Aaron Emigh v. West Calcasieu Cameron Hospital, 145 So. 3d 369

On Aug. 13, 2010 Laura Delouche was treated at West Calcasieu Cameron Hospital (WCCH) after an automobile accident; she was insured under a Blue Cross individual high-deductible (Blue Saver) policy.
WCCH was a contracted provider with Blue Cross and, by provider agreement, agreed to accept Blue Cross’ negotiated "Allowable Charge" as payment in full and hold insureds harmless for amounts beyond deductible/copay/coinsurance.
WCCH refused Delouche’s insurance, charged the full $718 billed amount, and asserted a lien on any tort recovery (alleged balance billing in violation of La. R.S. 22:1874).
Delouche sued WCCH and later added Blue Cross, alleging breach of contract and detrimental reliance because Blue Cross promised discounted rates (and that providers would submit claims) but failed to ensure performance.
The trial court overruled Blue Cross’s exception of no cause of action; the Supreme Court of Louisiana affirmed, holding Delouche’s petition sufficiently pleads a cause of action under La. Civ. Code art. 1977 (promesse de porte-fort) and remanded for further proceedings.

Issue	Plaintiff's Argument	Defendant's Argument	Held
Whether an insured may state a cause of action against her insurer for a contracted provider’s refusal to accept negotiated, discounted rates	Delouche: Blue Cross promised insureds access to negotiated discounts and that providers would submit claims; failure to secure those promised discounts (and claim filing) makes Blue Cross liable	Blue Cross: The contract’s object is payment of covered medical expenses only; provider performance is a separate third‑party obligation and Blue Cross is not guarantor or insurer of provider compliance	Court: Petition states sufficient facts to survive a no‑cause‑of‑action exception under La. Civ. Code art. 1977 — insurer’s promise that a third party would render performance (discounted charges) can be an object of the contract; remand for proceedings
Whether factual/contractual defenses (no claim filed, deductible not met, policy clause disclaiming responsibility for providers) defeat the petition at the pleading stage	Delouche: allegations suffice; merits defenses are for later resolution	Blue Cross: No claim was submitted; charge below deductible; policy disclaims liability for provider acts	Court: These are factual/merits defenses not appropriate on exception of no cause of action; court declines to resolve them now

Everything on Wheels Subaru, Inc. v. Subaru South, Inc., 616 So.2d 1234 (La. 1993) (describing purpose of peremptory exception of no cause of action)
Greemon v. City of Bossier City, 65 So.3d 1263 (La. 2011) (explaining Louisiana’s fact‑pleading regime and requirement to allege material facts)
Foti v. Holliday, 27 So.3d 813 (La. 2009) (noting de novo review of legal questions presented by exceptions of no cause of action)
City of New Orleans v. Bd. of Directors of La. State Museum, 739 So.2d 748 (La. 1999) (allowing consideration of evidence admitted without objection to enlarge pleadings on exception)