Blue Cross & Blue Shield of Delaware v. National Alcoholism Programs/Cooper City, Florida, Inc.

Citations: 648 So. 2d 231; 1994 Fla. App. LEXIS 12571; 1994 WL 715014Docket: No. 93-2634

Court: District Court of Appeal of Florida; December 27, 1994; Florida; State Appellate Court

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Blue Cross and Blue Shield of Delaware appeals a non-final order that denied its motion to dismiss an amended complaint by National Alcoholism Programs/Cooper City, Florida, Inc., also known as High Point, for lack of in personam jurisdiction. The appeal is jurisdictionally valid under Florida Rule 9.130(a)(3)(C)(i). High Point's lawsuit seeks reimbursement for medical services provided to a patient insured by Blue Cross. Initially, Blue Cross had the first complaint dismissed due to insufficient jurisdictional facts. Following this, High Point filed an amended complaint, prompting another dismissal motion from Blue Cross.

During the hearing on the amended complaint, the trial court reviewed the amended complaint, supporting affidavits, and additional documentation. High Point's evidence included a referral from a Delaware physician within Blue Cross’s network, confirmation from Blue Cross of the patient’s coverage and payment assurances, and direction to obtain precertification from Intracorp, a Florida company. High Point argued that it relied on Blue Cross’s assurances for treatment provision. Additionally, an agreement existed for payment for services between High Point and Blue Cross and Blue Shield of Florida, which processed claims for Blue Cross.

In its defense, Blue Cross asserted it had no physical presence, agents, or registration in Florida, and the insurance policy was executed in Delaware for a Delaware resident. It claimed that it did not authorize the patient's admission and refuted the necessity of precertification, asserting that the numbers provided by High Point were not valid pre-certification numbers but rather case numbers from Intracorp. This evidence highlighted a lack of jurisdiction over Blue Cross in Florida.

Blue Cross denied any contractual relationship with Blue Cross and Blue Shield of Florida, asserting that it typically advises providers to bill local Blue Cross plans directly if there is a direct contractual relationship. However, it clarified that such advice does not constitute authorization or precertification of treatment. Blue Cross contested the notion of a continuous relationship with High Point, stating that prior to High Point's complaint, it had only communicated about one other patient. On appeal, Blue Cross claimed for the first time that Intracorp is not a Florida corporation and argued that its actions did not warrant personal jurisdiction under Florida's long-arm statute, as it had no office or agency in Florida, did not conduct business there, and the insurance contract was executed in Delaware. It also claimed that merely failing to pay medical bills incurred in Florida does not establish sufficient minimum contacts to satisfy due process requirements. Blue Cross cited precedents where courts found no personal jurisdiction over foreign insurance carriers but distinguished those cases from the current situation, noting that High Point’s claims involved a direct referral from a Delaware Blue Cross Plan physician to its Florida facility, which could indicate more substantial involvement than merely assigning a claim. High Point's allegations, if substantiated, suggest that Blue Cross's activities in Florida exceeded mere claim assignment and payment.

National Alcoholism Programs/Cooper City, Florida, Inc. d/b/a High Point's case against Blue Cross-Blue Shield of Rhode Island is distinguishable based on its facts. The concurring opinion emphasizes that the out-of-state insurer did not engage in business activities in Florida simply by compensating a local provider. To establish long-arm jurisdiction, two inquiries are necessary: first, whether the complaint presents sufficient facts under the statute, and second, whether there are adequate "minimum contacts" to meet due process standards. The allegations indicate that a Delaware physician referred a patient to High Point and that Blue Cross instructed High Point to seek precertification from Intracorp, a Florida corporation, and to process claims through its Florida agent. These actions suggest that Blue Cross should have anticipated being subject to jurisdiction in Florida due to their involvement in the treatment's precertification process. Despite the trial court's review of the pleadings and evidence, conflicting affidavits necessitate a remand for an evidentiary hearing on jurisdiction. Consequently, the appellate court reversed the trial court’s denial of Blue Cross's motion to dismiss and ordered further proceedings consistent with the findings.