Zieba v. Health Care Service Corp.

2025 IL App (1st) 242423-U
CourtAppellate Court of Illinois
DecidedSeptember 19, 2025
Docket1-24-2423
StatusUnpublished

This text of 2025 IL App (1st) 242423-U (Zieba v. Health Care Service Corp.) is published on Counsel Stack Legal Research, covering Appellate Court of Illinois primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Zieba v. Health Care Service Corp., 2025 IL App (1st) 242423-U (Ill. Ct. App. 2025).

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. No. 1-24-2423

¶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

-2- No. 1-24-2423

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

-3- No. 1-24-2423

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

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