Olivia Reyes v. Blue Cross Blue Shield of Florida, Inc.

Summary

The Florida Third District Court of Appeal affirmed summary judgment in favor of the Florida Keys Aqueduct Authority in a dispute over coverage for complications arising from elective cosmetic surgery. The court held that undisputed medical records established that the hospitalization resulted from complications of a noncovered procedure and that the plaintiff's affidavit did not create a genuine dispute of material fact. The court also held that the self-funded governmental health plan was exempt from the federal requirement to cover emergency services.

Holdings

1. Summary judgment for FKAA was proper because the undisputed medical records established that Reyes's hospitalization resulted from a postoperative infection at the incision site caused by the excluded cosmetic surgery, and her opposing affidavit did not identify admissible evidence creating a genuine dispute of material fact.
2. Federal law did not require FKAA's self-funded governmental health plan to cover Reyes's emergency medical services because self-funded plans maintained by governmental entities are exempt from the applicable Patient Protection and Affordable Care Act requirement.
3. Reyes's new arguments concerning FKAA's compliance with state law were waived because they were not presented to the trial court.

Questions Presented

1. Whether summary judgment was proper on the issue of whether Reyes's hospitalization resulted from complications of an excluded elective cosmetic surgery.
2. Whether federal law required FKAA's self-funded governmental health plan to cover Reyes's emergency medical services.
3. Whether Reyes preserved new arguments concerning FKAA's compliance with state law.

Disposition

affirmed