Harvey v. Centene Corporation

CourtDistrict Court, E.D. Washington
DecidedMay 12, 2020
Docket2:18-cv-00012
StatusUnknown

This text of Harvey v. Centene Corporation (Harvey v. Centene Corporation) is published on Counsel Stack Legal Research, covering District Court, E.D. Washington primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Harvey v. Centene Corporation, (E.D. Wash. 2020).

Opinion

1 FILED IN THE U.S. DISTRICT COURT 2 EASTERN DISTRICT OF WASHINGTON May 12, 2020 3 UNITED STATES DISTRICT COURT SEAN F. MCAVOY, CLERK EASTERN DISTRICT OF WASHINGTON 4 CYNTHIA HARVEY, individually No. 2:18-cv-00012-SMJ 5 and on behalf of all others similarly situated, ORDER DENYING PLAINTIFF’S 6 MOTION FOR CLASS Plaintiff, CERTIFICATION 7 v. 8 CENTENE MANAGEMENT 9 COMPANY LLC and COORDINATED CARE 10 CORPORATION,

11 Defendants.

12 Plaintiff Cynthia Harvey alleges Defendants Centene Management 13 Company, LLC and Coordinated Care Corporation administered a health insurance 14 plan (the “Ambetter” product) with a legally inadequate network of medical 15 providers and, when members were forced to seek care outside the Ambetter 16 network, illegally allowed them to be billed more than they would have paid for in- 17 network services. Because the Court finds there are superior alternatives to a class 18 action to resolve Plaintiff’s claims, and because necessary individualized 19 determinations make a class action impractical, the Court denies Plaintiff’s motion 20 to certify a class of all Ambetter customers between 2012 and the present. 1 BACKGROUND 2 Centene1 is a provider of health insurance coverage throughout the country,

3 including in Washington State, where it sells the Ambetter insurance plan at issue in 4 this case in nineteen different counties. ECF No. 106-1 at 23. Federal law requires 5 health insurance plans like the Ambetter product offer coverage for ten categories of

6 “essential health benefits” and provide “a network that is sufficient in number and 7 types of providers” so that “all services will be accessible without unreasonable 8 delay.” 42 U.S.C. §§ 300g-13, 18022; 45 C.F.R. § 156.230(b)(2). 9 Washington law independently requires health insurance plans to provide

10 certain benefits and an adequate network of providers, including in certain 11 specialties. Wash. Admin. Code §§ 284-170-200(1)–(2), 284-170-270. Washington 12 also obligates insurers to disclose limitations on their networks and maintain up-to-

13 date provider directories. Wash. Admin. Code §§ 284-170-200(8), 284-170-260. 14 Where an insurer’s provider network is inadequate, Washington law requires it to 15 ensure that an insured may “obtain[] the covered service from a provider or facility 16 within reasonable proximity of the [insured] at no greater cost” than the insured

18 1 Defendant Coordinated Care Corporation and Centene Management Company LLC are both subsidiaries of Centene Corporation, which is not a named Defendant 19 in this action. Coordinated Care administers the Ambetter insurance program in Washington while Centene Management Company provides administrative 20 support. ECF No. 92-1 at 185. For the sake of simplicity, unless otherwise noted, references to “Centene” should be understood as references to both Defendants. 1 would pay in-network. Wash. Admin. Code § 284-170-200(5). The Ambetter 2 “evidence of coverage”—Centene’s contract with plan members—describes each of

3 these rights. See ECF No. 94 at 10–13 4 The crux of Plaintiff’s allegations is that Centene has for years failed to 5 maintain an adequate network of providers, forcing members to receive care at out-

6 of-network facilities and from out-of-network providers. See ECF No. 62. Plaintiff 7 alleges Centene fails to prevent members forced to seek care outside the Ambetter 8 network from being billed for the difference between what the provider or facility 9 charges and what the member would pay had they received care in-network—so-

10 called “balance billing.”2 ECF No. 91 at 18. Plaintiff asserts that between 2014 and 11 2018, Centene denied thousands of claims because the member received care from 12 an out-of-network facility or provider. Id. at 16.

