Misty Duff, et al. v. Centene Corporation, et al.

District Court, S.D. Ohio·Decided August 28, 2026·No. 1:19-cv-00750·Unknown

Opinion

IN THE UNITED STATES DISTRICT COURT FOR THE SOUTHERN DISTRICT OF OHIO WESTERN DIVISION

MISTY DUFF, et al., : : Plaintiffs, : Case No. 1:19-cv-750 : v. : Judge Jeffery P. Hopkins : CENTENE CORPORATION, et al., : : Defendants. :

OPINION AND ORDER

Choosing the right health-insurance plan each year can be time intensive and stressful. That decision often requires consumers to compare coverage options, premiums, and deductibles, as well as determine whether their doctors are within a plan’s network. Allegedly, Centene Corporation and its codefendants (together, “Defendants”) made that process more difficult. Specifically, Plaintiffs, a group of individuals who purchased health insurance from Defendants, claim that Defendants failed to provide an accurate and up-to-date directory of in-network providers, as required by federal and state regulations. Because Defendants’ directory may have listed many providers who were actually out of network, Plaintiffs allege they paid more for their plans’ premiums than they would have if they had known the true, limited extent of Defendants’ network. Plus, Plaintiffs had to pay out of pocket for services that they believed their insurance contracts covered. As a result, Plaintiffs filed a putative class action, seeking compensatory and punitive damages. In support of their claims, Plaintiffs secured an expert witness, Dr. Adam E. Block, to determine the extent to which Defendants’ directory overstated the providers covered in network and to calculate an estimate of their damages. Defendants then retained their own expert witness, Mr. Brian E. Hoyt, to rebut Dr. Block’s analysis. After both experts submitted their reports, Defendants discovered additional records relevant to this case, so the Court provided both parties with an opportunity to submit supplemental expert reports. Plaintiffs

now move to strike Mr. Hoyt’s second report, arguing that it improperly supplements his initial disclosure. But that second report does not violate either the Court’s rulings or the Federal Rules of Civil Procedure. And even if it did, any error would be harmless. Accordingly, the Court DENIES Plaintiffs’ Motion to Strike Defendants’ Second Expert Report (Doc. 55). I. BACKGROUND In 2010, Congress enacted the Patient Protection and Affordable Care Act (“ACA”) with the stated goal of providing quality, affordable healthcare to all Americans. See 42 U.S.C. ch. 157. Among many other provisions, the ACA required each state to establish an exchange

where consumers could purchase qualified health-insurance plans. Id. § 18031(b)(1). And the ACA placed requirements on health-insurance companies that offered plans through those exchanges. For example, health-insurance companies are required to “publish an up-to-date, accurate, and complete provider directory . . . in a manner that is easily accessible to plan enrollees [and] prospective enrollees.” 45 C.F.R. § 156.230(b)(2). Like many other states, Ohio has implemented its own laws and regulations that govern health insurers, too. Specifically, health-insurance companies may not “misrepresent[] the terms of any policy issued or to be issued or the benefits or advantages promised.” Ohio Rev. Code Ann. § 3901.21(A). They also cannot make “any assertion, representation, or

statement” that is “untrue, deceptive, or misleading.” Id. § 3901.21(B). As a result, Ohio regulations require health-insurance companies to “ensure that the format and content of a provider directory of a health benefit plan is sufficiently complete and clear to avoid deception.” Ohio Admin. Code § 3901-8-16(D)(1). To that end, the regulations outline various steps that health insurers must take, such as updating their directories at least quarterly

and making “clear to an enrollee which providers and facilities belong to each network.” Id. § 3901-8-16(D)(1)(a), (h). Centene Corporation is a publicly traded company that is reportedly the nation’s largest insurer on the ACA exchange. Compl., Doc. 1, ¶¶ 34, 36. In Ohio, Centene offers health-insurance plans under the name Ambetter. Id. ¶¶ 14, 43. According to Plaintiffs, Centene “advertise[d] that Ambetter’s ‘most up to date list of in-network providers’ is available online on its website” and that “[p]roviders listed in the Ambetter . . . online directory are in-network.” Id. ¶ 48. Despite these representations, Plaintiffs allege that “Ambetter’s online directory appears to be nothing more than a copy of a general medical

directory comprised of both providers who do and do not accept Ambetter insurance plans.” Id. ¶ 49. Indeed, Plaintiffs claim that Ambetter’s online directory includes “hundreds of facilities and physicians who do not accept the insurance.” Id. ¶ 51. The purported goal of these alleged misrepresentations? To attract customers who believe that certain providers are in network. Id. ¶ 55. But once those customers purchase an Ambetter policy and visit a physician who was incorrectly listed as in network, Centene denies the claim as “out of network,” thus saving the company money and boosting profits. Id. Plaintiffs speak from personal experience. For example, when Misty Duff began shopping for insurance products a few years ago, she sought to confirm that her

rheumatologist would be covered. Id. ¶¶ 63, 65. After she discovered that her doctor was included in Ambetter’s network directory, Duff purchased an Ambetter policy. Id. ¶ 67. But after her first visit with that rheumatologist, Duff received a statement denying payment because her doctor was out of network, which means that Duff may now be on the hook for the bill. Id. ¶¶ 69–70. Duff alleges that she “would not have purchased an Ambetter insurance

product if she had known her rheumatologist was out-of-network.” Id. ¶ 72. Duff also has a minor daughter with specialized medical needs. Id. ¶ 73. So when Duff was shopping for insurance policies, she sought to ensure that her plan would cover Cincinnati Children’s Hospital and her daughter’s specialists. Id. ¶¶ 74–75. According to Ambetter’s online provider directory, the hospital and her daughter’s specialists were in network, so Duff relied on those representations in purchasing an Ambetter policy. Id. ¶¶ 75– 76. Yet when her daughter had an outpatient procedure and surgery at Cincinnati Children’s, Centene denied coverage, claiming the hospital and doctors were out of network. Id. ¶ 79. As a result, Duff’s daughter has needed to switch to healthcare providers who are actually in

Ambetter’s network, forcing her care to essentially “start[] all over again” as her new doctors get up to speed. Id. ¶¶ 80, 82. Other named plaintiffs alleged similar experiences. See, e.g., id. ¶¶ 84–87. As a result, Plaintiffs filed a putative class action, asserting claims for breach of contract, breach of the duty of good faith and fair dealing, fraud, negligent misrepresentation, and unjust enrichment. Id. ¶¶ 133–178. In support of their claims, Plaintiffs retained Dr. Adam E. Block, a health economist, as an expert witness. See Doc. 52-1, PageID 1874. Dr. Block opined that Ambetter’s “provider network is materially different than what was represented in their provider directory,” so members received “a product with a lower overall

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Misty Duff, et al. v. Centene Corporation, et al., (S.D. Ohio 2026).

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