Amended April 27, 2017 Wellmark, Inc. D/B/A Wellmark Blue Cross and Blue Shield of Iowa, an Iowa Corporation, and Wellmark Health Plan of Iowa, Inc., an Iowa Corporation v. Iowa District Court for Polk County

CourtSupreme Court of Iowa
DecidedFebruary 17, 2017
Docket15–1922
StatusPublished

This text of Amended April 27, 2017 Wellmark, Inc. D/B/A Wellmark Blue Cross and Blue Shield of Iowa, an Iowa Corporation, and Wellmark Health Plan of Iowa, Inc., an Iowa Corporation v. Iowa District Court for Polk County (Amended April 27, 2017 Wellmark, Inc. D/B/A Wellmark Blue Cross and Blue Shield of Iowa, an Iowa Corporation, and Wellmark Health Plan of Iowa, Inc., an Iowa Corporation v. Iowa District Court for Polk County) is published on Counsel Stack Legal Research, covering Supreme Court of Iowa primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

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Amended April 27, 2017 Wellmark, Inc. D/B/A Wellmark Blue Cross and Blue Shield of Iowa, an Iowa Corporation, and Wellmark Health Plan of Iowa, Inc., an Iowa Corporation v. Iowa District Court for Polk County, (iowa 2017).

Opinion

IN THE SUPREME COURT OF IOWA No. 15–1922

Filed February 17, 2017

Amended April 27, 2017

WELLMARK, INC. d/b/a WELLMARK BLUE CROSS AND BLUE SHIELD OF IOWA, an Iowa Corporation, and WELLMARK HEALTH PLAN OF IOWA, INC., an Iowa Corporation,

Plaintiffs,

vs.

IOWA DISTRICT COURT FOR POLK COUNTY,

Defendant.

Certiorari to the Iowa District Court for Polk County, Arthur E.

Gamble, Chief Judge.

Defendant health insurer petitioned for writ of certiorari

challenging district court rulings allowing chiropractors to proceed with

an antitrust rule-of-reason claim after procedendo issued from decision

affirming summary judgment dismissing this civil action with prejudice.

WRIT SUSTAINED.

Ryan G. Koopmans, Hayward L. Draper, and John T. Clendenin

(until withdrawal) of Nyemaster Goode, P.C., Des Moines, for plaintiffs.

Glenn L. Norris of Hawkins & Norris, P.C., Des Moines, Steven P.

Wandro of Wandro & Associates, P.C., Des Moines, and Harley C. Erbe of

Erbe Law Firm, Des Moines, for defendant. 2

WATERMAN, Justice.

When is a case over? We have decided two prior appeals in this

civil action: Mueller v. Wellmark, Inc., 818 N.W.2d 244, 267 (Iowa 2012)

(reversing summary judgment in part) (Mueller I), and Mueller v.

Wellmark, Inc., 861 N.W.2d 563, 575 (Iowa 2015) (affirming summary

judgment dismissing the fourth amended petition) (Mueller II). After

procedendo issued in Mueller II, the plaintiffs persuaded the district court

to proceed with an antitrust claim they had previously stipulated was not

included in their fourth amended petition. We granted the defendant’s

petition for a writ of certiorari and now clarify what we thought was clear

before—that Mueller II ended this civil action.

I. Background Facts and Proceedings.

A. Procedural History Through Mueller II. This civil action

commenced in December 2007 when Steven A. Mueller, a doctor of

chiropractic, filed a breach-of-contract claim against Wellmark over a

$17,376 billing dispute. Mueller I, 818 N.W.2d at 247–48. In May 2008,

Mueller, joined by Bradley J. Brown, D.C.; Mark A. Kruse, D.C.; Kevin D.

Miller, D.C.; and Larry E. Phipps, D.C., filed an amended petition

asserting claims on behalf of a putative “class of Iowa-licensed doctors of

chiropractic” who “have billed for services provided to patients enrolled in

Wellmark health insurance plans.” Id. at 248. Plaintiffs alleged

Wellmark discriminatorily fixed prices for services performed by

chiropractors at rates lower than those paid to medical doctors and

doctors of osteopathic medicine. Id. at 247. Their amended petition

alleged violations of Iowa insurance regulatory statutes, the Iowa

Competition Law (Iowa Code chapter 553), and a national class-action

settlement. See id. at 249–50. The district court, without certifying this 3

case as a class action, granted Wellmark’s motions to dismiss and for

summary judgment. Id. at 250, 252.

