Condry v UnitedHealth Group Inc.,et.al

Filing 257

ORDER RE HEARING ON RENEWED MOTION FOR CLASS CERTIFICATION. Signed by Judge Vince Chhabria on 11/20/2019. (vclc2S, COURT STAFF) (Filed on 11/20/2019)

UNITED STATES DISTRICT COURT
NORTHERN DISTRICT OF CALIFORNIA

RACHEL CONDRY, et al.,

Case No. 17-cv-00183-VC

Plaintiffs,
v.
UNITEDHEALTH GROUP, INC., et al.,

ORDER RE HEARING ON RENEWED
MOTION FOR CLASS
CERTIFICATION

Defendants.

Assume for argument’s sake that it would be appropriate in this case to certify classes of
people who were denied claims for out-of-network services if the evidence showed that UHC
uniformly denied claims for out-of-network services without regard to whether in-network
services were available (with the potential remedy being that all claims be reprocessed with
regard to the availability of in-network services). At tomorrow’s hearing, the parties should be
prepared to address the following, in no particular order:
•

What evidence supports a conclusion that claims for out-of-network services were
uniformly denied without regard to the availability of in-network services, and where
is that evidence in the record?

•

The plaintiffs make reference to an analysis they conducted of 33,000 claims for outof-network services. Is there evidence in the record that the Court can examine to
better understand this analysis, and if so where is it?

•

The plaintiffs assert that, of the 33,000 out-of-network claims they analyzed, 12%
were allowed. If that’s true (and if the plaintiffs’ methodology for identifying these
claims as claims for lactation services is reliable), then it would seem to undermine

the notion that claims were uniformly denied without regard to the availability of
lactation services in-network. In other words, if the 12% truly consisted of claims for
out-of-network lactation services (as opposed to some other type of out-of-network
service), it seems reasonable to assume that many of them were allowed because innetwork lactation services were unavailable. Have the plaintiffs presented any
evidence about why this 12% of claims were allowed, and if so where is that in the
record?
•

Can the parties better explain the significance of the gap exception? How does the
gap exception work? Where is the evidence in the record of how it works? Perhaps
more importantly, where is the evidence of what participants are told about how it
works? Is there evidence in the record that would help the Court better understand
whether the gap exception is a reasonable means of obtaining coverage for out-ofnetwork lactation services in situations where in-network services are unavailable?

•

The plaintiffs assert, without explanation, that evidence of the number and percentage
of claims granted for in-network lactation services is irrelevant. However, this
information is potentially quite relevant, because it potentially sheds light on how
widely available in-network lactation services were. In turn, if in-network lactation
services were widely available, it might support an assumption that the 88% of the
33,000 claims were denied because of the availability of in-network services (and
such denials would be consistent with the ACA).

IT IS SO ORDERED.
Dated: November 20, 2019
______________________________________
VINCE CHHABRIA
United States District Judge

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