Managed Care Litigation Update Volume 82: June 15, 2017

• Jurisdiction: United States,Federal
• Publication year: 2017
• Citation: Vol. 82

Newsworthy

Putative antitrust class action against provider of vision insurance benefits and alleged subsidiary of Highmark, alleging inter alia improper restrictions to prohibit Independent PA Eyecare Providers from steering patients to eyeglass frames and lenses that are less expensive than those which must be offered to patients with Davis Vision Insurance. Frank v. Davis Vision, Inc., et al., USDC ED PA, No. 17-2629 (filed 06/12/17).

Putative class action on behalf of Iowa chiropractors, filed in 2015 and removed on 06/14/17, alleging conspiracy in restraint of trade or commerce for setting prices at a "discriminatory low level and in restricting patient access to ... treatment ...." Chicoine, et al. v. Wellmark, Inc., et al., USDC SD IA, No. 17-210.

Denial of coverage upheld for partial hospitalization to treat eating disorders, finding evidence supported the determination that participant could have been effectively treated on outpatient basis. Ariana M. v. Humana Health Plan of Texas, Inc., 854 F.3d 753 (5^th Cir. 2017). This case was covered in MCLU Vol. 20.

Recently filed actions

Steven G. Pettit v. Cigna Health and Life Insurance Company, U.S.D.C. E.D. TN, Doc. No. 3:17-cv-00235-PLR-CCS, (filed June 2, 2017). Member seeks recovery of benefits associated with a total joint arthroplasty hip surgery procedure on his left hip, followed by the same procedure on his right hip. The medical expenses for the two procedures total approximately $106,194.00. "Cigna advised Pettit that Cigna was delaying processing of the claims on the basis that Cigna believed there may have been a pre-existing condition." Plaintiff alleges the condition had been diagnosed on March 3, 2014, shortly before pre-certification was requested. Plaintiff alleges his coverage effective date was September 1, 2013.

I.B. v. JP Morgan Chase U.S. Benefits Executive and CIGNA Health and Life Insurance Company, U.S.D.C. S.D. NY, Doc. No. 1:17-cv-04137-LGS, (filed June 2, 2017). Minor child under father's health plan seeks recovery of mental health benefits associated with admission to the Residential Mental Health Treatment Center at the Asheville Academy for Girls. Coverage was denied on grounds that "[Y]our symptoms do not meet Cigna Medical Necessity Criteria for Residential Mental Health Treatment for Children and Adolescents ... The treatment provided has led to sufficient stabilization of your symptoms so that you can be safely and effectively treated at a less restrictive level of care" (brackets in original).

IHC Health Services, Inc. dba Utah Valley Regional Medical Center v. Coventry Healthcare, Inc., et al., U.S.D.C. D. UT, Doc. No. 2:16-cv-00802-BCW, (filed July 18, 2016). Hospital and alleged...