Puerto Rico College of Dental Surgeons v. Triple S Management Inc.

290 F.R.D. 19, 2013 WL 1010684, 2013 U.S. Dist. LEXIS 36300
CourtDistrict Court, D. Puerto Rico
DecidedMarch 13, 2013
DocketCivil No. 09-1209 (JAF)
StatusPublished
Cited by2 cases

This text of 290 F.R.D. 19 (Puerto Rico College of Dental Surgeons v. Triple S Management Inc.) is published on Counsel Stack Legal Research, covering District Court, D. Puerto Rico primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Puerto Rico College of Dental Surgeons v. Triple S Management Inc., 290 F.R.D. 19, 2013 WL 1010684, 2013 U.S. Dist. LEXIS 36300 (prd 2013).

Opinion

OPINION AND ORDER

JOSÉ ANTONIO FUSTÉ, District Judge.

Before the court is Plaintiffs’ motion for class certification. (Docket No. 383.) We ordered the parties to brief the issue of class certification simultaneously to the court. [22]*22(Docket No. 396.) The parties complied with that order and submitted simultaneous briefs. Plaintiffs filed a memorandum in support of class certification, and defendants submitted memorandums in opposition to class certification.1 Plaintiffs and a few of the defendants then submitted response briefs.2 We have considered the parties’ arguments. For the 20 following reasons, we deny Plaintiffs’ motion to certify the class.

I.

Factual Background

Plaintiffs are the Puerto Rico College of Dental Surgeons (“College”) and nine individual dentists licensed to practice in Puerto Rico. (Docket No. 169.) The College is an entity created by the Puerto Rico legislature. See 20 L.P.R.A. §§ 111-123. With minor exceptions, every dentist licensed to practice in Puerto Rico must belong to the College. The nine individually-named plaintiffs are dentists who are members of the College and who allegedly “entered into provider contracts with defendants.” (Docket No. 169.) Defendants are twenty-two insurance companies providing dental insurance and other health-care plans in Puerto Rico.

Plaintiffs allege that Defendants have committed a wide-ranging series of actions that breached their dentist provider contracts. Plaintiffs’ allegations are set forth in their amended complaint, memorandum of law in support of class certification, and in a three-page “Summary of Claims” (“Summary”) attached to their memorandum. (Docket Nos. 69, 383, 383-1.) Plaintiffs’ Summary includes one or two-line descriptions of each wrongful practice Plaintiffs allege the Defendants committed. (Docket No. 383-1.) In the two columns next to each wrongful practice, Plaintiffs list the total number of claims, as well as the specific insurance companies that allegedly committed each practice. (Id.)

For example, Plaintiffs’ Summary alleges that ten of the defendants engaged in “Retaliation ... for objections to amendments of clauses to contracts.” (Id. at 1.) The defendants alleged to have committed this practice are American Health, Cruz Azul, Delta, Humana, MCS, Preferred Health Care, Preferred Medical Choice, Salud Dorada, TripleS, and IMC. (Id.) Each wrongful practice has a different number of claims attached, and corresponds to (mostly) different defendants. For example, Plaintiffs allege ten claims for “Forcing Dentists to accept audit results under penalty of contract cancellation.” The only defendants alleged to have committed this practice are Delta, MCS and Triple-S. (Id.) Consistent with this overall pattern, Defendants MetLife and CGLIC are each alleged to have committed unlawful practices that the other did not commit, and vice-versa. (Docket No. 387 at 4.)

Defendants have also submitted affidavits in support of their opposition briefs. Defendants MetLife and Humana argue that this evidence demonstrates the individualized, rather than common, questions relevant to determining Plaintiffs’ injuries. (Docket Nos. 79, 387.)

