Frantz Ward attorneys Mike Smith and Greg Farkas recently obtained the dismissal of federal antitrust and other claims against a health insurer. The plaintiffs in the case were denied an out-of-network waiver for a requested surgery performed at a facility with which the insurer had no provider contract, resulting in increased deductible and co-pay obligations. Plaintiffs alleged that the insurer’s preferred provider network was an illegal tying arrangement and that the insurer was engaged in a conspiracy to restrain trade under the Sherman Act. Plaintiffs also claimed they were entitled to copies of the insurer’s contracts with contracting providers under the Employee Retirement Income Security Act (“ERISA”).
The insurer filed a motion to dismiss, arguing the plaintiffs failed to allege any antitrust injury and other necessary elements of their antitrust claims. The insurer also argued that the ERISA regulations at issue only allowed for the production of a narrow universe of documents actually used in making a benefits decision for the purpose of appealing that decision, rather than the broad disclosure of documents sought by plaintiffs. There are few reported opinions on the appropriate scope of an insurer’s disclosure obligations under ERISA. The Northern District of Ohio adopted the insurer’s arguments and dismissed all of the plaintiffs’ claims with prejudice. Read a copy of the decision.