Managed Care Litigation Update Volume 151: April 30, 2020

• Jurisdiction: United States,Federal
• Publication year: 2020
• Citation: Vol. 151

NEWSWORTHY

Fifth Circuit affirms dismissal of claims by OON blood test developer for lack of jurisdiction where plaintiff failed to respond to "factual attack" pursuant to FRCP 12(b)(1) with proof of assignments of benefits. Cell Science Systems Corp. v. Louisiana Health Service Indemnity Co., USCA 5th Cir., No. 18-31034, (Doc. 00515347305, filed Mar. 17, 2020).

District court grants motion to dismiss mental health facility's claims asserting various theories of recovering billed charges, admonishing that "Plaintiff should not again utilize a kitchen-sink approach in trying to recover the blanket amount of all 'usual and customary' amounts it charged BCBS." Windmill Wellness Ranch, LLC v. Blue Cross and Blue Shield of Texas, USDC WD TX, No. 5:19-cv-1211-OLG, (Doc. 17, filed Apr. 22, 2020).

Sixth Circuit affirms denial of motion to dismiss ERISA claim for LTD benefits on basis the participant's remedies were "deemed exhausted," with concurring opinion challenging the ERISA exhaustion of remedies requirement. Wallace v. Oakwood Healthcare, Inc., USCA 6th Cir., No. 18-2316, 954 F.3d 879, (Mar. 31, 2020).

Health insurers are reported to prosper given declining demand for elective procedures. https://khn.org/news/health-insurers-prosper-as-covid-19-deflates-demand-for-elective-treatments/

RECENTLY FILED ACTIONS

Perry McCoy Smith v. Cigna Health & Life Insurance Company, U.S.D.C. D. OR, Doc. No. 3:20-cv-624-SI, (filed Apr. 16, 2020). Member seeks ERISA benefits (and subsequently COBRA benefits) associated with seven years of her son's treatment of Autism Spectrum Disorder, including Applied Behavioral Analysis and Speech and Language Pathology. "Defendant continues to owe Plaintiff over $44,000.00 in unreimbursed claims during the period of November, 2012 through the end of May, 2018." "[F]or the period June, 2018 to December 31, 2019, Defendant have not reimbursed over $1,700.00 in ABA therapy services and approximately $1,300.00 in SLP therapy services." Plaintiff alleges failure to process claims and inaccurate processing but does not otherwise state basis of denials.

Gail P., et al., v. United Healthcare Services, Inc., et al., U.S.D.C. D. UT, Doc. No. 2:20-cv-258-DBP, (filed Apr. 17, 2020). Member seeks "almost $200,000" in ERISA benefits associated with son's inpatient mental health treatment at New Vision and Echo Springs. The New Vision claim was denied on the basis it was a wilderness program and the Echo Springs claim was denied for lack of...