YDM was the assignee of claims of Doctor’s Express which was not a contracted provider of medical services for Sharp, a preferred provider health insurer. YDM claimed that it was entitled to reimbursement at the reasonable and customary value of the services provided because the bills were for emergency services. Sharp met its initial burden on summary judgment by submitting a declaration from one of its experienced employees, attesting that none of the assigned bills used CPT codes indicating that emergency medical services had been provided. The CPT codes on the bills were admissions binding on the billing entity and its assignee YDM. YDM did not submit any admissible testimony to show that emergency services CPTs were on the bills or that despite the codes used, emergency services were in fact provided. A declaration by YDM’s president opining generally that some or all of the bills were for emergency services was inadmissible as he offered no reasoning and no documentary backup for his opinion. Accordingly, summary judgment for Sharp is affirmed.
California Court of Appeal, Fourth District, Division One (Aaron, J.); October 25, 2017; 2017 WL 4801570.