MetLife and CGLIC submitted factual evidence opposing Plaintiffs’ motion. (Docket No. 387-1, 387-2.) In a sworn declaration, Courtney Ransom (“Ms. Ransom”), MetLife’s Assistant Vice-President for Dental Products, attests that only two of the named plaintiff dentists—Dr. Noel Aymat and Dr. Norma Martinez Acosta—entered into provider contracts with MetLife. (Id.) Ms. Ransom attaches true and correct copies of the [23]*23dental service agreements entered into with these Plaintiffs. (Id.) Ms. Ransom also submits an example of the “explanation of benefits” that MetLife sends to dentists. These explanations contain the following information: The patient’s name, the date(s) of service, the CDT codes the dentist identified on the claim form, the CDT codes MetLife paid or denied, and amount paid per CDT code. Ransom also includes examples of the table for maximum allowable charges for the years 2000 to 2010; she states that the tables are amended “from time to time.”

Humana has also submitted factual evidence in opposition to class certification. (Docket Nos. 379, 379-1, 379-2, 379-3, 379-4, 379-5, 379-6.) The main piece of evidence is a sworn statement made under penalty of perjury provided by Marelli Moro, an employee of Humana. (Docket No. 379-1.) Moro’s statement, which she labels a “supplemental declaration,” supplements an earlier declaration that she made in March 2011. (Id.) In her earlier “declaration,” Moro provided true and correct copies of the agreements between Humana and three of the provider plaintiffs: Drs. Noel Aymat, Angel Robles Adorno, and Pedro A. Cheverez-González. (Docket Nos. 195-1, 195-2, 195-3, 195-4.) In this supplemental declaration, she provides true and correct copies of the agreements that exist between Humana and three additional provider plaintiffs, including Drs. Thomas Manuel Medina, Isabel M. del Valle Díaz, and Norma Martinez. (Docket Nos. 379-1, 379-2, 379-3, 379-4, 379-5, 379-6.) Moro also states that, to the best of her knowledge, the remaining provider plaintiffs—Drs. Valmin Miranda Santiago, Jose Mercado Gigliotty, and Ramon Fernando González García—have not entered into Dental Service Agreements with Humana. (Docket No. 379-1 at 3.)

Moro’s statement, and the accompanying copies of the agreements, establish that the “provisions of the Dental Service Agreements that Humana and its predecessor companies have entered into with dental providers in Puerto Rico over the last 15 years have varied over time and may also vary from dentist to dentist.” (Id.) For example, Dr. Martinez entered into a Dental Services Agreement with PCA Insurance Group, a predecessor of Humana, on October 4, 1996. (Id.) Another plaintiff, Dr. del Valle, signed a Dental Services Agreement with Humana on January 27, 2011. (Id.) The contracts that plaintiffs signed with Humana vary in the following ways: Reimbursement amounts for covered services provided under the government-administered health plan; reimbursement amounts for covered services provided under private commercial plans; the time period in which providers must submit claims to Humana; the time periods in which Humana must pay clean claims; the time periods in which providers must respond to requests from Humana for additional information on a claim; and the time periods associated with adjudicating disputes over claims. (Id.) Some of the relevant agreements contain arbitration provisions, while others do not. (Id. at 2.)

There are also abundant differences between the contracts offered by different defendants. For example, MetLife and CGLIC’s contracts do not contain arbitration clauses, while some of Humana’s contracts do. (Docket No. 399 at 9.) The MetLife contracts require providers to submit reimbursement claims within thirty days, while Humana’s contracts offer reimbursement periods of either sixty to ninety days. (Id.) Some of the named plaintiffs have contracts that contain the sixty-day period, while others have contracts mandating a ninety-day period. (Id.)

In their response brief, Plaintiffs do not challenge any of these facts submitted by Humana and MetLife.3 (Docket No. 397.) Plaintiffs present a slew of legal arguments, but do not provide any factual treatment beyond their Summary.

II.

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Bluebook (online)
290 F.R.D. 19, 2013 WL 1010684, 2013 U.S. Dist. LEXIS 36300, Counsel Stack Legal Research, https://law.counselstack.com/opinion/puerto-rico-college-of-dental-surgeons-v-triple-s-management-inc-prd-2013.