Managed Care Litigation Update Volume 215: December 31, 2022

• Publication year: 2022

YEAR END REFLECTIONS

This is the 215^th issue of Managed Care Litigation Update^® as it enters its ninth year of publication. A heartfelt "thank you" to all who have contributed to the continued success of my newsletter, which reaches about 2,000 lawyers in the managed care space every two weeks.

My firm's practice is dedicated to solely representing Payers and I have extraordinary respect and admiration for the in-house counsel who tirelessly devote their energies to resolving the intellectually sophisticated problems that arise daily. Whether in the context of litigation or compliance, the genuine pursuit of "the right answer" is a constant and I feel privileged to be a part of these challenges.

But I take a special delight when I see certain counsel for Providers on the opposite side of a dispute. These individuals are also in search of "the right answer" for their clients and I genuinely appreciate the opportunity to reach resolution of our dispute, through trial or compromise, with counsel who force us to think through every avenue as we collectively navigate the problem. My hat's off to you as well, for you are what make both our profession and our practice area so rewarding.

Please take a moment to visit the Representative Subscribers, who have graciously agreed to publish their firm logos and links to their profiles on www.managedcarelitigationupdate.com

Best wishes to all for health and prosperity in 2023. JMH

RECENTLY FILED ACTIONS

E.S. v. Bluecross Blueshield of North Carolina, et al., U.S.D.C. D. UT, Doc. No. 1:22-cv-172-TC, (filed Dec. 20, 2022). Member seeks over $275,000 in ERISA benefits from self-funded plan associated with residential treatment at Uinta Academy. The claim was denied for lack of pre-authorization, though plaintiff asserts that the plan provides for a $200 penalty rather than a denial of benefits for lack of PA.

Bruce Woodworth Franklin v. Horizon Blue Cross Blue Shield of New Jersey, U.S.D.C. E.D. MO, Doc. No. 4:22-cv-1358-RWS, (filed Dec. 20, 2022). Member seeks ERISA benefits associated with noninvasive outpatient prostate surgery. Member asserts the procedure was medically necessary but denied nonetheless.

Jennifer Howland v. Blue Cross and Blue Shield of Texas, U. S.D.C. D. SC, Doc. No. 8:22-cv-4606-TMC, (filed Dec. 21, 2022). Member seeks ERISA benefits from fully-insured plan associated with an unspecified claim. Plaintiff asserts the plan wrongfully excluded important evidence from its review of the appeal.

RECENTLY FILED ACTIONS

Alexandra Popovchak, et al. v. Unitedhealth Group Incorporated, et al, U.S.D.C. S.D. NY, Doc. No. 1:22-cv-10756-LLS, (filed Dec. 21, 2022). Putative class action in which members of self-funded ERISA plans assert TPA improperly profited at the expense of members by repricing OON claims and retaining a percentage of any difference between billed charges and the repriced amount.

Harmony Dasher v. Blue Cross Blue Shield of Texas, U.S.D.C. W.D. TX, Doc. No. 6:22-cv-1297-ADA-DTG, (filed Dec. 22, 2022). Trans-gender member seeks marketplace benefits associated with gender-affirming surgeries. Plaintiff asserts the procedures were covered but that the network was inadequate to provide the services and that the plan refused to approve any OON providers.

Robert Otero v. Cigna Health and Life Insurance Company, et al., U.S.D.C. D. CO, Doc. No. 1:22-cv-3298-DDD-NRN, (filed Dec. 22, 2022). Removed action in which member seeks benefits from a city government plan associated with implantation of a permanent spinal cord stimulator where a trial stimulator had been pre-approved and relieved pain.

Ashan Williams Warner v. United Healthcare Inc., U.S.D.C. S.D. TX, Doc. No. 4:22-cv-4469, (filed Dec. 23, 2022). Removed action in which member seeks ERISA benefits associated with prescription for Ozempic for use as a weight...