Managed Care Litigation Update Volume 142: December 15, 2019

• Jurisdiction: United States,Federal
• Publication year: 2019
• Citation: Vol. 142

Newsworthy

9th Circuit COA affirms district court's decision finding lack of personal jurisdiction over BCBS MN holding, inter alia, provider-initiated phone calls and denial of benefit letters insufficient to create jurisdiction. Healthcare Ally Mgmt. of CA, LLC. v. BCBS MN., USCA 9th Cir., No. 18-55899 (12/11/19).

Hospitals challenge transparency rule requiring public disclosure of negotiated rates. There is "no reliable evidence that publicizing negotiated rates would have any impact [ ] on patient behavior." American Hospital Assoc., et al. v. Alex M. Azar II, USDC D DC, No. 19-3619 (Doc. 1, 12/4/19).

5th Circuit COA affirms summary judgment in favor of Humana, finding Humana did not err in finding at least one of the Mihalik criterial lacked supporting evidence and the final 106 days of partial hospitalization were medically unnecessary. 49 days of benefits were approved and exhausted. Ariana M. v. Humana Health Plan of Texas, Inc., USCA 5th Cir., No. 18-20700 (11/08/19). See also MCLU Vol. 20.

Recently filed actions

Robert P. Scurek, Sylvester Scurek and Agnes Scurek v. UnitedHealthcare of Illinois, Inc., U.S.D.C. N.D. IL, Doc. No. 1:19-cv-7875, (filed Dec. 2, 2019). Removed action in which member seeks reimbursement pertaining to alleged underpayment following surgery in Poland to replace two heart valves. "[A]fter PLAINTIFFS paid the S5.000.00 deductible [,] DEFENDANT only paid $2,888.49 and refuse [sic] to reimburse PLAINTIFFS for the $16,473.00 they paid directly to the Polish medical provider."

Dr. Arash Emami as Amy M.'s attorney-in-fact v. Community Insurance Company, U.S.D.C. D. NJ, Doc. No. 21061-ES-SCM, (filed Dec. 4, 2019). OON ER physician seeks ERISA reimbursement as attorney-in-fact of patient. "Patient underwent emergency spine surgery that included a revision lumbar laminectomy at L4-L5, diskectomy and placement of intervertebral device, lumbar interbody fusion with a PEEK cage, posterior lumbar interbody fusion with a PEEK cage, posterior spinal pedicle screw instrumentation at L4-L5 for fusion, posterolateral fusion at L4- L5, L5 nerve root neurolysis, and other related procedures." $315,530 was billed to Anthem but the claim was denied. The grounds for the denial are not stated in the complaint.

Jamie Bassel, D.C. v. [ ], Aetna Life and Health Insurance Company, U.S.D.C. E.D. NY, Doc. No. 1:19-cv-6838, (filed Dec. 4, 2019). Removed action in which OON chiropractor alleges underpayment associated with services provided to member. Plaintiff alleges Aetna agreed to pay 90th percent of the UCR rate for services provided but that a balance of $3,000 remains after alleged underpayment. Notice of removal alleges the same claim for the same member was included in a prior action by this provider and reported in MCLU Vol. 88.

SEE ALSO (similar claims, different amount):

o Jamie Bassel, D.C. v. [ ], Aetna Life and Health Insurance Company, U.S.D.C. E.D. NY, Doc. No. 1:19-cv-6839, (filed Dec. 4, 2019).
o Jamie Bassel, D.C. v. [ ], Aetna Life and

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