Pacific Bay Recovery v. CA Physicians’ Serv
California Physicians' Services dba Blue Shield of California (Blue Shield) is a health care service plan subject to the Knox-Keene Health Care Service Plan Act of 1975 (Knox-Keene Act), Health and Safety Code section 1340 et seq. Pacific Bay Recovery, Inc. (Pacific Bay) is a medical provider that treats substance abuse and narcotic addiction. Blue Shield contracts with certain medical groups and providers to provide medical care at reduced costs through a network of provider contracts. (§ 1342.6.) Pacific Bay had no provider contract with Blue Shield during the time at issue in this matter. Thus, Pacific Bay was an out-of-network provider.
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