Aetna Life Insurance v. Methodist Hospitals of Dallas

95 F. Supp. 3d 950, 60 Employee Benefits Cas. (BNA) 1753, 2015 U.S. Dist. LEXIS 26455, 2015 WL 918586
CourtDistrict Court, N.D. Texas
DecidedMarch 4, 2015
DocketNo. 3:14-cv-347-M
StatusPublished

This text of 95 F. Supp. 3d 950 (Aetna Life Insurance v. Methodist Hospitals of Dallas) is published on Counsel Stack Legal Research, covering District Court, N.D. Texas primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Aetna Life Insurance v. Methodist Hospitals of Dallas, 95 F. Supp. 3d 950, 60 Employee Benefits Cas. (BNA) 1753, 2015 U.S. Dist. LEXIS 26455, 2015 WL 918586 (N.D. Tex. 2015).

Opinion

MEMORANDUM OPINION AND ORDER

BARBARA M.G. LYNN, District Judge.

Before the Court are Defendants’ Motion to Dismiss under Rule 12(b)(7) [Docket # 14], Plaintiffs Motion for Summary Judgment [Docket # 17], and Defendants’ Cross-Motion for Summary Judgment [Docket #42], For the reasons stated below, Defendants’ Motion to Dismiss under Rule 12(b)(7) is DENIED; Plaintiffs Motion for Summary Judgment is DENIED; and Defendants’ Cross-Motion for Summary Judgment is GRANTED.

I. Background

The Court is asked to decide whether ERISA preempts the Texas Prompt Payment Act’s mandatory payment deadlines, insofar as the deadlines apply to third-party administrators of self-funded health insurance plans. The Court finds that ERISA does not preempt the TPPA’s application in the narrow circumstances presented in this case.

Aetna Health, Inc. (“AHI”), a health maintenance organization, contracted with the Defendants, Methodist Hospital and Texas Health Resources (collectively called the “Providers”), by which the Providers [953]*953agreed to provide benefits to the plan beneficiaries of AHI and its affiliates. AHI, expressly on behalf of itself and its affiliates, was obligated to reimburse the Providers for covered claims within 45 days of AHI’s receipt of a clean claim,1 or such shorter time as required by applicable law or regulation. Plaintiff Aetna Life Insurance Company (“ALIC”) is an affiliate of AHI that provides claims administration services for self-funded employee benefit plans. In a traditional insurance plan, a corporation enters “into a contract with an insurance company for a fixed cost to provide health benefits to [the company’s] employees.” America’s Health Ins. Plans v. Hudgens, 742 F.3d 1319, 1323 (11th Cir.2014) (providing a helpful explanation of the difference between “insured” health benefit plans and “self-funded” or “self-insured” plans). In contrast, a company providing “a self-insured” benefit plan pays health claims from its own funds, thereby assuming the financial risk associated with paying its employees’ health care costs. Companies that self-fund “often contract with third-party administrators ... to perform certain administrative functions for the employer and each plan.” Id. ALIC is such a third-party administrator.

In September of 2013, the Providers each sent AHI a “Pre-Arbitration Demand” letter, alleging that AHI owed them more than ten million dollars each in late-payment penalties. The Providers alleged that AHI was obligated to abide by the claim payment deadlines set forth in the Texas Health Maintenance and Organization Act and Texas Insurance Code Chapter 1301, which together comprise the Texas Prompt Payment Act (“TPPA”). [Docket # 5, p. 6; Ex. E-G]. The TPPA dictates that the maximum time for an “insurer” to pay certain claims is thirty to forty-five days, depending on the claim format.2 The letters stated that the Providers would initiate arbitration proceedings if AHI did not pay the penalties under the TPPA. ALIC then filed this declaratory judgment action, in federal district court in Houston, naming Methodist Hospitals, and later adding THR. The case was transferred to this Court. [Docket # 29]. Around the same time that ALIC [954]*954sued the Providers, the Providers filed their own lawsuits in state court in Tarrant County, Texas, claiming TPPA penalties from AHI. Although those suits were removed, they were then remanded to state court for lack of federal subject matter jurisdiction.

ALIC asks this Court to declare that “(1) the Texas Prompt Pay Statute, by its terms, doe's not apply to self-funded plans, which do not involve the insurance relationship that is required under the Statute, or (2) if the Statute does apply to self-funded plans, it is preempted by ERISA.” [Docket # 17, at 9], The Providers filed a motion for this Court to dismiss or abstain. This Court decided to abstain from determining whether or not the TPPA applies to self-funded plans, because one of the state district courts presiding over the related proceedings was about to rule on that precise issue. On October 3, 2014, that state court issued its Order, finding that “the Texas Prompt Pay Act applies to Aetna with respect to claims administered by Aetna for self-funded plans.” This Court defers to that non-final interpretation of state law.3 Therefore, the only remaining question for this Court to decide on the motions pending before it is whether ERISA preempts the TPPA.

II. Jurisdiction and the Providers’ 12(b)(7) Motion to Dismiss

Although ALIC initiated this suit under the federal Declaratory Judgment Act (“DJA”), 28 U.S.C. § 2201, it must still show that this Court has federal question or diversity jurisdiction, since the DJA does not create subject matter jurisdiction. Volvo Trucks N. Am., Inc. v. Crescent Ford Truck Sales, Inc., 666 F.3d 932, 938 (5th Cir.2012).

This Court has diversity jurisdiction over- cases where the matter in controversy exceeds $75,000 and there is complete diversity of citizenship. 28 U.S.C. § 1332. “The amount in controversy, in an action for declaratory or injunctive relief, is the value of the right to be protected or the extent of the injury to be prevented.” St. Paul Reinsurance Co. v. Greenberg, 134 F.3d 1250, 1252-53 (5th Cir.1998). ALIC notes that “Defendants are demanding millions of dollars from Aetna under the Texas Prompt Pay Act,” and the Defendants do not contest that the amount in controversy exceeds $75,000. The named parties are diverse, as ALIC has its principal place of business in Connecticut, and the Defendants are Texas corporations with their principal place of business in Texas. See Corfield v. Dallas Glen Hills LP, 355 F.3d 853, 857 (5th Cir.2003). The Court has considered the facts on the record and concludes that the parties are completely diverse and the amount in controversy exceeds $75,000. Because diversity jurisdiction exists, the Court need not determine if it would also have federal question jurisdiction under 28 U.S.C. § 1331.

Providers challenge the Court’s diversity jurisdiction in their motion to dismiss under Rule 12(b)(7), in which they argue that AHI is a necessary party that would defeat diversity jurisdiction if joined to this action. Rule 12(b)(7) of the Federal Rules of Civil Procedure allows dismissal of a complaint for failure to join a party under Rule 19. Rule 19 provides that all parties whose presence is required to fairly and completely resolve the dispute must [955]*955be joined. If those parties cannot be joined, the lawsuit can be dismissed. HS Res., Inc. v. Wingate, 327 F.3d 432, 438 (5th Cir.2003).

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Bluebook (online)
95 F. Supp. 3d 950, 60 Employee Benefits Cas. (BNA) 1753, 2015 U.S. Dist. LEXIS 26455, 2015 WL 918586, Counsel Stack Legal Research, https://law.counselstack.com/opinion/aetna-life-insurance-v-methodist-hospitals-of-dallas-txnd-2015.