Managed Care Litigation Update Volume 203: June 30, 2022

• Publication year: 2022

NEWSWORTHY

District court concludes that the CARES Act does not provide a private right of action, dismissing claims asserting underpayment of COVID-19 testing. Saloojas, Inc. v. Aetna Health of California, Inc., USDC ND CA, No. 22-cv-1696, 2022 WL 2267986, (Doc. 24, filed Jun. 23, 2022). Previously reported at MCLU Vol. 197.

Texas Supreme Court rules premiums on stop-loss policies paid by self-insured employer plan are properly taxed under Insurance Code Chapters 222 and 257, overturning lower court decisions. Hegar v. Health Care Serv. Corp., Tex. Sup. Ct., No. 21-0080, 2022 WL 2183134 (filed Jun. 17, 2022).

District court dismisses remaining ERISA claim asserting underpayment by mental health and substance use disorder treatment facility against various consolidated insurer defendants, finding that plaintiff failed to prove that each individual assigned their benefits to plaintiff. ABC Serv. Group, Inc. v. Health Net of California, Inc., et al., USDC CD CA, No. 8:19-cv-243-DOC, 2022 WL 2348062 (Doc. 627, filed Jun. 13, 2022) (NOA filed Jun. 23, 2022). Previously reported at MCLU Vol. 125, 126, 127, 128.

RECENTLY FILED ACTIONS

William J. v. Bluecross Blueshield of Texas, et al., U.S.D.C. D. UT, Doc. No. 2:22-cv-407-DBP, (filed Jun. 16, 2022). Member seeks over $70,000 in ERISA benefits associated with residential treatment at Shelterwood Residential Treatment Center. The claim was denied on the grounds the center did not have 24-hour nursing care.

Jane Doe v. Independence Blue Cross, U.S.D.C. E.D. PA, Doc. No. 2:22-cv-2412-TJS, (filed Jun. 20, 2022). Member seeks benefits and alleges unlawful discrimination in violation of Section 1557 as a result of a denial of facial feminization surgery to treat gender dysphoria.

Alysia Heumann by her attorney in fact Shawn Sieler, M.D. v. Aetna Life Insurance Company, U.S.D.C. D. NJ, Doc. No. 3:22-cv-4150-GC-RLS, (filed Jun. 20, 2022). OON physician seeks ERISA benefits and asserts underpayment associated with unspecified surgical treatment. Billed charges were $12,232 and the amount paid was $2,109.53. Plaintiff alleges payment was equivalent to 125% of Medicare.

Shawn Sieler, M.D. v. Anthem Blue Cross and Blue Shield, U.S.D.C. D. NJ, Doc. No. 3:22-cv-4167-FLW-LHG, (filed Jun. 21, 2022). OON physician seeks ERISA benefits and asserts underpayment associated with emergency hemiarthroplasty. Billed charges were $11,757 and the amount paid was $3,275.77, with an additional $818.93 applied to coinsurance.

RECENTLY FILED ACTIONS

Wesley Lewis v. [ ], Anthem Health Plans, Inc., U.S.D.C. N.D. OK, Doc. No. 4:22-cv-264-GKF-SH, (filed Jun. 21, 2022). Removed action in which member seeks $25,385.51 in benefits from self-funded ERISA plan associated with Stereotactic Body Radiation Therapy. The basis for denial is not stated in the underlying complaint.

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