Blue Cross of Northern California v. Superior Court

California Court of Appeal Sep 10, 1976 No. Civ. 15763Published

Before: Friedman

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Holding. The court held that the physician-patient privilege is not waived when a patient's identity and ailment are disclosed to a prepaid health plan for the purpose of processing insurance claims, as such disclosure is reasonably necessary to accomplish the purpose of the medical consultation. Consequently, the health plan may assert the privilege on behalf of its patients to prevent discovery of these records.

Issues

Whether the disclosure of patient identities and ailments to a prepaid health plan for payment purposes constitutes a waiver of the physician-patient privilege.
Whether a prepaid health plan has the authority to assert the physician-patient privilege on behalf of its subscribers.

Disposition. Peremptory writ of mandate issued.

Quotations verified verbatim against the opinion

“The information’s disclosure to accomplish payment is reasonably necessary to achieve the consultation’s diagnostic and treatment purposes.”

Opinion

FRIEDMAN, Acting P. J.

In Rudnick

Superior Court,

11 Cal.3d 924 [114 Cal.Rptr. 603, 523 P.2d 643], the Supreme Court delineated the boundaries of the physician-patient privilege in its application to medical histories in the files of a drug manufacturer. Here we confront the privilege in relation to patients’ identities and ailments recorded in the claim files of a prepaid health care plan.

Carolyn Blair, the real party in interest, was enrolled in a prepaid health care plan operated by Blue Cross of Northern California, a nonprofit corporation. She brought suit against Blue Cross, charging it with wrongful refusal to pay medical expenses she had incurred for psoriasis treatment. As a means of pretrial discovery, she propounded interrogatories, one of which sought the names, addresses and telephone

[800]

numbers of other Blue Cross subscribers who had filed claims for psoriasis treatment. Blue Cross objected to the interrogatory, claiming overbreadth and privilege. The trial court sustained the first ground of objection and narrowed the inquiry of two branch offices of Blue Cross. It overruled the assertion of privilege and rejected a protective order which Blue Cross had proposed in order to preserve the anonymity of its psoriasis claimants.

Blue Cross then filed a petition for mandamus or prohibition in this court. We issued an order to show cause because the confidentiality issue, as it affects the claims records of prepaid health plans, is one of general interest and first impression.

(Valley Bank of Nevada

Superior Court,

15 Cal.3d 652, 655 [125 Cal.Rptr. 553, 542 P.2d 977].)

Privileged information is exempt from disclosure. (Code Civ. Proc., §§ 2016, subd. (b), 2030, subd. (c).) The physician-patient privilege embraces more than verbal communication; it extends to information obtained by an examination of the patient and includes the physician’s diagnosis and advice. (Evid. Code, §§ 994, 992.) The answer sought by Ms. Blair’s interrogatory is within the general range of the privilege, for it would simultaneously reveal patients’ identities and their ailments.

Blue Cross of Northern California v. Superior Court

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