Zieba v. Health Care Service Corp.

2025 IL App (1st) 242423-U
Appellate Court of Illinois·Decided September 19, 2025·No. 1-24-2423·Unpublished

Opinion

2025 IL App (1st) 242423-U FIRST DISTRICT,

SIXTH DIVISION

September 19, 2025

No. 1-24-2423

NOTICE: This order was filed under Supreme Court Rule 23 and is not precedent except in the limited circumstances allowed under Rule 23(e)(1).

IN THE

APPELLATE COURT OF ILLINOIS FIRST JUDICIAL DISTRICT

ALEKSANDRA ZIEBA, ) Appeal from the ) Circuit Court of

Plaintiff-Appellee, ) Cook County, Illinois.

v. )

) No. 2020 CH 06466

HEALTH CARE SERVICE CORPORATION d/b/a ) BLUE CROSS BLUE SHIELD OF ILLINOIS, ) Honorable ) Thaddeus L. Wilson, Defendant-Appellant. ) Judge Presiding.

JUSTICE GAMRATH delivered the judgment of the court.

Presiding Justice C.A. Walker and Justice Hyman concurred in the judgment.

ORDER

¶1 Held: Class certification was improper where the trial court acknowledged plaintiff did not demonstrate that common questions would predominate over individual ones, since calculation of damages and other issues would involve highly individualized inquiries for each class member.

¶2 This interlocutory appeal stems from a class certification order that skims over the requirements of class certification to fit a case that does not qualify for class certification because plaintiff has not met her burden of proof.

¶4 Plaintiff Aleksandra Zieba had a health insurance policy with defendant Health Care Service Corporation (also known as Blue Cross and Blue Shield of Illinois, “Blue Cross”) and used an out-of-network provider to treat her Lyme disease. She submitted claims to Blue Cross totaling $82,888.53, of which Blue Cross paid none. Zieba then filed a breach of contract suit against Blue Cross, alleging it breached the terms of her policy requiring it to adjudicate her claims within 45 days and provide dates of service in its explanation of benefits statements (EOBs).

¶5 Upon Zieba’s fourth motion for class certification, the trial court certified two classes “for liability purposes only”: (1) Illinois policyholders whose claims Blue Cross adjudicated beyond the contractual 45-day deadline, and (2) Illinois policyholders who received EOBs without line-item dates of service. Blue Cross appeals pursuant to Supreme Court Rule 306(a)(8) (eff. Oct 1, 2020), arguing that certification was improper where, among other things, common issues do not predominate. We agree and reverse the grant of class certification.

¶6 I. BACKGROUND

¶7 According to the third amended complaint (“complaint”), Zieba contracted Lyme disease from a tick bite in 2000. After 18 years of pain and “a plethora of contradictory diagnoses” from various doctors, she was diagnosed with Lyme disease in 2018.

¶8 A. Zieba’s Blue Cross Insurance Policy

¶9 Starting on January 1, 2018, and at all relevant times thereafter, Zieba was insured under a Blue Cross insurance plan. Zieba’s policy provides that when the insured submits a complete post-service claim, “Blue Cross and Blue Shield must notify you of the claim determination (whether adverse or not)” within 30 days. This deadline may be extended for “up to 15 days” if Blue Cross “(1) determines that such an extension is necessary due to matters beyond the control

of the Plan and (2) notifies you in writing, prior to the expiration of the initial 30-day period, of the circumstances requiring the extension of time and the date by which Blue Cross and Blue Shield expects to render a decision.” If the initial claim is incomplete, Blue Cross has 30 days to notify the insured of that fact, whereupon the insured has 45 days to provide complete claim information to Blue Cross. After Blue Cross receives the complete information, it has 45 days to notify the insured of its claim determination.

¶ 10 Zieba’s policy additionally provides that if a claim is denied or not paid in full, Blue Cross will notify the insured in writing of (1) the reasons for denial, (2) “[a] reference to the benefit plan provisions on which the denial is based, or the contractual, administrative or protocol for the determination,” and (3) subject to privacy laws and other restrictions, “the identification of the Claim, date of service, health care provider, Claim amount (if applicable), and a statement describing denial codes with their meanings and the standards used.”

¶ 11 B. Zieba’s Treatment and Claims

¶ 12 For treatment of her Lyme disease, Zieba underwent a 19-week course of treatment from March 12 to July 16, 2018, at the Sponaugle Wellness Institute in Florida (“Sponaugle”), an out- of-network provider. Sponaugle does not accept insurance and charges its patients the full cost of all services in advance. Additionally, it does not prepare claim forms or submit bills to insurance providers on behalf of its patients. Zieba understood this and knew she would have to submit to Blue Cross her own paper claim forms and invoices to support a request for reimbursement.

¶ 13 After completion of her 19-week treatment, Zieba submitted two claims to Blue Cross. Her first claim for “infusion therapy,” submitted on August 8, 2018, totaled $15,702.53 and included 108 pages of attached receipts. The claim covered supplies and services from February through July 2018, consisting chiefly of medical tests ordered by Sponaugle and medications and

supplements prescribed by Sponaugle. Zieba’s second claim for “infusion therapy,” submitted on October 22, 2018, included 58 additional pages of receipts. The claim totaled $67,186.00, consisting of $66,000 in Sponaugle medical treatments and $1,186.00 for a PICC line removal and medical tests. It covered services and supplies from March through August 2018, which overlaps with the period covered by her first claim.

¶ 14 Months passed with no response from Blue Cross. In January 2019, Zieba’s husband contacted Blue Cross to inquire about the status of the claims. “Around the same time,” Blue Cross sent its first EOB to Zieba. In total, Blue Cross sent three EOBs, with processing dates of December 26, 2018, January 7, 2019, and July 10, 2019. None of the EOBs correspond exactly to either of Zieba’s two claims, but reference overlapping treatment dates. Moreover, the line- item charges on the EOBs contain labels such as “Medical Visits,” “Med/Surg Supplies,” and “Treatment Other,” and none of the line items include corresponding dates of treatment or procedure codes. Zieba alleges this makes it impossible to determine which procedures are being referenced in each EOB. Blue Cross determined that of $64,280 in claims, a total of $9,874.67 was covered, which was less than Zieba’s deductible of $15,000 for out-of-network providers.

¶ 15 According to Zieba’s complaint, Zieba’s symptoms were alleviated by her treatment at Sponaugle, but began to return. Zieba was left “in limbo” because she could not afford further treatment on her own and had “no clear guidance on what future treatment Blue Cross might reimburse and in what amount.” Thus, Zieba was “depriv[ed] *** of the ability to make timely and informed decisions about [her] medical treatment.” If she had received timely and clear adjudications, she could have made different decisions regarding her treatment, including borrowing money to cover additional treatment while knowing some portion of that money

would be reimbursed, or seeking treatment with a provider who would be covered. Instead, she discontinued treatment and her condition worsened.

¶ 16 C. Procedural History

¶ 17 Zieba filed the instant suit against Blue Cross on October 26, 2020. The court dismissed her complaint without prejudice. After multiple attempts to replead, Zieba filed the operative third amended complaint on August 17, 2022. Zieba seeks relief in seven counts.

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