On Wednesday, ERLC, LLC filed a complaint in the County Court of Galveston County, Texas against Blue Cross Blue Shield of Texas and Guadalupe Guzman for failure to pay Guzman’s hospital bill after agreeing to do so as her insurer.
The plaintiff is an emergency hospital located in League City, Texas that treated defendant Guzman on February 11, 2020. She was insured by the defendant BCBS, but they allegedly considered ERLC an out of network provider. On March 9, 2020, “BCBS accepted coverage and provided [a] partial payment” to the plaintiff; however, they only covered $466.50of a $90,473.01 total bill. BCBS has since “refused” to cover the remaining $89,594.01 so Guzman is “jointly and severally liable” to finish the payment.
In September 2021, ERLC and BCBS entered into mediation to discuss the payment of Guzman’s bill, but it was declared unsuccessful on September 23.
The plaintiffs argued in their complaint that “BCBS is obligated to pay ERLC directly” as an insurance provider. ERLC “was obligated by law” to provide medical services to Guzman and that BCBS was “reasonably expected” to pay the medical bill. Furthermore, ERLC’s emergency medical care to Guzman was, per the complaint, “essential and necessary to allow BCBS to satisfy its contractual and other legal obligations to its patient member.”
The plaintiff is suing on the counts of breach of contract under the Texas Insurance Code, violation of Texas Insurance Code Section 1467.0575, and breach of implied contract for both defendants.
The plaintiff is seeking actual damages, consequential damages, pre- and post-judgment interest, attorney’s fees and costs, and other relief.
ERLC is represented by Munsch Hardt Kopf & Harr, P.C.