Van Ness v. Blue Cross of California

In Van Ness v. Blue Cross of California (2001) 87 Cal.App.4th 364, Division Four of this District disagreed with the appellant's characterization that "the limited fee schedule in his health insurance agreement operated as an exclusion from coverage . . . because nothing in the schedule restricted the kinds of covered services under the policy. Instead, it fixed the maximum amount Blue Cross would pay for those services when obtained from a nonparticipating provider." The court found that because the "schedule does not identify risks that are not insured, but rather identifies the extent of benefits available for nonnetwork care," it was not subject to the Ponder test. ( Id. at p. 374.)