Smith v. Blue Shield of California Life & Health Insurance Co.

228 F. Supp. 3d 1056, 2017 U.S. Dist. LEXIS 5620
CourtDistrict Court, C.D. California
DecidedJanuary 13, 2017
DocketCase No.: SACV 16-00108-CJC(KESx)
StatusPublished
Cited by7 cases

This text of 228 F. Supp. 3d 1056 (Smith v. Blue Shield of California Life & Health Insurance Co.) 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
Smith v. Blue Shield of California Life & Health Insurance Co., 228 F. Supp. 3d 1056, 2017 U.S. Dist. LEXIS 5620 (C.D. Cal. 2017).

Opinion

ORDER GRANTING DEFENDANT’S MOTION FOR SUMMARY JUDGMENT

CORMAC J. CARNEY, UNITED STATES DISTRICT JUDGE

I. INTRODUCTION

Plaintiff Shannon Smith brings this case against Defendant California Physicians’ Service, d/b/a Blue Shield of California (“Blue Shield”)1 alleging violations of the Telephone Consumer Protection Act (“TCPA”), 47 U.S.C. § 227. (Dkt. 1 Ex. A (Complaint originally filed in Orange County Superior Court and removed by Blue Shield to this Court).) Plaintiffs claim is brought on behalf of herself and all others who received an automated, prerecorded telephone call on December 3, 2015, from Blue Shield regarding renewal of health insurance for 2016. (Id. ¶ 6.) Before the Court is Blue Shield’s motion for summary judgment. (Dkt. 46 [Motion, hereinafter “Mot.”].) For the following reasons, the motion is GRANTED.

II. BACKGROUND

Plaintiff completed an application for health coverage for her family through Covered California for insurance provided by Blue Shield. (Dkt. 46-7 Ex. J at 7-8; Dkt. 68 at 12; Dkt. 46-2 ¶ 1 (Statement of Uncontroverted Facts).) As part of the application, Plaintiff provided her telephone number as the best number at which to contact her. (Dkt. 46-2 ¶ 2.) The coverage agreement was effective as of April 1, 2014, and remained in effect until December 31, 2015. (Id. ¶ 3.) Coverage was set to renew automatically, though with modifications, for the 2016 year. (Id. ¶ 4.)

The Affordable Care Act and its regulations mandate that an individual’s insurance coverage automatically renews to ensure continuity of coverage. (Dkt. 46-5 ¶ 4 (referencing 42 U.S.C. § 300gg-2 and 45 C.F.R. § 147.106).) However, insurance providers such as Blue Shield are authorized to modify insurance plans each year in various ways, including increasing premiums or copayment amounts, modifying [1058]*1058coverage for particular services, and delineating which medical providers were within the insurance network. (See id.) To ensure that individuals are aware of changes to their insurance, providers such as Blue Shield are required to provide written notice of renewal “before the date of the first day of the next annual open enrollment period” in which the individual can opt to select different coverage and/or a different insurance provider. See 45 C.F.R. § 147.106(f)(1); see also id. § 147.106(f)(2) (delineating notice requirements to individuals in plans that are not being modified); id. § 147.200 (describing the “summary of benefits and coverage” which must be included in notice given to individuals).

As authorized by the implementing regulations, the Centers for Medicare and Medicaid Services has issued guidance on the “form and manner of the notices that are required to be provided when a health insurance issuer .,. renews a product.” (Dkt, 46-8 Ex. L at 1.) The guidance states that insurers must include information about premiums, “significant changes to the enrollee’s coverage,” “other health coverage options,” and “[c]ontact information for the consumer to call with questions.” (Id. at 6; see also id. Attachment 7 (listing examples of significant changes as “changes in deductibles, cost sharing, ... covered benefits, eligibility and provider network”).) The form letters provided in the guidance as examples of sufficient notice include phrases such as;

• Important: [Name of issuer] is continuing to over your health coverage for next year. Some plan details may have changed. Unless you take action by [Date], you will be automatically enrolled to continue this coverage next year.... Read this letter to learn more and to review you options.
• This letter summarizes any changes to your coverage so you can decide if you want to keep your plan or look for a different one.
• You can choose a new plan during Open Enrollment from [beginning date through end date].
• So what are my options if ... I don’t like the plan changes presented above? YOU HAVE THREE WAYS TO LOOK INTO OTHER PLANS AND ENROLL: 1. Visit [Marketplace website] and look at other [Name of Marketplace] plans.
• Questions? Call [Name of issuer] at [Issuer phone number], or visit [Issuer website].

(Id. Attachment 1 (emphasis in original).)

Blue Shield, in compliance with applicable statutes and regulations, mailed Plaintiff a packet of information regarding changes to her insurance (e.g., increasing premiums) in late 2015. (Dkt. 46-2 ¶ 5; Dkt. 46-5 ¶ 4; Dkt. 46 at 10.) Included in the packet was information of alternative insurance plans offered by Blue Shield. (Dkt. 46-5 ¶ 4.) In response to the numerous packets that were returned as undelivered in previous years, Blue Shield decided to call each of its existing members using a pre-recorded message to alert them to the fact that their packets had been mailed. (Id. ¶ 7.)

The text of the pre-recorded message went through several iterations and was drafted by Blue Shield’s marketing communications department, which “houses the professional writers that are responsible for crafting all communications” with existing and prospective customers. (Id. ¶ 9.) The final script read:

Hello.
This is an important message from Blue Shield of California. It’s time to review your 2016 health plan options and see what’s new.
[1059]*1059Earlier this month, we mailed you information about your 2016 plan and benefit changes. It compares your current health plan to other options from Blue Shield. You can also find out more online at blueshieldca.com. If you have not received your information packet in the mail, or if you have any questions, please call the number on the back of your member ID card.
Thank you.
Goodbye.

(Dkt. 46-2 ¶ 6.)

Blue Shield called Plaintiff at the number she provided on the Covered California application, which was her cellular telephone number, on December 3, 2015. (Id.) Three days later, she completed an application with Blue Shield for a different health insurance plan for the 2016 year, (Id. ¶ 7.)

III. LEGAL STANDARD

The Court may grant summary judgment on “each claim or defense—or the part of each claim or defense—on which summary judgment is sought.” Fed. R. Civ. P. 56(a). Summary judgment is proper where the pleadings, the discovery and disclosure materials on file, and any affidavits show that “there is no genuine dispute as to any material fact and the movant is entitled to judgment as a matter of law.” Id.; see also Celotex Corp. v. Catrett,

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Cite This Page — Counsel Stack

Bluebook (online)
228 F. Supp. 3d 1056, 2017 U.S. Dist. LEXIS 5620, Counsel Stack Legal Research, https://law.counselstack.com/opinion/smith-v-blue-shield-of-california-life-health-insurance-co-cacd-2017.