Jackson v. The Aliera Companies Inc

District Court, W.D. Washington·Decided July 20, 2020·No. 2:19-cv-01281·Unknown

Opinion

1 2 3 4 5 UNITED STATES DISTRICT COURT FOR THE 6 WESTERN DISTRICT OF WASHINGTON AT SEATTLE 7 GERALD JACKSON, ROSLYN ) JACKSON and DEAN MELLOM, ) 8 Individually and on behalf of all others ) Similarly situated, ) 9 ) CASE NO. 2:19-cv-01281-BJR Plaintiffs, ) 10 v. ) ) ORDER DENYING DEFENDANTS’ THE ALIERA COMPANIES, INC., a ) CONSOLIDATED MOTION TO 11 Delaware corporation; ALIERA ) COMPEL ARBITRATION AND STAY HEALTHCARE, INC., a Delaware ) PROCEEDINGS PENDING 12 Corporation; TRINITY HEALTHSHARE, ) ARBITRATION PURSUANT TO 9 U.S.C. INC., a Delaware corporation, ) §§ 3 AND 4; AND MOTION TO STAY 13 ) DISCOVERY PENDING DECISION ON Defendants, ) MOTION TO COMPEL ) 14 ) ____________________________________) 15 I. INTRODUCTION 16 Plaintiffs Gerald Jackson, Roslyn Jackson, and Dean Mellom (“Plaintiffs”) bring this 17 putative class action suit against Defendants Aliera Companies, Inc., including its now-defunct 18 subsidiary Aliera Healthcare, Inc. (collectively “Aliera”), and Trinity HealthShare, Inc. 19 (“Trinity”). See First Am. Compl. (“FAC”), Dkt. No. 16. Plaintiffs allege that Defendants sold 20 them unauthorized health insurance plans in violation of Washington law and engaged in unfair 21 and deceptive practices in violation of the Washington Consumer Protection Act, RCW 19.86.010 22 et seq. Id. at ¶¶ 17–19; 103; 105. 23 24 1 Currently before the Court is Defendants’ consolidated motion to compel arbitration and 2 motion to stay discovery1 (“the motion to compel”). See Defs.’ Mot. to Compel Arb., Dkt. No. 3 52.2 Plaintiffs oppose the motions. See Pls.’ Resp. to Defs.’ Mot. to Compel Arb., Dkt. No. 53. 4 The Court heard arguments on June 9, 2020. See Dkt. Nos. 53, 56. Having reviewed the motions 5 and opposition thereto, the record of the case, the relevant legal authority, and having heard oral

6 argument, the Court will deny the motion to compel. The reasoning for the Court’s decision 7 follows. 8 II. BACKGROUND 9 Defendant Trinity offers a healthcare cost sharing plan known as “AlieraCare” and 10 Defendant Aliera markets, sells, and administers AlieraCare in Washington State on behalf of 11 Trinity. See FAC at ¶ 11. According to Plaintiffs, Trinity is a health insurance company and 12 AlieraCare is a health insurance plan, and therefore subject to federal and state laws governing 13 health insurance companies. See FAC at ¶ 7. Defendants counter that Trinity is not an insurance 14 company and does not provide health insurance. See Defs.’ Answers to Pls.’ Second Am. Compl., 15 Dkt. Nos. 62, 63. Instead, Defendants assert that Trinity is a health care sharing ministry3

16 (“HCSM”) that facilitates the sharing of healthcare expenses among its members. Id. The parties 17 agree that AlieraCare provides members with benefits for medical coverage in exchange for their 18

