Guardsmark, Inc. v. Blue Cross & Blue Shield of Tennessee

313 F. Supp. 2d 739, 33 Employee Benefits Cas. (BNA) 1336, 2004 U.S. Dist. LEXIS 6746, 2004 WL 803718
CourtDistrict Court, W.D. Tennessee
DecidedMarch 3, 2004
Docket01-2117 MA
StatusPublished
Cited by3 cases

This text of 313 F. Supp. 2d 739 (Guardsmark, Inc. v. Blue Cross & Blue Shield of Tennessee) is published on Counsel Stack Legal Research, covering District Court, W.D. Tennessee primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Guardsmark, Inc. v. Blue Cross & Blue Shield of Tennessee, 313 F. Supp. 2d 739, 33 Employee Benefits Cas. (BNA) 1336, 2004 U.S. Dist. LEXIS 6746, 2004 WL 803718 (W.D. Tenn. 2004).

Opinion

ORDER DENYING PLAINTIFFS’ MOTION TO STRIKE, GRANTING IN PART AND DENYING IN PART PLAINTIFFS’ MOTION FOR SUMMARY JUDGMENT, GRANTING IN PART AND DENYING IN PART DEFENDANT’S MOTION FOR PARTIAL SUMMARY JUDGMENT AND DENYING DEFENDANT’S MOTION FOR SUMMARY JUDGMENT

MAYS, District Judge.

On February 14, 2001, Plaintiffs filed a complaint bringing state law breach of contract claims and claims for breach of fiduciary duties prescribed by the Employee Retirement Income Security Act (“ERISA”), 29 U.S.C. § 1001, et seq. Defendant answered and counterclaimed for breach of contract under state law. This court has jurisdiction pursuant to 28 U.S.C. § 1331 and 29 U.S.C. § 1132(e).

Before the court are four pending motions. On May 6, 2003, Plaintiffs filed for summary judgment, 1 to which Defendant filed a response on September 2, 2003. Defendant filed for partial summary judgment on May 6, 2003, to which Plaintiffs filed a response on September 2, 2003. Defendant filed a motion for summary judgment on January 6, 2004, to which Plaintiffs filed a response on January 15, 2004, and Defendant filed a reply on February 4, 2004. On January 8, 2004 Plaintiffs filed a motion to strike Defendant’s second motion for summary judgment to which Defendant filed a response of January 13, 2004. For the following reasons, Plaintiffs’ motion to strike is DENIED. Plaintiffs’ motion for summary judgment is GRANTED in part and DENIED in part. Defendant’s motion for partial summary judgment is GRANTED in part and DENIED in part. Defendant’s motion for summary judgment is DENIED.

I. Background

The following facts are undisputed unless otherwise noted. Blue Cross and Blue Shield of Tennessee (“BCBST”) is organized under Tennessee law and is authorized to do business in Tennessee as an insurance company. (Compl. at ¶ 7.) Guardsmark, Inc. (“Guardsmark”) is a private security firm organized under the laws of the state of Delaware and headquartered in Memphis, Tennessee. (Pis.’ Mot. for Summ. J. at 3; Compl. at ¶ 4.) 2 Guardsmark established the Guardsmark, Inc. Medical Plan (the “Plan”), a self-funded plan, to provide healthcare benefits to its approximately 18,000 employees. (Pis.’ Mot. for Summ. J. at 3; Compl. at ¶ 4). The Board of Trustees of the Guardsmark, Inc. Medical Plan Trust Fund (the “Board”) was established by Guardsmark to fund the Plan and to hold the Plan’s assets. (Compl. at ¶ 6.) Guardsmark, the Plan, and the Board have instigated the instant suit, and the court will refer to them collectively as “Plaintiffs.”

*743 From 1984 until 1995, Memphis Hospital Service and Surgical Association, Inc. d/b/a Blue Cross and Blue Shield of Memphis served as the third-party administrator for the Plan. (Def.’s Mot. for Summ. J. at 3.) BCBST is the successor in interest to Memphis Hospital Service and Surgical Association, Inc. (Compl. at ¶ 8.)

