Regina Carson v. Blue Cross Blue Shield of Texas, Inc., et al. (No. 15-24-00108-CV; December 18, 2025) arose from a dispute between a public school teacher and Blue Cross, the administrator of her health insurance provided by her ISD under the TRS ActiveCare Plan. Plaintiff scheduled mastopexy surgery in March 2021, but Blue Cross didn’t authorize her chosen in-network surgeon until the day after the surgery was scheduled. Unable to reschedule with her in-network surgeon, Plaintiff chose an out-of-network surgeon who required an upfront payment of $45,800 and would not submit an insurance claim on her behalf. She sought pre-approval of the new surgeon and was informed that Blue Cross would not cover her surgery at the same level as an in-network procedure. Plaintiff alleged that she received pre-authorization, had the surgery, and submitted her claim. She further alleged that Blue Cross denied her claim, though TRS and Blue Cross denied that. Blue Cross claimed that it paid her the benefits owed under the Plan. Plaintiff sued Blue Cross, TRS, and other defendants for negligent misrepresentation, Insurance Code and DTPA violations, declaratory relief, seeking damages and attorney’s fees. Defendants filed pleas to the jurisdiction based on sovereign immunity. Plaintiff filed a motion to compel discovery from TRS of its contract with Blue Cross, arguing that the contract was necessary to the determination of the court’s jurisdiction. Eventually, the trial court granted Defendants’ pleas and dismissed the case.
In an opinion by Justice Farris, the court of appeals affirmed. First, the court held that Plaintiff did not preserve error on the issue of production of the TRS-Blue Cross contract. Although the trial court heard Plaintiff’s motion to compel, it did not rule on it, choosing instead to invite the parties to agree to a protective order. After a “protracted letter writing campaign in which they demonstrated their efforts and eventual unsuccess in agreeing on a protective order,” Plaintiff did not further pursue a ruling on her motion or object to the trial court’s failure to rule. Because she didn’t secure a ruling, she didn’t preserve error for appeal. Issue one to TRS and Blue Cross.
Next, respecting TRS’s assertion of sovereign immunity, Plaintiff argued that TRS’s immunity was waived under the UDJA, which allows a plaintiff to seek “relief regarding interpretation or application of a statute, ordinance, or contact.” § 37.004, CPRC. Observing that the UDJA does not contain a general waiver of sovereign immunity, the court determined that because Plaintiff didn’t challenge the validity of a statute or ordinance, but only whether her insurance claim should have been paid, her pleading under the UDJA failed to waive immunity. Plaintiff asserted further that the APA waived immunity and provided “an independent avenue for judicial review of her insurance claim.” But, the court noted, Plaintiff didn’t assert an APA claim in her live pleading in the trial court, only a declaratory judgment claim. Because she didn’t do that, she failed to plead facts affirmatively demonstrating that the APA’s “waiver or exception of judicial review” applied.
Turning to Plaintiff’s argument that the trial court erred in granting Blue Cross’s plea to the jurisdiction, the court observed that “[a] private company, such as BCBSTX, operating as a third-party administrator to an insurance program that is funded by the State, such as TRS, is entitled to sovereign immunity like the governmental entity for which it contracts” (citations omitted). Plaintiff contended that as a “private entity that exercises independent discretion regarding the TRS Plan,” Blue Cross was not entitled to derivative sovereign immunity. Blue Cross’s evidence, however, established that Blue Cross was a third-party administrator of the TRS Plan, thus affording it “the same protections of sovereign immunity as TRS enjoys and is immune from suit and claims that [Plaintiff] has asserted against it.”
Finally, the court ruled that the trial court did not err in dismissing Plaintiff’s negligent misrepresentation, Insurance Code and DTPA, and estoppel claims against individual employees of Blue Cross. Those employees were acting in the course and scope of their employment and “enjoyed the same derivative sovereign immunity” as Blue Cross. Plaintiff unsuccessfully made an ultra vires argument but didn’t allege that the employees “were acting without legal authority or failing to perform a merely ministerial act.” Plaintiff also sought damages, overlooking the fact that “ultra vires claims may only seek prospective injunctive remedies.” Thus, the court found no error in dismissal of those claims.
As to Plaintiff’s argument that she should have been given the opportunity to replead based on her alleged entitlement to the TRS-Blue Cross agreement, the court observed that she “had ample time to conduct discovery and filed a motion to compel, but failed to obtain a ruling on that motion or object to the trial court’s failure to rule.” Additionally, she didn’t “inform the trial court how she would amend her pleadings to assert waiver of immunity for TRS, BCBSTX, and the Individual Defendants.” There was no error in the trial court’s dismissal of her claims with prejudice.
