CASE UPDATE: PLAINTIFFS’ CROSS-MOTION FOR SUMMARY JUDGMENT AGAINST UNITEDHEALTHCARE FOR FAILING TO COVER LACTATION SERVICES GRANTED IN PART

On June 27, 2018, U.S. District Judge Vince Chhabria for the Northern District of California, issued a ruling on the cross-motions for summary judgment filed by the parties in Condry et al. v. UnitedHealth Group Inc. et al. – granting in part and denying in part the motions (outlined in the chart below).  See the Order here. 

In its motion for summary judgment, defendant UnitedHealthcare (“UHC”) argued that the named plaintiffs received in-network comprehensive lactation support and counseling (“CLS”) and/or had in-network CLS providers available to them, but chose to go out-of-network.  In response, plaintiffs opposed and also moved for cross-motion for summary judgment arguing that UHC’s coverage for CLS violated the ACA, and that UHC: (a) did not establish a provider network that included trained providers of CLS, (b) did not provide access to in-network trained providers of CLS, (c) was not permitted under the ACA to deny, or apply cost-sharing to, claims submitted for CLS; and (d) did not timely and/or properly process the plaintiffs’ claims for CLS.

Plaintiffs are very pleased with the ruling because, among other things, the Court’s Order held that, contrary to UHC’s argument, not every member of its health plans had meaningful access to in-network lactation services, and found that “a woman does not have access to lactation support if she cannot practically find those services.”  See, Order at page 2.  The Court also took issue with UHC’s “attempt to draw a line between” (i) preventive lactation services, and (ii) diagnostic lactation services.  Judge Chhabria said, UHC’s “limited view of the [ACA’s] coverage provisions would mean that mothers would stop receiving free lactation support and counseling exactly at the moment that they started experiencing the kinds of difficulties that lead mothers to stop breastfeeding.” See, Order at page 3.   The Court also granted plaintiffs’ motion for summary judgment on their claim that the defendants violated their obligations under ERISA to “provide adequate notice” and a “reasonable opportunity . . . for a full and fair review” of denials, finding that the UHC defendants “breached their duty to provide adequate notices” to the plaintiffs in that the “claims denials [] were written in a way that made them virtually impossible to understand.” Plaintiffs are also pleased with the Court’s ruling denying UHC’s motion for summary judgment as to Counts III and V.