Houston Metro Ortho and Spine Surgery Center LLC v. Health Care Service Corporation et al

Filing 328

ORDER entered: DENYING 186 MOTION TO DISMISS FOR FAILURE TO STATE A CLAIM as to Certain Claims - Plaintiff's Third Amended Complaint,GRANTING 197 MOTION to Dismiss (Partial) Motion to Dismiss Plaintiff'sThird Amended Complaint and Memorandum in Support, GRANTING 184 MOTION TO DISMISS FOR FAILURE TO STATE A CLAIM as to Certain Claims - Plaintiff's Third Amended Complaint, GRANTING 188 MOTION TO DISMISS FOR FAILURE TO STATE A CLAIM as t o Certain Claims - Plaintiff's Third Amended Complaint, GRANTING IN PART and DENYING 181 MOTION TO DISMISS FOR FAILURE TO STATE A CLAIM - Plaintiff's Third Amended Complaint, DENYING AS MOOT 171 MOTION to Dismiss Plaintiff's Third Amended Complaint in its Entirety, and alternative Motion to Transfer. Discovery hearing set for 11/20/17 art 4:00 PM in Courtroom 11-D (Signed by Chief Judge Lee H Rosenthal) Parties notified.(leddins, 4)

United States District Court
Southern District of Texas

ENTERED
IN THE UNITED STATES DISTRICT COURT
FOR THE SOUTHERN DISTRICT OF TEXAS
HOUSTON DIVISION
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Plaintiff,
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v.
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HEALTH CARE SERVICE CORPORATION, §
d/b/a BLUECROSS BLUESHIELD OF
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ILLINOIS, et al.,
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Defendants.
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October 26, 2017
David J. Bradley, Clerk

HOUSTON METRO AND SPINE
SURGERY CENTER,LLC,

CIVIL ACTION NO. H-16-1402

ORDER
The court held an interim pretrial conference in this case on October 24, 2017. The court
heard oral argument from counsel on a number of pending motions to dismiss and a discovery
dispute. For the reasons stated in detail on the record, the motions are resolved as follows:
The motion to dismiss for improper venue, or in the alternative to transfer the case, filed by
the defendant CareFirst of Maryland, (Docket Entry No. 171), is denied as moot.
The motion to dismiss filed by the defendants Anthem, Inc. and Anthem Insurance Company,
Inc. (AIC), (Docket Entry No. 181), is granted in part and denied in part. The motion to dismiss the
parent corporation, Anthem, Inc is granted with prejudice. The motion to dismiss the subsidiary,
AIC, is denied.
The motion to dismiss the claims against the defendant Anthem Blue Cross, (Docket Entry
No. 186), is denied. The plaintiff, Houston Metro, must provide the defendant Anthem Blue Cross
with the documents it received in response to its subpoena.
The motions to dismiss filed by Blue Cross and Blue Shield of Georgia, (Docket Entry No.

184), and Community Insurance, Inc., (Docket Entry No. 188), are granted with leave to amend as
to claims number 58, 62, 145, 157, 158, 159, and 163. The motions to dismiss claims 60, 61, and
175 for which the plaintiffs provided the defendants with the information, but the defendants could
not locate the claims, are granted. The defendants, Blue Cross and Blue Shield of Georgia and
Community Insurance, Inc., will provide the plaintiffs with information about which entity
administered the specific claims during the relevant period, to the extent they have that information,
within 30 days. The plaintiffs may file an amended complaint within two weeks of receiving that
information.
The motion to dismiss count 2 filed by the defendant, Health Care Service Corporation,
(Docket Entry No. 197), is granted with prejudice and without leave to amend.
The court heard argument on a discovery dispute. The parties are ordered to produce and
exchange the documents they each assert show whether the insurer did or did not identify to the
plaintiff the basis for an “allowable amount” payment determination when a claim was paid only in
part or denied. The parties must exchange these documents no later than November 7, 2017. The
parties will appear at a hearing to address the discovery issue on November 20, 2017 at 4:00 p.m.
in Courtroom 11D.
SIGNED on October 26, 2017, at Houston, Texas.
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Lee H. Rosenthal
Chief United States District Judge