Legal Case Against Wellpoint Blue Cross of California for Non-Payment of Services Related to Cell Culture Drug Resistance Testing (6/18/2002)

Introduction: Blue Cross of California was previously a non-profit corporation and approved payment for Cell Culture Drug Resistance Testing (CCDRT) as stipulated in an "internal directive" dated December, 1993. However, this company later became a wholly-owed, for-profit subsidiary of Wellpoint, Inc., and then denied coverage for CCDRT, on the grounds that the service did not meet Wellpoint's medical necessity guidelines. Greater than 10 court cases were brought against Wellpoint Blue Cross in California by patients seeking payment for CCDRT by Wellpoint Blue Cross. In each and every case, Wellpoint Blue Cross was found by the court to be in the wrong, and was ordered to provide full payment of services as originally billed, plus court costs. In a small claims court case argued and adjudicated in January, 2002, Wellpoint Blue Cross appealed the judgment to the Superior Court of California, County of San Diego. Oral arguments were heard April 12, 2002, with follow-up written arguments filed on behalf of both plaintiff (April 25, 2002) and defendant (May 9, 2002). The State of California Superior Court Judgment was rendered June 3, 2002.

Presented on this website are:

Brief introduction to the case

Plaintiff's arguments (in favor of compelling Blue Cross reimbursement)

Defendant's arguments (against compelling Blue Cross reimbursement)

Superior Court Judgment (6/3/02)

Additional relevant letters sent by Larry Weisenthal:

Letter to National BlueCross/Blue Shield Technology Eval Ctr (5/4/02)

Follow-up letter to Wellpoint Blue Cross (6/18/02)