In 1994, various healthcare providers under contract to Blue Cross and Blue Shield entities united in a national network known as the Blue Card Program to offer their customers access to preferred pricing agreements that had been negotiated by Blue Cross and Blue Shield entities. (Def.’s Mot. for Summ. J. at 3.) Within this program, a customer would contract with the local Blue Cross entity known as the home plan. (Pis.’ Mot. for Summ. J. at 8.) The home plan negotiated preferred pricing agreements with local health care providers within its territory. (Pis.’ Resp. to Def.’s Mot. for Summ. J. at 6-7.) For employees who incurred medical expenses outside the home plan’s territory, the Blue Cross plan where the expenses were incurred, known as the host plan, would handle the employees’ claims, thereby providing access to the preferred pricing agreements the host plan had negotiated with its local health care providers. (Id.) In exchange for this service, host plan Blue Cross programs would assess a percentage fee based on the amount their preferred pricing agreements saved the customer. (Pis.’ Mot. for Summ. J. at Ex. A.) The home plan would then collect its fee, the host plan’s fee, and the amount of the actual bill from the customer. (Id.) The home plan would then forward the host plan’s fee and the actual bill amount to the host plan, which paid the provider’s bill. (Def.’s Mot. for Summ. J. at 9.)

Some Blue Cross plans also negotiated agreements with local health care providers whereby those providers would rebate a percentage of the amount of the actual bill paid. (Pis.’ Resp. to Def.’s Mot. for Summ. J. at 11.) When this practice came to light, a number of Blue Cross customers filed suit claiming that these refund agreements masked the true costs of the Blue Cross entities’ services as costs for actual medical services. 3 The Secretary of Labor brought suit against BCBST in this court, and a consent decree was entered in 1994 requiring BCBST to reveal the details of any such arrangements to its customers and prospective customers. (Id. at 10-11.)

Guardsmark and BCBST executed an “Agreement to Provide Certain Administrative Services Only” (the “Agreement”) on February 12, 1996. (Pis.’ Mot. for Summ. J. at Ex. A.) The Agreement set forth the terms under which BCBST would provide Guardsmark access to the Blue Card Program in 1995 and 1996. (Id.) The Agreement also anticipated year-to-year renewals, but failed to provide a mechanism for determining fees or increases for years following 1996. (Id.) Clause 9 in the Agreement required that any amendments to the Agreement be made in writing upon agreement by the parties. (Id.) The Agreement, which was retroactively effective to July 1, 1995, stated that: (1) Guardsmark would pay a general administrative fee of $5.25 per employee per month; (2) Guardsmark would pay an administrative fee of $1.50 per employee per month for utilization review; (3) BCBST *744 would retain any rebates it was able to negotiate with local providers. (Pis.’ Mot. for Summ. J. at Ex. A.) The Agreement also stated that, effective July 1, 1996, the general administrative fee of $5.25 was to increase by five percent or the increase in the consumer price index, whichever was greater. (Id.) On April 25, 1996, BCBST informed Guardsmark that it would raise the general administrative fee by five percent on July 1, 1996. BCBST also attempted to raise the administrative fee for utilization review from $1.50 to $1.58 per person although the Agreement made no allowance for such an increase. (Id. at 4.) After Guardsmark objected to the latter increase, BCBST agreed to maintain the administrative fee for managed care services at $1.50 per employee per month. (Id.)

In December 1996, BCBST offered to provide Guardsmark employees with a prescription drug benefit for $1.00 per employee per month. (Id.

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313 F. Supp. 2d 739, 33 Employee Benefits Cas. (BNA) 1336, 2004 U.S. Dist. LEXIS 6746, 2004 WL 803718, Counsel Stack Legal Research, https://law.counselstack.com/opinion/guardsmark-inc-v-blue-cross-blue-shield-of-tennessee-tnwd-2004.