Lakeland Anesth., Inc. v. United Health. of La.

871 So. 2d 380, 2004 WL 728165
CourtLouisiana Court of Appeal
DecidedMarch 17, 2004
Docket2003-CA-1662
StatusPublished
Cited by48 cases

This text of 871 So. 2d 380 (Lakeland Anesth., Inc. v. United Health. of La.) is published on Counsel Stack Legal Research, covering Louisiana Court of Appeal primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Lakeland Anesth., Inc. v. United Health. of La., 871 So. 2d 380, 2004 WL 728165 (La. Ct. App. 2004).

Opinion

871 So.2d 380 (2004)

LAKELAND ANESTHESIA, INC.
v.
UNITED HEALTHCARE OF LOUISIANA, INC.

No. 2003-CA-1662.

Court of Appeal of Louisiana, Fourth Circuit.

March 17, 2004.

*382 Andrew A. Lemmon, The Lemmon Law Firm, Hahnville, LA and Dennis G. Pantazis, Wiggins, Child, Quinn & Pantazis, Birmingham, AL, for Plaintiffs/Appellees.

Errol J. King, Jr., Juston M. O'Brien, Layna S. Cook, McGlinchey Stafford, PLLC, Baton Rouge, LA, Monica A. Frois, Nathalie G. Simon, McGlinchey Stafford, PLLC, New Orleans, LA and Edward Soto, Weil, Gotshal & Manges, LLP, Miami, FL and Gregory S. Coleman, Weil, Gotshal & Manges, Austin, TX, for Defendant/Appellant.

Court composed of Judge CHARLES R. JONES, Judge PATRICIA RIVET MURRAY, Judge MICHAEL E. KIRBY.

PATRICIA RIVET MURRAY, Judge.

This is a commercial litigation by several medical providers against a health management organization (HMO). The providers allege that the HMO implemented a practice of routinely delaying payment for the services they rendered to its subscribers. The narrow issue presented is twofold: whether the trial court erred in refusing to grant the HMO's motion to compel arbitration of the entire proceeding; or, in the alternative, whether the court erred in refusing to stay the entire proceeding while the matters subject to arbitration are arbitrated. For the reasons that follow, we affirm in part, reverse in part, and remand for further proceedings.

I.

On February 28, 2000, Lakeland Anesthesia, Inc., commenced this suit as a plaintiffs-class action on behalf of itself and other similarly situated medical providers who have submitted claims to United Healthcare of Louisiana, Inc., a HMO, according to a physician agreement or other oral or written contracts. The petition alleges that United has offered such contracts to hospitals, physicians, and other medical providers and that, according to these contracts, is obligated to pay the providers for the medical treatment they rendered to its subscribers. The petition seeks damages arising out of United's alleged routine practice of either intentionally or negligently artificially delaying payment of valid claims beyond the time provided for payment under these contracts.[1] Based on these alleged improper payment practices, the petition asserts that United is liable under: (i) the Civil Code for breach of contract and breach of the general tort duty not to cause harm to others (La. C.C. arts. 2315 and 2316), (ii) the Insurance Code for bad faith, and (iii) both codes for abuse of rights.

On April 14, 2000, United removed the case to federal court, asserting federal question jurisdiction based on complete preemption by the Employee Retirement Income Security Act, 29 U.S.C. § 1000, et seq. ("ERISA"). On April 20, 2000, Lakeland filed an amended petition in federal *383 court to add Medical Advantage Company as a plaintiff. On June 22, 2000, the federal district court, finding no basis for removal under ERISA, remanded the case. In so doing, the court noted that "Lakeland does not purport to be an assignee of a participant or beneficiary" and that "Lakeland's complaint is based on separate provider agreements as opposed to any ERISA plan or plans, and no evidence has been offered to the contrary."

On July 3, 2000, Lakeland filed a second amended petition to add Dr. Leslie Hightower as a plaintiff. The amended petition clarifies the definition of the class as including medical providers who have submitted claims to United as "in-network" or "participating" providers at any time since January 1, 1991. The amended petition also clarifies that "[t]he suit seeks interest or other delay damages and penalties arising from `in-network' `participating' claims that have been acknowledged by Defendant, but were not timely paid." The amended petition still further clarifies that the suit neither seeks damages for claims for medical treatment that was not "covered" nor for claims arising from "out-of-network" claims based only on an assignment.

On July 25, 2000, United filed a motion to stay discovery and class certification. On August 4, 2000, United filed a motion to stay all proceedings, including discovery, and to compel arbitration, and in the alternative summary judgment. Following the November 3, 2000 hearing, the trial court deferred ruling on United's motion to compel.[2]

On January 13, 2003, United filed a second motion to stay proceedings and compel arbitration. In that motion, United asserted that arbitration was required for the following reasons:

• Dr. Hightower entered into a participating physician agreement with United entitled United Healthcare of Louisiana, Inc. Physician Participation Agreement (the "Hightower Agreement").
• Section 8 of the Hightower Agreement is entitled Resolution of Disputes and requires binding arbitration for any dispute arising under the Hightower Agreement.[3] Each and every claim asserted by Dr. Hightower is subject *384 to binding arbitration under that provision.
• Medical Advantage has admitted that it is bound by the Hightower Agreement. Thus, its claims are subject to Section 8 of that agreement.
• Lakeland contends that it is a third party beneficiary under a contract similar to the Hightower Agreement, which contains an arbitration provision.[4] It is thus required to arbitrate. That contract, which is between United and Columbia Healthcare Systems of La., Inc., is the Community Health Network Hospital Participation Agreement (the "Columbia/HCA Agreement").[5]

On April 11, 2003, a hearing was held on United's motions, the trial court requested the parties file supplemental briefs addressing two issues.[6] On June 3, 2003, the trial court granted United's motion in part, ordering that the claims asserted by Dr. Hightower and Medical Advantage arising after the April 1, 2000 effective date of the Hightower Agreement be arbitrated. As to all other claims, the trial court denied United's motion to compel arbitration.[7] In so holding, the trial court relied heavily on this court's recent decision involving one of the same plaintiffs and strikingly similar issues. Lakeland Anesthesia, Inc. v. Cigna Healthcare of Louisiana, Inc., XXXX-XXXX (La.App. 4 Cir. 2/6/02), 812 So.2d 695.

Treating the claims by Dr. Hightower and Medical Advantage together,[8] the trial *385 court reasoned that the arbitration clause in the Hightower Agreement was intended to have prospective, not retrospective, application from the April 1, 2000 effective date of that agreement. In so finding, the trial court relied on the following reasoning in Lakeland, supra:

The mandatory arbitration provision in the instant case clearly refers to disputes, controversies, and questions arising under "this Agreement." Unquestionably, that provision is broad; however, as stated in Security Watch, [Inc. v. Sentinel Systems, Inc., 176 F.3d 369 (1999),] "this breadth of scope does not extend over time." Id." ...

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Cite This Page — Counsel Stack

Bluebook (online)
871 So. 2d 380, 2004 WL 728165, Counsel Stack Legal Research, https://law.counselstack.com/opinion/lakeland-anesth-inc-v-united-health-of-la-lactapp-2004.