Dougherty v. U.S. Behavioral Health Plan (Apr. 24, 2024, E079741) ___ Cal.App.5th ___ [2024 WL 1752872]
Christine Matlock Dougherty’s employer entered a Group Subscriber Agreement (GSA) with UnitedHealthcare that included an arbitration provision and made various attachments part of the agreement. Dougherty enrolled herself and her son, Ryan, in a UnitedHealthcare HMO plan by executing an enrollment form that included an arbitration provision meeting the disclosure requirements in Health & Safety Code section 1363.1. Dougherty was given the plan’s Evidence of Coverage (EOC) booklet, which explained that disputes between enrollees and UnitedHealthcare would be arbitrated, and a supplement explaining that U.S. Behavioral Health Plan (USB) would provide substance abuse services. Neither the EOC nor the supplement required Dougherty’s signature. Later, Ryan checked himself into a residential drug treatment facility. USB initially agreed to cover Ryan’s residential treatment, but later determined that he could be treated at home. After Ryan was discharged, he fatally overdosed. Dougherty sued USB, which moved to compel arbitration. The trial court denied the motion, ruling that the enrollment agreement Dougherty signed with UnitedHealthcare and the supplement regarding USB’s treatment services were separate legal documents. The trial court concluded the supplement did not comply with section 1363.1 disclosure requirements, thus USB could not compel arbitration. USB appealed.
The Court of Appeal reversed. The court explained that section 1363.1 disclosure requirements apply only to a “health care service plan”—an agreement in which a person or organization arranges for the provision of healthcare services to enrollees in exchange for payment. (Health & Saf. Code, § 1345.) Here, the only health care service plan was the UnitedHealthcare plan in which Dougherty enrolled to gain access to health benefits, including USB’s services. Because UnitedHealthcare’s GSA and enrollment form (which Dougherty executed) complied with section 1363.1 disclosure requirements, the trial court erred by denying USB’s motion to compel arbitration. It was immaterial that the EOC and supplement regarding coverage for USB’s services lacked those disclosures.
