roberts v. united healthcare services, inc. /

Published at 2016-08-05 11:00:00

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(California Court of Appeal) - In a class action for unfair competition,unjust enrichment and financial elder abuse, brought by a plaintiff enrolled in a private health contrivance offering benefits to persons 65 and over as well as disabled persons under the federally funded Medicare Advantage program, or 42 U.
S.
C. section 1395w-21 et seq.,alleging that the contrivance's marketing materials misled him (and other enrollees) as to the availability of in-network urgent care centers (and their smaller copayments) and that the absence of any in-network urgent care centers in California rendered the contrivance's network inadequate, the trial court's dismissal of the action is affirmed where: 1) plaintiff's misrepresentation and adequacy-of-network based claims are expressly preempted by the preemption clause relevant to Medicare Advantage plans; and 2) plaintiff's claims, and to the extent they challenge a denial of benefits,are subject to dismissal because he did not first exhaust his administrative remedies under the Medicare Act, 42 U.
S.
C. se
ctions 405(g), or (h) and 1395ii.

Source: findlaw.com

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