Everson v. Blue Cross and Blue Shield of Ohio

How courts have described this case

Verbatim parenthetical descriptions written by other courts when citing this decision. Ranked by citation-network relevance.

• holding that one Plan Certificate, when read alone, left ambiguous whether the “reasonable charge” from which copayments are calculated reflected agreed upon discounts, and construing the ambiguity against the insurer
• finding that certain plaintiffs stated a claim for breach of fiduciary duty when it alleged that insurer did not share in the discounts it received from health care providers in violation of subscriber certificates
• finding Blue Cross Blue Shield had discretionary authority regarding claims and negotiation with providers regarding charges that it would pay under terms of plan
• policy language defining \provider’s reasonable charge” as \the charge that we determine is reasonable for Covered Services provided to you. A Contracting Provider’s Reasonable Charge is established by the agreement between us and the provider ”, read alone, is ambiguous

Source: CourtListener parenthetical corpus (CC0).