Odell v. Critical Care Medflight

CourtDistrict Court, D. Kansas
DecidedNovember 25, 2020
Docket2:20-cv-02060
StatusUnknown

This text of Odell v. Critical Care Medflight (Odell v. Critical Care Medflight) is published on Counsel Stack Legal Research, covering District Court, D. Kansas primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Odell v. Critical Care Medflight, (D. Kan. 2020).

Opinion

IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF KANSAS

RODNEY ODELL,

Plaintiff,

v. Case No. 20-2060-JWB

CRITICAL CARE MEDFLIGHT and BLUE CROSS AND BLUE SHIELD OF KANSAS, INC.,

Defendants.

MEMORANDUM AND ORDER This case comes before the court on separate motions to dismiss by Defendants. (Docs. 19, 32.) The motions are fully briefed and are ripe for decision. (Docs. 20, 24, 27, 33, 34, 38.) For the reasons stated herein, the motion of Defendant Blue Cross Blue Shield of Kansas, Inc. (“BCBS-Kansas”) is DENIED and the motion of Defendant Critical Care Medflight (“CCM”) is GRANTED IN PART and DENIED IN PART. I. Facts and Background The following allegations are taken from Plaintiff’s amended complaint (Doc. 13) and are assumed to be true for purposes of deciding the motions to dismiss. Plaintiff suffered an injury while working in Kansas on December 4, 2017. He had an active health insurance policy with BSBC-Kansas at the time. Plaintiff and BCBS-Kansas agree the policy was part of an employee benefit plan subject to the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. § 1001 et seq. (Doc. 20 at 2; Doc. 24 at 1-2.) Plaintiff was admitted to Via Christi Hospital in Kansas for medical treatment on December 7, 2017. On December 28, 2017, Plaintiff was transported by aircraft1 from Via Christi Hospital in Kansas to Craig Hospital in Colorado. The aircraft was owned and operated by CCM. (Doc. 13 at 2.) Plaintiff signed no contract for air transportation with CCM prior to being transported and, given his medical condition at the time, he lacked the capacity to form a contract with CCM. No one who may have signed a contract with CCM on Plaintiff’s behalf had legal authority or

sufficient information to bind Plaintiff to a contract. Prior to providing transportation, CCM never advised Plaintiff or anyone who may have signed on Plaintiff’s behalf that it could charge an unlimited price for air transportation, nor did it advise anyone of the cost or availability of ground transportation from Via Christi to Craig Hospital. (Id.) CCM later charged Plaintiff $175,250.00 for the flight to Craig Hospital. CCM submitted a claim to BCBS-Kansas for that amount, but BCBS-Kansas claimed the reasonable price for the service was $24,345.60, and it issued payment to CCM for that amount. (Id. at 3.) CCM requested Plaintiff’s assistance in appealing BCBS-Kansas’s denial of the claim and assured him he would not face personal responsibility for any amount beyond what BCBS-Kansas

paid so long as he allowed CCM to file an appeal and asked BCBS-Kansas for payment of the full amount. BCBS-Kansas subsequently denied the appeal and refused to pay more than the $24,345.60 already paid. (Id.) CCM again asked for Plaintiff’s assistance. Plaintiff, under the impression CCM would not pursue him personally if he assisted, sent BCBS-Kansas a letter requesting payment of the remaining $150,904.40 to CCM. BCBS-Kansas again refused, despite having paid $180,909.03 on behalf of a different policy holder for air transportation provided by CCM in 2017. CCM thereafter informed Plaintiff it planned to pursue him personally for the full amount, and on

1 The briefs state that the aircraft was a helicopter. (Doc. 34 at 1.) January 31, 2020, CCM issued a demand to Plaintiff for payment of $175,250.00. CCM’s demand failed to disclose or take account of the payment already issued by BCBS-Kansas. Plaintiff asked CCM to cancel the remaining balance but it refused to do so. (Id. at 3-4.) Plaintiff’s amended complaint alleges subject matter jurisdiction based on a claim arising under federal law and based on supplemental jurisdiction. (Id. at 1.) Count I seeks a declaration

of the parties’ rights pursuant to 28 U.S.C. § 2201, including determinations that Plaintiff lacked legal capacity to enter a contract with CCM; that Plaintiff and CCM had no agreement because CCM failed to disclose or negotiate a price; that any agreement as to price by someone other than Plaintiff is unenforceable against Plaintiff; that Plaintiff’s obligation to CCM was limited to assisting CCM with its claim; and that if CCM has any legal right to further payment, BCBS- Kansas is obligated to pay it. (Id. at 6-7.) Count II alleges that CCM committed various violations of the Kansas Consumer Protection Act (KCPA) including by making false or misleading representations of fact, making willful use of ambiguity as to a material fact, and willfully concealing or omitting a material fact. (Id. at 7-9.) Count III alleges a wrongful denial of benefits

by BCBS-Kansas. It alleges that the denial of the remainder of the CCM claim by BCBS-Kansas was arbitrary and capricious, was inconsistent with prior payments by BCBS-Kansas for identical services, and was not supported by substantial evidence. It seeks judgment against BCBS-Kansas for the remaining balance of the CCM claim, as well as other relief. (Id. at 11.) II. Motion to Dismiss Standards In order to withstand a motion to dismiss for failure to state a claim under Fed. R. Civ. P. 12(b)(6), a complaint must contain enough allegations of fact to state a claim to relief that is plausible on its face. Robbins v. Oklahoma, 519 F.3d 1242, 1247 (10th Cir. 2008) (citing Bell Atl. Corp. v. Twombly, 550 U.S. 544, 127 S. Ct. 1955, 1974 (2007)). Plausible does not mean “likely to be true,” but refers “to the scope of the allegations in a complaint: if they are so general that they encompass a wide swath of conduct, much of it innocent,” then the plaintiff has not “nudged [his] claims across the line from conceivable to plausible.” Id. (citing Twombly, 127 S. Ct. at 1974). All well-pleaded facts and the reasonable inferences derived from those facts are viewed in the light most favorable to Plaintiff. Archuleta v. Wagner, 523 F.3d 1278, 1283 (10th Cir. 2008).

Conclusory allegations, however, have no bearing upon the court's consideration. Shero v. City of Grove, Okla., 510 F.3d 1196, 1200 (10th Cir. 2007). As the Tenth Circuit observed: Though a complaint need not provide detailed factual allegations, it must give just enough factual detail to provide fair notice of what the claim is and the grounds upon which it rests. Threadbare recitals of the elements of a cause of action, supported by mere conclusory statements do not count as well-pleaded facts. If, in the end, a plaintiff's well-pleaded facts do not permit the court to infer more than the mere possibility of misconduct, the complaint fails to state a claim. Carbajal v. McCann, No. 18-1132, 2020 WL 1510047, at *3 (10th Cir. Mar. 30, 2020). III. Analysis A. Claim against BCBS-Kansas Count III of the amended complaint alleges that BCBS-Kansas wrongfully denied Plaintiff benefits under the insurance policy. BCBS-Kansas argues Count III2 fails to plausibly state a claim for benefits due under an ERISA plan because it does not identify the plan language that BCBS- Kansas allegedly violated. (Doc. 20 at 6.) ERISA authorizes a civil action by a participant or beneficiary of an ERISA plan to recover benefits due him under the terms of the plan, to enforce his rights under the terms of the plan, or to clarify his rights to future benefits under the terms of the plan. 29 U.S.C.

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Odell v. Critical Care Medflight, Counsel Stack Legal Research, https://law.counselstack.com/opinion/odell-v-critical-care-medflight-ksd-2020.