BlueCross BlueShield of Tennessee, Inc. v. Nicolopoulos (JRG3)

District Court, E.D. Tennessee·Decided September 18, 2023·No. 1:21-cv-00271·Unknown

Opinion

UNITED STATES DISTRICT COURT EASTERN DISTRICT OF TENNESSEE AT CHATTANOOGA

BLUECROSS BLUESHIELD OF ) TENNESSEE, INC., ) ) Plaintiff, ) ) v. ) No. 1:21-CV-00271-JRG-CHS ) DAVID J. BETTENCOURT, in his ) Official Capacity as Acting ) Commissioner of the New Hampshire ) Insurance Department, ) ) Defendant.1 )

MEMORANDUM OPINION AND ORDER This matter is before the Court on Bluecross Blueshield of Tennessee, Inc.’s (“BCBST”) Supplemental Briefing to the Court’s June 26, 2023 Memorandum Opinion and Order (the “June 26 Order”) [Doc. 84], the New Hampshire Insurance Department’s (collectively with Defendant David J. Bettencourt, in his official capacity as Commissioner, “NHID”) Response [Doc. 85], and BCBST’s Reply [Doc. 86]. For the reasons stated below the Court finds that no questions of fact or law remain as to New Hampshire’s fertility treatment mandate. Accordingly, the Court GRANTS SUMMARY JUDGMENT to NHID as to all claims arising from New Hampshire’s fertility treatment mandate. Additionally, the Court finds that a question of law remains as to New Hampshire’s unfair-business practices law. Accordingly, the parties are ORDERED, within fourteen days of this Order’s date,

1 Previously, the Defendant in this action was Christopher R. Nicolopoulos, in his Official Capacity as Commissioner of the New Hampshire Insurance Department. It appears, however, that Commissioner Nicolopoulos has ceased holding office on July 4, 2023. See Sruthi Gropalakrishnan, New Hampshire Insurance Commissioner Nicolopoulos to step down, CONCORD MONITOR, available at https://www.concordmonitor.com/Commissioner- Chris-Nicolopoulos-to-Not-Seek-Reappointment-50946273 (last visited August 30, 2023). Therefore, pursuant to Federal Rule of Civil Procedure 25(d), his successor Acting Commissioner Bettencourt is automatically substituted as Defendant. to confer and file with the Court a proposed briefing schedule as to the unfair-insurance-practices law issue. To the extent one or both of the parties believes that factual discovery is necessary, they shall include with their filing a proposed discovery schedule identifying the facts that they contend remain in dispute.

BACKGROUND New Hampshire has a fertility treatment mandate that requires insurance companies doing business there to provide coverage for medically necessary fertility treatments. N.H. Rev. Stat. § 417:G2 (“Diagnosis of Infertility, Fertility Treatment, and Fertility Preservation”). In 2020 and 2021, BCBST sold PhyNet Dermatology, LLC (“PhyNet”), a Tennessee-based company with employees and operations in New Hampshire group health insurance plans (the “PhyNet Plans”). [Am. Compl., Doc. 20, ¶ 14; BCBST Statement of Material Facts, Doc. 39, ¶¶ 12, 16–22]. As permitted by Tennessee law, the PhyNet Plans excluded coverage for fertility treatments. [BCBST

Statement of Material Facts, Doc. 39, ¶¶ 12–14, 27–35; NHID Resp. Statement Material Facts, Doc. 80 ¶¶ 27–28, 35; see also 2020 Group Agreement, Doc. 39-2, at PageID # 655; 2020 Evidence of Coverage, Doc. 39-4, at PageID # 744; 2021 Group Agreement, Doc. 39-5, at PageID # 800; 2021 Evidence of Coverage, Doc. 39-7, at PageID # 889]. In October 2021, NHID issued an Order to Show Cause and Notice of Hearing (the “Show Cause Order”) to BCBST after it learned that BCBST denied coverage for B.C.’s fertility treatments. B.C. is a New Hampshire resident, PhyNet employee, and Member of the PhyNet Plans. The Show Cause Order alleges that BCBST violated various New Hampshire laws (N.H. Rev. Stat. §§ 400-A:15 (“Statutes, Rules, and Regulations; Violation”), 417-G:2 (“Diagnosis of