19 1 The Court’s ruling on the motion to compel arbitration renders the motions to stay moot. 2 Defendants filed this motion on June 4, 2020. See Defs.’ Mot. to Compel Arb. However, with this Court’s 20 permission, Plaintiffs filed a second amended complaint on June 10, 2020, which added two plaintiffs to this action. See Pls.’ Second Am. Compl., Dkt. No. 57. Thereafter, Defendants filed a second motion to compel arbitration and stay proceedings pending arbitration. See Defs.’ Second Mot. to Compel Arb., Dkt. No. 61. Defendants filed the 21 second motion to: (1) compel the new plaintiffs to arbitration; and (2) restate their arguments against the original plaintiffs to the extent that the filing of the second amended complaint mooted the first motion to compel. See id. at 22 1–2. 3 HCSMs are organizations in which their members are exempt from having traditional health insurance coverage as 23 required by the federal Patient Protection and Affordable Care Act (“ACA”). See 26 U.S.C. § 5000A(b)(1). To qualify as an HCSM, an organization must meet the requirements listed under 26 U.S.C. § 5000A(d)(2)(B). Relevant to the instant order, HCSMs are not traditional insurance companies and are exempt from complying with federal and 24 state insurance laws. 1 monthly premiums. Id. at ¶ 15. 2 Plaintiffs enrolled in AlieraCare in 2018 and 2019. Id. at ¶¶ 86; 95. Plaintiffs, all of whom 3 paid their monthly premiums and met their standard deductibles, expected that Trinity would pay 4 their medical claims as detailed by the AlieraCare benefits booklet (“Member Guide”). Id. at ¶¶ 5 31; 93–94; 99–10; see Member Guide, Ex. B to FAC, Dkt. No. 16-2. However, each was denied

6 healthcare coverage after submitting their claims to Trinity. Id. 7 Important to the instant motion, the Member Guide contains a multi-tiered dispute 8 resolution appeal process. See Member Guide at 36–37, Ex. B to FAC. Under this process, in the 9 event a “sharing member” (i.e., Plaintiffs) “disagrees” with a determination to deny healthcare 10 coverage and who “believes there is a logically defensible reason why the initial determination is 11 wrong”, the sharing member “may file an appeal.” Id. at 36. The Member Guide sets forth four 12 “Level[s] of Appeal”, listing them as “1st Level Appeal” through “Final Appeal.” Id. at 36–37. 13 The first level of appeal is simply a telephone call to Trinity disputing the determination. Id. at 14 36. If the phone call does not resolve the dispute, the sharing member may request that the 15 determination be reviewed by an “Internal Resolution Committee”. Id. If this does not resolve

16 the dispute, the sharing member may next request that an “External Resolution Committee” review 17 the determination. Id. at 36–37. If the sharing member remains unhappy after completing these 18 levels of appeal, he or she may request that a medical expense auditor review the determination. 19 Id. at 37. If the sharing member remains dissatisfied after the expense auditor’s review, he or she 20 must submit the dispute to mediation. Id. The final level of appeal is binding arbitration. Id. 21 On November 1, 2019, Defendants moved to dismiss the lawsuit for failure to state a claim 22 under Federal Rule 12(b)(6). See Defs.’ Mots. to Dismiss, Dkt. Nos. 21, 23. Defendants sought 23 dismissal of the case in its entirety on the ground that Trinity is not an insurance company and, 24 1 instead, qualifies as a HCSM under the ACA, and is therefore exempt from Washington’s health 2 insurances laws. Id. In the alternative, Defendants argued that Plaintiffs filed this lawsuit 3 prematurely because they failed to exhaust the foregoing dispute resolution procedures as outlined 4 in the Member Guide. Id. 5 The Court denied Defendants’ motions to dismiss on May 26, 2020. See Court’s Order

6 Den. Defs.’ Mots. to Dismiss, Dkt. No. 47. In doing so, this Court concluded that Plaintiffs 7 sufficiently pled allegations, that if proven true, would establish that Trinity is an insurance 8 company subject to Washington’s health insurance laws. Id. at 9. The Court further concluded 9 that Plaintiffs sufficiently pled that the dispute resolution procedures set forth in the Member Guide 10 are illegal under Washington law and if Plaintiffs’ allegations are proven true, Plaintiffs would be 11 relieved “of any obligation to follow” such procedures. Id. at 12. 12 III. DISCUSSION 13 The parties agree that the Federal Arbitration Act (“FAA”) governs this dispute. See 9 14 U.S.C. § 1 et seq. The FAA provides that arbitration agreements shall “be valid, irrevocable, and 15 enforceable, save upon such grounds as exist at law or in equity for the revocation of any contract.”

16 9 U.S.C.

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