Total Benefits Planning Agency v. Anthem Blue Cross and Blue Shi

CourtCourt of Appeals for the Sixth Circuit
DecidedDecember 22, 2008
Docket07-4115
StatusPublished

This text of Total Benefits Planning Agency v. Anthem Blue Cross and Blue Shi (Total Benefits Planning Agency v. Anthem Blue Cross and Blue Shi) is published on Counsel Stack Legal Research, covering Court of Appeals for the Sixth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Total Benefits Planning Agency v. Anthem Blue Cross and Blue Shi, (6th Cir. 2008).

Opinion

RECOMMENDED FOR FULL-TEXT PUBLICATION Pursuant to Sixth Circuit Rule 206 File Name: 08a0453p.06

UNITED STATES COURT OF APPEALS FOR THE SIXTH CIRCUIT _________________

X - TOTAL BENEFITS PLANNING AGENCY, INC.,

Plaintiffs-Appellants, - et al.,

- - No. 07-4115 v. , >

- - ANTHEM BLUE CROSS AND BLUE SHIELD,

Defendants-Appellees. - et al.,

- - N Appeal from the United States District Court for the Southern District of Ohio at Cincinnati. No. 05-00519—Michael R. Barrett, District Judge.

Argued: July 30, 2008

Decided and Filed: December 22, 2008 * Before: GILMAN and ROGERS, Circuit Judges; ZOUHARY, District Judge.

_________________

COUNSEL ARGUED: Richard B. Reiling, LAW OFFICE, Dayton, Ohio, for Appellants. James M. Burns, WILLIAMS MULLEN, Washington, D.C., Mark Edward Elsener, PORTER, WRIGHT, MORRIS & ARTHUR, Cincinnati, Ohio, for Appellees. ON BRIEF: Richard B. Reiling, LAW OFFICE, Dayton, Ohio, for Appellants. James M. Burns, WILLIAMS MULLEN, Washington, D.C., Mark Edward Elsener, PORTER, WRIGHT, MORRIS & ARTHUR, Cincinnati, Ohio, Kent A. Britt, Glenn V. Whitaker, VORYS,

* The Honorable Jack Zouhary, United States District Judge for the Northern District of Ohio, sitting by designation.

1 No. 07-4115 Total Benefits Planning Agency, et al. v. Page 2 Anthem Blue Cross and Blue Shield, et al.

SATER, SEYMOUR & PEASE, Cincinnati, Ohio, B. Scott Jones, REMINGER CO. LPA, Cincinnati, Ohio, Thomas J. Gruber, McCASLIN, IMBUS & McCASLIN, Cincinnati, Ohio, Peter L. Cassady, Sarah Clay Leyshock, Brian R. Redden, BECKMAN WEIL SHEPARDSON, Cincinnati, Ohio, John R. Folkerth, Jr., WEPRIN, FOLKERTH & ROUTH, Dayton, Ohio, Christopher Freeman Johnson, FREUND, FREEZE & ARNOLD, Dayton, Ohio, Maria Del Monaco, ULMER & BERNE, Cleveland, Ohio, John M. Hands, ULMER & BERNE, Cincinnati, Ohio, Edward R. Goldman, RENDIGS, FRY, KIELY & DENNIS, Cincinnati, Ohio, for Appellees.

OPINION _________________

JACK ZOUHARY, District Judge. Total Benefits Planning Agency and four of its insurance agents (collectively “Total Benefits”) appeal a dismissal of their amended complaint for failure to state a claim under 12(b)(6) of the Federal Rules of Civil Procedure. Total Benefits maintained contracts with Anthem Blue Cross and Blue Shield; Anthem Life Insurance Company, Inc.; Anthem Health Plans of Kentucky, Inc.; Anthem Insurance Company, Inc. (collectively “Anthem”); and Cornerstone Broker Insurance Services Agency (“Cornerstone”) for the sale of group life and health insurance policies in Ohio, Indiana, and Kentucky. Total Benefits allege Anthem conspired to boycott and blacklist Total Benefits in violation of Section 1 of the Sherman Act. In addition to appealing the dismissal, Total Benefits also appeal the district court’s failure to sua sponte permit them to file a second amended complaint before dismissing their case.

