Kenavan v. Empire blue Cross & Blue Shield

OPINION OF THE COURT

Naírdelli, J.

Plaintiffs paid premiums for Medigap insurance (i.e., coverage for the 20% difference the patient is liable for when a doctor does not accept assignments from Medicare). In so doing, they believed that they would be covered for any difference in the amount paid by Medicare to the doctor and the reasonable amount billed. Defendant Empire failed to live up to its obligations under the policies and breached the insurance contracts. In the words of plaintiff Robert Kenavan at his deposition, “I got a policy that ain’t being lived up to”.

Medicare Part A covers…