Managed Care Litigation Update Volume 138: October 15, 2019

• Publication year: 2019

Newsworthy

District Court grants dismissal of OON hospital's claim for plan benefits, finding AOB's ineffective because they did not name the plaintiff, certain claims were barred by limitations, and plaintiff's failure to exhaust admin. remedies. Innova Hosp. San Antonio v. Health Care Service Corp., USDC ND TX, No. 12-1607 (Doc. 411, 10/2/19).

District Court dismisses air transport provider's claims under TX emergency care statute for lack of standing, holding statute contains no private right of action. Unfair settlement practices act claim likewise dismissed. Apollo MedFlight, LLC v. BlueCross Blue Shield of TX, USDC ND TX, No. 18-166 (Doc. 60, 10/4/19). See also MCLU Vol. 112.

District court dismisses claims for injunctive relief in putative class action seeking benefits for residential treatment of eating disorders. Aurora Bailey v. Anthem Blue Cross Life and Health, USDC ND CA, No. 16-4439 (Doc. 65, 12/7/18, Doc. 78, 5/31/19), appeal filed, 9th Cir. 19-16978 (10/7/19). See also MCLU Vol. 62.

Recently filed actions

IHC Health Services, Inc. dba Dixie Regional Medical Center v. [ ], and Anthem Blue Cross and Blue Shield, U.S.D.C. D. UT, Doc. No. 2:19-cv-00721-PMW, (filed Oct. 1, 2019). Hospital and alleged assignee seeks recovery for "Intensity Modulated Radiation Therapy" rendered to a plan member to treat "Stage 1A follicular lymphoma of the lymph nodes of his head, face, and neck." "The billed charges for [the] claim totaled $13,139.45," and the "Defendants have paid $0.00 for this claim." "The Defendants and/or their agents denied the claim by contending that the treatment was experimental or investigational." Multiple lawsuits by this provider against major health insurers reported in multiple prior MCLU issues.

Steve H., and C.H. v. Cigna Health and Life Insurance Company, et al., U.S.D.C. D. UT, Doc. No. 2:19-cv-00722-PMW, (Oct. 1, 2019). Father seeks recovery of $107,000 in benefits associated with child's residential mental health treatment received at New Visions Wilderness and Discovery Ranch for Boys. The New Wilderness claim was denied on the grounds that the patient did not "clearly demonstrate[] a need for active treatment in a 24-hour supervised setting." The Discovery Ranch claim was denied on the grounds that "symptoms did not meet Cigna's Behavioral Health Medical Necessity Criteria for admission or continued stay at Residential Mental Health Treatment for Children and Adolescents level of care." Plaintiff also alleges violations of the federal Mental Health Parity Act.

Houston Home Dialysis, LP v. Blue Cross and Blue Shield of Alabama, et al., U.S.D.C. S.D. TX, Doc. No. 4:19-cv-03791, (filed Oct. 2, 2019). Putative class action in which provider of "staff-assisted home dialysis treatments" seeks damages from plans' alleged anti-trust violations by "engag[ing] in a horizontal market allocation." Plaintiff alleges defendants' "illegal Market Allocation Conspiracy is a horizontal Price-Fixing and Boycott Conspiracy under which every other Blue...