Tanzer v. Health Insurance Plan of Greater New York
Tanzer v. Health Insurance Plan of Greater New York
Opinion of the Court
OPINION OF THE COURT
Memorandum.
The order of the Appellate Division should be reversed, with costs, and the order of Supreme Court reinstated.
Plaintiff brought this action on behalf of herself and others similarly situated to recover insurance reimbursement for the cost of surgery-related anesthesiologist’s services. Defendant insurer contends that such costs cannot be recovered because the parties’ insurance contract, which covers the cost of certain medical and surgical care, contains a specific exclusion for "anesthesia.” We agree with plaintiff, however, that this exclusion does not unambiguously apply to the medical services associated with the administration of anesthetic agents and could just as readily be construed to exclude only the cost of those agents themselves.
While, as defendant contends, several dictionaries definé the term "anesthesia” broadly to mean the entire process of becoming anesthetized, the term has also often been used to refer only to the substance that is administered by an anesthesiologist (see, e.g., Stanski v Ezersky, 228 AD2d 311, 322; Houck v Sparks, 81 F3d 168; Alston v Howard, 925 F Supp 1034, 1038;
Moreover, none of the other provisions in the parties’ insurance contract serves to clarify the ambiguity inherent in the use of the term "anesthesia.” Defendant relies on the separate policy exclusion for "inpatient drugs or supplies,” arguing that that exclusion would render the "anesthesia” exclusion redundant if the latter were interpreted narrowly to encompass only the substances used to anesthetize surgical patients. However, the provision appears to exclude only the cost of those "inpatient drugs or supplies” that are "normally included in a hospital’s” charges.
Finally, a reading of the remainder of defendant’s policy reveals a number of specifically worded exclusions for the cost of such enumerated professional services as podiatry, chiropractic and cosmetic surgery. The absence of any similarly worded exclusion for anesthesiologists’ services could reasonably be understood as meaning that such fees are, in fact, reimbursable.
In short, it cannot be said that defendant satisfied its burden of demonstrating that the proposed exclusion for anesthesiolo
Chief Judge Kaye and Judges Titone, Bellacosa, Smith, Levine, Ciparick and Wesley concur in memorandum.
Order reversed, etc.
The provision in question states: "This Contract does not provide benefits for hospital services, such as room and board, nursing services, inpatient drugs or supplies, services by hospital employees or other services or supplies which are normally included in a hospital’s charges” (emphasis supplied).
Reference
- Full Case Name
- Deborah Tanzer v. Health Insurance Plan of Greater New York
- Cited By
- 2 cases
- Status
- Published