properly granted summary judgment in its favor. See 42 U.S.C.

6 § 18021(b)(1)(A)–(B) (providing an “exception for self-insured plans” from

compliance with the Act).3

Affirmed.

3 To the extent Reyes raises new issues regarding FKAA’s compliance with state law, those issues were not presented below. Thus, they are deemed waived and not properly preserved for appellate review. See Van Lent v. Everglades Found., Inc., 400 So. 3d 64, 74–75 (Fla. 3d DCA 2024) (“We begin our analysis with a basic tenet of Florida appellate review that it is improper to raise for the first time on appeal matters which should have been raised to the trial court.”).