Managed Care Litigation Update Volume 205: July 31, 2022

• Publication year: 2022

NEWSWORTHY

District court dismisses ERISA plan's counterclaim seeking $13 million in alleged overpayment associated with genetic testing, holding that damages are not available under Section 1132(a)(3). Genomind, Inc. v. UnitedHealth Group, Inc., et al., USDC ED PA, No. 21-cv-373, 2022 WL 2905173 (Doc. 55, filed Jul. 22, 2022). Previously reported at MCLU Vol. 169.

District court grants motion to dismiss claim by weight-loss surgical center for lack of standing because "a patient's assignment that conveys to a health care provider only the right to directly receive payment from the patient's health insurance company for services rendered does not convey the patient's right to ERISA benefits or the right to sue to enforce those benefits." Southcoast Specialty Surgery Center, Inc. v. Blue Cross of California, USDC CD CA, No. 21-cv-1944-TJH, 2022 WL 3009129 (Doc. 30, filed Jul. 19, 2022) (NOA filed Jul. 27, 2022). Previously reported at MCLU Vol. 189.

District court grants motion to dismiss claim for residential care benefits where ERISA plan's denial was for lack of proper licensure and complaint did not sufficiently plead that the "either Evoke or Live Strong House was a residential treatment center as defined by the plan." J.W., et al. v. Bluecross Blueshield of Texas, USDC D UT, No. 1:21-cv-21-HCN, 2022 WL 2905657 (Doc. 35, filed Jul. 22, 2022). Previously reported at MCLU Vol. 171.

RECENTLY FILED ACTIONS

Rebecca Landrum v. Anthem Blue Cross / Blue Shield, U.S.D.C. S.D. GA, Doc. No. 1:22-cv-90-JRH-BKE, (filed Jul. 18, 2022). Member seeks ERISA benefits associated with unspecified preauthorized treatment. Plaintiff asserts no response to the request for external review has been provided in 2 years.

Frank Grandinetti by his attorney in fact Steven Reich, M.D. v. Aetna Life Insurance Company, U.S.D.C. D. NJ, Doc. No. 3:22-cv-4620, (filed Jul. 18, 2022). Physician and alleged assignee seeks ERISA benefits associated with cervical discectomy and fusion procedure. Billed charges were $105,169 and the amount paid was $47,985, with an additional $2,395 designated as patient's responsibility.

H.A., et al. v. [ ], Cigna Behavioral Health, U.S.D.C. D. UT, Doc. No. 2:22-cv-476-DBP, (filed Jul. 19, 2022). Member seeks over $390,000 in ERISA benefits associated with residential treatment at Fulshear Treatment to Transition and alleges violations of MHPAEA. Coverage was provided from July 22, 2020 through August 5, 2020 but denied thereafter for failure to meet...