Kennedy v. United Healthcare of Ohio, Inc.

206 F.R.D. 191, 27 Employee Benefits Cas. (BNA) 2791, 2002 U.S. Dist. LEXIS 5002, 2002 WL 416334
CourtDistrict Court, S.D. Ohio
DecidedMarch 14, 2002
DocketNo. C-2-98-0128
StatusPublished
Cited by4 cases

This text of 206 F.R.D. 191 (Kennedy v. United Healthcare of Ohio, Inc.) is published on Counsel Stack Legal Research, covering District Court, S.D. Ohio primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Kennedy v. United Healthcare of Ohio, Inc., 206 F.R.D. 191, 27 Employee Benefits Cas. (BNA) 2791, 2002 U.S. Dist. LEXIS 5002, 2002 WL 416334 (S.D. Ohio 2002).

Opinion

OPINION AND ORDER

GEORGE C. SMITH, District Judge.

Plaintiffs filed this putative class action on February 2, 1998, asserting claims under the Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. §§ 1001 et seq. Plaintiffs seek to enforce the terms of their health maintenance organization (“HMO”) coverage. Plaintiffs aver that defendant, an HMO, improperly failed to pay plaintiffs benefits as required under the plan when it obtained undisclosed discounts from health care providers, but did not reduce plaintiffs’ co-pay which the plan calculates on the basis of a percentage of the health service providers’ charges.

Plaintiffs moved to certify on August 31, 2000 (Doc. 60).1 Defendant opposes certification, arguing, among other things, that claims under Certificate of Coverage 10/92 are barred under that certificate’s three-year limitation period.

For the reasons that follow, the Court grants plaintiffs’ motion.

I. Facts

The amended complaint (Doc. 50) names the following plaintiffs: Ida Kennedy; John Kennedy; Ashley Kennedy; Donna Myers; Sherri Hamilton; Georgia Tigner; and Georgia Tigner as the Administrator of the Estate of Ralph Tigner. Thompson Electronics (“Thompson”) sponsored an ERISA health and welfare plan (“Plan”) for its employees. Plaintiffs Ida Kennedy, Donna Kennedy, and Georgia Tigner worked for Thompson, and participated in the Plan. The other plaintiffs benefitted under the Plan as relatives of Thompson employees.

Defendant United Healthcare of Ohio, Inc. (“defendant”) provided benefits under the Plan throughout the relevant period, from 1985 until at least 1995. Defendants issued group certificates for the Plan during this period, all of which provided that the participant and defendant were each responsible for a specific percentage of the health service provider’s reasonable charges.2 The Plan required the provider to request payment from defendant for eligible expenses3 upon which the co-payment was based.4 Participants’ co-payments were calculated as “20% of Eligible Expenses.”

Plaintiffs aver that in the 1980s, unbeknownst to the Plan participants, defendant began to negotiate and enter secret agreements with health service providers under which providers agreed to accept less for their medical services than the amounts they had billed, which is the amount upon which participants’ co-payments were based under the Plan. Defendant, however, did not pass on to participants any of the savings realized through the reduced fees. Hence, contrary to the language of the Plan, participants effectively paid more than the 20% co-payment the Plan required.

Plaintiffs provide the following example in their Memorandum in Support of their Motion to Certify:

[194]*194Plaintiff Georgia Tigner’s claims history indicates that [defendant] UHCO paid $90.48 to Doctors Ohio Health Corporation on September 19, 1992, for a claim related to services provided on August 8, *1997. (Ps’ Exhibit “11”, K100418-100419). UHCO’s records clearly show that UHCO determined Georgia Tigner’s co-payment for this claim, $26.31, by calculating 20% of $131.53, the provider’s scheduled charge. However, instead of the scheduled charge, Doctor’s Ohio Health Corporation accepted $116.79 as payment for the services ($26.31 from Georgia Tigner and $90.48 from UHCO) — a discount of $14.74. UHCO did not give Ms. Tigner the benefit of the discount. Plaintiffs claim that UHCO should have calculated Ms. Tigner’s co-payment for this particular claim to be $23.36 (i.e., 20% of $116.79 — the amount the health care provider was actually paid) and not the $26.31 Ms. Tigner was forced to pay.

Mem. in Support of Mot. for Class Cert. (Doc. 60) at 4-5.

On November 23, 1994, the Ohio Department of Insurance issued a public bulletin concerning disclosure and use of provider discounts. It stated that the Department considered it an unfair and deceptive practice for an insurance company “to not calculate the co-payment to be paid by an individual entitled to coverage under an insurance policy on the basis set forth in that insurance policy [and where the] contract provides for a calculation of a covered individual’s co-payment, not to disclose such method of calculation in the certificate or evidence of coverage provided to individuals entitled to coverage.” In response to the bulletin, defendant changed its calculation practices, and later changed its certificate language.

Plaintiffs filed this putative class action on February 2, 1998, seeking declaratory and equitable relief, including restitution. On March 31, 1999, the Court granted defendant’s motion to dismiss Count II (breach of fiduciary duty), Count III (to clarify and enforce right to recover excessive payments made by participants), and Count IV (accounting). One claim remained, Count I, for breach of the Plan under 29 U.S.C. § 1132(a)(1)(B).

On April 20, 1999, defendant moved for summary judgment. On March 8, 2000, the Court granted defendant’s summary judgment motion in part, and dismissed two of the originally-named plaintiffs from the action. The Court, however, denied summary judgment as to claims related to Ida Kennedy, and granted plaintiffs leave to amend their complaint. Plaintiffs filed their amended complaint on March 8, 2000, naming additional plaintiffs, and asserting claims for benefits under the Plan, and for breach of fiduciary duty.

Plaintiffs moved for class certification on August 31, 2000. Defendant filed a response on October 20, 2000, opposing certification on the following grounds:

1. This lawsuit is an abuse of the class action device.
2. Plaintiffs fail to include a time element in their proposed class definition.
3. Plaintiffs fail to satisfy Rule 23(b)(1) because there is no danger that separate judgments would order conflicting practices since defendant has already ceased the challenged practice.
4. Plaintiffs fail to satisfy Rule 23(b)(2) because injunctive and declaratory relief are inappropriate in this case since defendant has already ceased the challenged practice, and because the relief plaintiffs seek relates exclusively or predominantly to money damages.
5. Plaintiffs fail to satisfy Rule 23(b)(3) because they have not demonstrated manageability or that a class action is superior to individual actions.
6. The Court may not properly certify any class that includes claims under Certificate of Coverage 10/92, because any claims under that certificate are time-barred.

Plaintiff filed a reply memorandum on November 29, 2000, which included a time element in the proposed class definition. Defendant filed a sur-reply memorandum on January 22, 2001, limited to the issue of the three-year limitation period set forth in Certificate of Coverage 10/92. Plaintiffs filed a [195]*195response to defendant’s sur-reply on February 23, 2001. Defendant filed a response to plaintiffs response on March 5, 2001.

On August 21, 2001, the Clerk reassigned this case to the undersigned District Judge.

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Cite This Page — Counsel Stack

Bluebook (online)
206 F.R.D. 191, 27 Employee Benefits Cas. (BNA) 2791, 2002 U.S. Dist. LEXIS 5002, 2002 WL 416334, Counsel Stack Legal Research, https://law.counselstack.com/opinion/kennedy-v-united-healthcare-of-ohio-inc-ohsd-2002.