Plaintiffs appealed. Id. at 253. We affirmed the dismissal of claims

brought under the insurance statutes, holding they created no private

right to sue. Id. at 258. We also affirmed summary judgment dismissing

claims that Wellmark breached the national settlement in Love v.

Blue Cross Blue Shield Ass’n, No. 03–21296–CIV (S.D. Fla. Apr. 19,

2008). Id. at 264–65. But we reversed the district court’s summary

judgment dismissing antitrust claims against Wellmark based on the

state-action exemption in Iowa Code section 553.6(4) (2009). Id. at 263–

64. We remanded the case for further proceedings on plaintiffs’ claims

under the Iowa Competition Act. Id. at 264, 267. Meanwhile, plaintiffs,

joined by other doctors of chiropractic, commenced an administrative

action in the Iowa Insurance Division to litigate the violations of the

insurance regulatory statutes. 1

District court proceedings resumed in this civil action after our

remand in Mueller I. See Mueller II, 861 N.W.2d at 566. On

December 31, 2012, Wellmark moved to dismiss or stay this civil action

pending the insurance commissioner’s decision in the related administrative action. Wellmark argued the commissioner had primary

jurisdiction because the regulator was better suited to analyze the

complex antitrust allegations and effects on insurance markets.

Wellmark contended the commissioner’s decision may “moot” or “narrow”

the issues. Plaintiffs resisted, arguing there was no need to await the

1The insurance commissioner ultimately decided that case in Wellmark’s favor, and the district court affirmed on the plaintiffs’ petition for judicial review. Abbas v. Iowa Ins. Div., No. CVCV048885 (Iowa Dist. Ct. for Polk Cty. June 24, 2015). Plaintiffs’ appeal was submitted to our court on January 18, 2017. Abbas v. Iowa Ins. Div., No. 15–1248 (Iowa filed Jan. 18, 2017). 4

commissioner’s decision because their amended petition alleged “per se”

violations of the Iowa Competition Act that did not require the regulator’s

expert analysis of the Iowa health insurance market.

Under a per se violation, an agreement is “so plainly

anticompetitive that no elaborate study of the industry is needed to

establish . . . illegality.” Id. at 568 (quoting Texaco Inc. v. Dagher, 547

U.S. 1, 5, 126 S. Ct. 1276, 1279, 164 L. Ed. 2d 1, 7 (2006)). By contrast,

a rule-of-reason claim “requires plaintiffs to demonstrate that a

particular arrangement ‘is in fact unreasonable and anticompetitive

before it will be found unlawful.’ ” Id. (quoting Dagher, 547 U.S. at 5,

126 S. Ct. at 1279, 164 L. Ed. 2d at 7). In a rule-of-reason analysis,

the finder of fact must decide whether the questioned practice imposes an unreasonable restraint on competition, taking into account a variety of factors, including specific information about the relevant business, its condition before and after the restraint was imposed, and the restraint’s history, nature, and effect [on the market.]

State Oil Co. v. Khan, 522 U.S. 3, 10, 118 S. Ct. 275, 279, 139 L. Ed. 2d

199, 206 (1997). Plaintiffs specifically argued that because their

amended petition alleged per se violations, the commissioner was not

better suited to resolve the dispute.

Wellmark responded by inviting plaintiffs to stipulate that their

pleadings included no rule-of-reason claim:

If Plaintiffs will indeed stipulate that their case be strictly limited to a claim of per se price fixing, that might indeed moot out this motion and we could go right to summary judgment. But the allegations contained in Plaintiffs’ Fourth Amended and Substituted Petition . . . are not so limited, and that’s the pleading now before this Court . . . .

Wellmark sought a stipulation stating,

a. Plaintiffs hereby dismiss, with prejudice, all claims except any price-fixing claims that rise to a per se violation of the Iowa Competition Act; and 5 b. Wellmark, in turn, withdraws its pending motion to dismiss or stay.

At the hearing on Wellmark’s motion, the district court expressed an inclination to stay the proceedings. Plaintiffs rejected Wellmark’s

proposed stipulation but, to avoid the stay, agreed to limit their petition

to per se violations. They stipulated accordingly,

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