13 In 2017, Washington’s Office of the Insurance Commissioner (OIC) notified 14 Centene it had received hundreds of complaints from Washington consumers 15 concerning inadequacies in the Ambetter network and balance billing. See ECF 16 No. 91 at 16–17; ECF No. 94 at 93. The OIC brought enforcement action against

17 Centene, and the two eventually entered into a Consent Order by which Centene 18 agreed to pay $1.5 million, admitted its network was inadequate and failed to provide 19 2 Plaintiff also alleges Centene failed to protect its members from “surprise billing,” 20 which occurs when a member receives care at an in-network facility from an out- of-network provider. See ECF No. 62; ECF No. 106-6 at 2. 1 members sufficient access to care, and agreed to follow a “Compliance Plan” 2 approved by the OIC. See ECF No. 94 at 92–101; ECF No. 106-2 at 2–5. The

3 Compliance Plan required Centene to address network inadequacies in certain areas 4 and provide reimbursement to members who paid out-of-network charges when no 5 in-network option was available. ECF No. 106-2 at 2–5. Centene agreed to hire an

6 independent auditor to oversee the Compliance Plan’s implementation. Id. at 2. 7 Centene thereafter notified more than 70,000 members that reimbursement 8 may be available for amounts paid to out-of-network providers or facilities where 9 no in-network option was available; the auditor subsequently sent follow-up letters

10 to more than 10,000 members identified based on their claims history. ECF No. 106 11 at 4–5; ECF Nos. 106-3, 106-4. Several hundred members submitted requests for 12 reimbursement, of which Centene paid 113. ECF No. 94 at 810–14. In January 2019,

13 the OIC determined Centene had satisfied the requirements of the Compliance Plan, 14 though Centene remains subject to the federal and state statutory and regulatory 15 requirements described above. See ECF No. 106-5. 16 On January 11, 2018, Plaintiff brought suit against Defendants on behalf of

17 herself and others similarly situated. ECF No. 1. Plaintiff alleges Centene continues 18 to maintain an inadequate network and continues to allow balance billing, in breach 19 of its contract with members and in violation of Washington’s Consumer Protection

20 Act (CPA). See ECF No. 62; ECF No. 91 at 20–21. Before the Court is Plaintiff’s 1 Motion for Class Certification, ECF No. 91.3 Plaintiff seeks an order certifying a 2 class of all who purchased the Ambetter product between January 11, 2012 and the

3 present. Plaintiff also seeks an order appointing herself as class representative and 4 appointing her counsel as class counsel. Id. at 9, 40. Defendants oppose class 5 certification. ECF No. 105. Having reviewed the briefing and the file in this matter,

6 the Court is fully informed4 and denies the motion because a class action is not a 7 superior vehicle to adjudicate the putative class’s claims, and issues common to the 8 class do not predominate over individualized questions of law and fact. 9 LEGAL STANDARD

10 Federal Rule of Civil Procedure 23 permits a representative plaintiff or group 11 of plaintiffs to sue on behalf of others similarly situated to obtain redress for wrongs 12 common to all class members. Under Rule 23(a), all putative classes must satisfy

13 four requirements, known as “numerosity, commonality, typicality, and adequate 14 representation,” designed to “effectively limit the class claims to those fairly 15 encompassed by the named plaintiff’s claims.” Wal-Mart Stores, Inc. v. Dukes, 564 16

17 3 The Motion for Class Certification was filed under seal. ECF No. 91. An identical 18 version of Plaintiff’s motion with limited redactions appears at ECF No. 100.

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Harvey v. Centene Corporation, Counsel Stack Legal Research, https://law.counselstack.com/opinion/harvey-v-centene-corporation-waed-2020.