The district court, after originally denying the motion to dismiss, dismissed the amended complaint after finding Plaintiffs failed to allege a violation of Section 1 of the Sherman Act under either the per se analysis or the rule-of-reason test. The court was persuaded in part by two Supreme Court decisions handed down after the district court’s original ruling: Leegin Creative Leather Prods., Inc. v. PSKS, Inc., 551 U.S. ___, 127 No. 07-4115 Total Benefits Planning Agency, et al. v. Page 3 Anthem Blue Cross and Blue Shield, et al.

S. Ct. 2705 (2007); and Bell Atlantic Corp. v. Twombly, 550 U.S. 544, 127 S. Ct. 1955, 1974 (2007).

For the reasons that follow, we AFFIRM the dismissal.

FACTUAL BACKGROUND

Total Benefits developed “an innovative strategy for controlling health care costs . . . utiliz[ing] a 51-year old federal tax law to ‘refinance’ health-care costs by raising deductibles on existing group insurance policies and administering benefits through a medical expense reimbursement plan” (Am. Comp. ¶ 22). Total Benefits claim the system is able to “save businesses in Ohio, Indiana, and Kentucky, 20% or more on their health insurance costs, without cutting benefits” (Am. Comp. ¶ 23). In September 2004, Anthem advised Total Benefits that the strategy “was not in the best interest of Anthem or the more traditional insurance agencies,” and that Anthem would not permit Total Benefits, or any other Anthem agent, to engage in such practices and remain agents of Anthem. In June 2005, Anthem severed its agency relationship with Total Benefits because they continued to promote the strategy (Am. Comp. ¶ 24).

Total Benefits allege Anthem and its various agents1 conspired to blacklist and organize an industry boycott against Total Benefits in violation of the Sherman Act, 15 U.S.C. § 1, because Total Benefits refused to relinquish the strategy. Total Benefits also allege defamation, libel, tortious interference with contract, conspiracy, and breach of contract under state law.

PROCEDURAL BACKGROUND

On August 4, 2005, Total Benefits filed suit to prevent and restrain continuing violations of the Sherman Antitrust Act, 15 U.S.C. § 1. On September 8, 2005, Anthem filed a motion to dismiss, arguing dismissal was appropriate because Total Benefits

1 These other Defendants included Anthem Life Insurance Company, Inc.; Anthem Health Plans of Kentucky; Anthem Insurance Company, Inc.; Cornerstone Broker Insurance Services Agency, Inc.; John Does 1-100; Jane Does 1-100; CAI Insurance Agency; Horan Associates, Inc.; USI Midwest; McGohen- Brabender, Inc.; Brower Insurance Agency, LLC; Lange Financial Group; and Benefit Resources, Inc. No. 07-4115 Total Benefits Planning Agency, et al. v. Page 4 Anthem Blue Cross and Blue Shield, et al.

(1) failed to identify the subject, product and geographic markets that were at issue; (2) claimed harm only to themselves as opposed to harm to competition; (3) failed to adequately allege “a contract, combination or conspiracy” in sufficient detail; and (4) was barred from challenging the alleged conduct by the McCarren-Ferguson Act, 15 U.S.C. § 1012, because Total Benefits could not demonstrate a boycott. Cornerstone moved to dismiss on grounds identical to those set forth by Anthem.

On September 8, 2006, the district court denied the motions to dismiss of Anthem and Cornerstone, finding Anthem’s refusal to contract with Total Benefits to be a vertical boycott and that the complaint sufficiently alleged Anthem unlawfully coerced insurance agents who did business with Total Benefits. The district court concluded from these allegations that Total Benefits “sufficiently alleged a prima facie case of each element of the per se test” for their Sherman Act claim.

Anthem immediately filed a motion to reconsider, advancing the following arguments: (1) the district court erred by using per se principles for a vertical boycott; and (2) Plaintiffs’ claims must be reviewed under the rule-of-reason test, and Plaintiffs failed to adequately plead “a rule of reason case.” Cornerstone again joined Anthem’s motion.

On November 2, 2006, Total Benefits filed an amended complaint, further defining their claims against Anthem, Cornerstone, and the newly added other Defendants, claiming these Defendants had conspired with Anthem to boycott, coerce, and otherwise blacklist Total Benefits.

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Total Benefits Planning Agency v. Anthem Blue Cross and Blue Shi, Counsel Stack Legal Research, https://law.counselstack.com/opinion/total-benefits-planning-agency-v-anthem-blue-cross-ca6-2008.