Managed Care Litigation Update Volume 207: August 31, 2022

• Publication year: 2022

NEWSWORTHY

District court grants, in part, motion to dismiss for lack of standing due to Anti-Assignment provisions and rejects plaintiff's assertion of standing on the basis of a power of attorney because the power of attorney was not specific enough to satisfy state law requirements. Gotham City Orthopedics, LLC, et al. v. United Healthcare Ins. Co., et al., USDC D NJ, No. 2:21-cv-9056-BRM-ESK, 2022 WL 3500416, (Doc. 47, filed Aug. 18, 2022). Previously reported at MCLU Vol. 174.

District court rules CA DMHC rule forbidding exclusions for legal abortion coverage violates the Free Exercise Clause in part because DMHC did not have a policy to review exemption requests from members. Church v. Watanabe, USDC ED CA, No. 2:15-cv-2165-KJM-EFB, 2022 WL 3684900 (Doc. 129, filed Aug. 25, 2022).

District court grants summary judgment in favor of ERISA plan where plaintiff sought benefits for residential care, holding that plan did not provide coverage for the type of long-term care received, applying a de novo standard due to delays in processing the claim. Anne M, et al. v. United Behavioral Health, et al., USDC D UT, No. 2:18-cv-808, 2022 WL 3576275, (Doc. 104, filed Aug. 19, 2022). Previously reported at MCLU Vol. 115.

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RECENTLY FILED ACTIONS

The Belchman Group, LLC v. Health Care Service Corporation, et al., U.S.D.C. S.D. TX, Doc. No. 4:22-cv-2779, (filed Aug. 16, 2022). Removed action in which home health care agency challenges recoupment and seeks temporary restraining order. The overpayment assessment was based on billing by the quarter hour instead of by the hour. Underlying petition does not identify the amounts at issue.

Stephen Mamanella v. Anthem Insurance Companies, Inc., U.S.D.C. E.D. MO, Doc. No. 4:22-cv-852-SEP, (filed Aug. 16, 2022). Member seeks ERISA benefits associated with two "successful diagnostic medial branch block procedures." The claims were denied as not medically necessary.

RV Behavioral, LLC, et al. v. Humana, Inc., et al., U.S.D.C. N.D. GA, Doc. No. 1:22-cv-3286-SCJ, (filed Aug. 16, 2022). Removed action in which contracted behavioral health providers seek ERISA benefits and challenge denials and nonpayment of claims. Plaintiff asserts breach of contract.

Vanguard Plastic Surgery PLLC v. Unitedhealthcare Insurance Company, U.S.D.C. S.D. TX, 4:22-cv-2794, (filed Aug. 17, 2022). Removed action in which OON plastic surgeon seeks benefits and alleges underpayment with alleged emergency surgery. Billed charges were $74,914 and nothing was allowed. Other actions filed by this provider are reported in MCLU Vol. 159, 161, 163, 168, 171, 178, 189, 191, 192, 197, 202.

RECENTLY FILED ACTIONS

IHC Health Services, Inc. v. Aetna Life Insurance Company, et al., U.S.D.C. D. UT, Doc. No. 2:22-cv-519-DBP, (filed Aug. 17, 2022). OON hospital and...