Infertility, Fertility Treatment, and Fertility Preservation”), and 417:4, I(h) (“Unfair Methods, Acts, and Practices Defined: Fraud or Deceit Upon Insured”)) when it issued health insurance to a New Hampshire resident that did not include required coverage for fertility treatments and refused to cover B.C.’s treatments. [Show Cause Order, Doc. 20-1, at PageID # 476]. The Show Cause Order demands that BCBST appear for an evidentiary hearing (the “Hearing”) to determine whether it violated New Hampshire insurance laws and, if so, requests a fine of no less than

$52,000 and an order requiring that BCBST cease and desist from offering health insurance in New Hampshire. [Id. at PageID # 475–78]. In response to the Show Cause Order, BCBST brought this four-count action under the Employee Retirement Income Security Act (“ERISA”), 29 U.S.C. § 1001 et seq., seeking injunctive and declaratory relief from the Show Cause Order and “any and all enforcement actions and adjudicatory, administrative, or legal proceedings ordered or initiated by [NHID] . . . and to bar the imposition of any related penalties, stemming from BCBST’s alleged denial of” B.C.’s fertility treatments. [Am. Compl., Doc. 20 ¶ 1]. Count One asks the Court to bar NHID from interfering with BCBST’s implementation of the PhyNet Plans in accordance with their terms (i.e., in accordance with their Tennessee choice-of-law provisions). [Id. ¶¶ 54–62]. Count Two asks the

Court bar NHID from interfering with BCBST’s compliance with its ERISA-mandated fiduciary duties. [Id. ¶¶ 63–74]. Count Three asks the Court to bar NHID from pursuing any adjudicatory, administrative, or legal actions against BCBST in contravention of ERISA’s exclusive remedy for the wrongful denial of benefits. [Id. ¶¶ 75–82]. Finally, Count Four asks the Court, pursuant to federal common law, to bar NHID from interfering with BCBST’s implementation of the PhyNet Plans and other BCBST-administered, ERISA-covered group health plans with Tennessee choice- of-law provisions. [Id. ¶¶ 83–93]. In response to this suit, NHID filed a Motion to Dismiss [Doc. 29], in which it argued that because New Hampshire’s fertility treatment mandate is not preempted by ERISA, the Court lacks subject matter jurisdiction over the case and personal jurisdiction over NHID. [NHID Mem. Supp. Dismiss, Doc. 30, at 8–18]. The Court denied NHID’s motion, holding that even if BCBST was not ultimately entitled to relief on the merits, because it sought relief under ERISA, the Court had jurisdiction to hear the case and, therefore, personal jurisdiction over NHID pursuant to ERISA’s

nationwide service of process. See [Mem. Op. & Order, Doc. 45]. After the Court’s denial of NHID’s Motion to Dismiss, BCBST filed a Motion for Partial Summary Judgment as to Counts One through Three [Doc. 37]. In its motion, as it has throughout this case, BCBST argued that this action is a involves a choice-of-law dispute over which state’s benefits mandates apply to the PhyNet Plans, New Hampshire’s or Tennessee’s. [BCBST Mem. Supp. Summ J., Doc. 38, at 1; see also BCBST Resp. Opp’n Mot. Dismiss, Doc. 32, at 1–2 (arguing that this case involves a choice-of-law dispute regarding what law applies to the PhyNet Plans)]. The assumption underlying BCBST’s argument is that the Show Cause Order is a vehicle through which NHID was attempting to enforce B.C.’s rights under the PhyNet Plans, thus implicating the plans’ terms.

In response to BCBST’s motion, NHID asserted that “[t]he question central to this case is whether it is lawful for [NHID] to exercise the State of New Hampshire’s regulatory authority over BCBST.” [NHID Resp. Br., Doc. 77, at 1]. In accord with that characterization of the case, NHID argued that, as evidenced by ERISA’s Saving Clause, “Congress intended to leave to the states the power to regulate insurance companies and insurance contracts.” [Id. at 11 (quoting Cate v. Blue Cross and Blue Shield of Ala., 434 F. Supp. 1187, 1191 n.5 (E.D. Tenn. 1977))].

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BlueCross BlueShield of Tennessee, Inc. v. Nicolopoulos (JRG3), (E.D. Tenn. 2023).

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