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  Connecticut Judge Wants More Info In Doctors’ Billing Row

  Posted by name on September 3, 2024 at 5:13 pm

  Connecticut Judge Wants More Info In Doctors’ Billing Row

  By Aaron Keller ·

  Law360 (August 30, 2024, 9:42 PM EDT) — A Connecticut federal judge on Friday declined to immediately dismiss a medical staffing company’s lawsuit against Harvard Pilgrim Health Care of Connecticut Inc. after the state’s highest court answered three certified questions in the insurer’s favor, asking for briefs after the insurer countered with a demand for a judgment.

  During a Friday morning status conference, U.S. District Judge Sarala V. Nagala gave Harvard Pilgrim until Sept. 5 to respond in writing to a Thursday request by NEMS PLLC to dismiss its own case. NEMS, in turn, will have until Sept. 10 to file a reply.

  Judge Nagala also ordered the parties to confer about a nascent Harvard Pilgrim request for cost reimbursements.

  The Connecticut Supreme Court on Aug. 21 answered three certified questions in Harvard Pilgrim’s favor, in essence confirming the insurer’s interpretation of Connecticut’s surprise billing law. Judge Nagala penned the questions, which the parties initially said were unnecessary.

  Harvard Pilgrim attorney Elizabeth P. Retersdorf of Day Pitney LLP characterized the state Supreme Court’s answers as a resounding win for the insurer, saying the case should not be dismissed at NEMS’ behest but instead should end with a judgment order in the insurer’s favor. Such an order could be based on prior summary judgment motions, she suggested.

  Granting NEMS’ dismissal bid without a strict judgment order would give Harvard Pilgrim “short shrift,” Retersdorf said.

  “We don’t believe the plaintiff is entitled to withdraw claims at this stage to avoid an adverse judgment, which is what we think is happening there,” she explained, saying civil procedure rules prevent plaintiffs from ending lawsuits after a certain point.

  But the judge seemed to at least temporarily credit NEMS’ arguments that two narrow causes of action under the Connecticut Unfair Insurance Practices Act remain on the table because they were not squarely presented to the state high court.

  Judge Nagala said she would need to hear more about the validity of those claims before issuing a judgment, telling the attorneys to ask their clients whether that stage of briefing was necessary, as it would push the case beyond the immediate question of whether she should dismiss the case or issue judgment orders.

  NEMS said it was willing to drop the case with prejudice, promising not to refile its claims if the judge simply dismisses them without rendering judgment. The staffing firm cited judicial economy as one reason the case should simply be dropped.

  NEMS sued the insurer to settle whether Connecticut’s surprise billing law allows insurance companies to pass shared costs, such as coinsurance, copayments and deductibles, to emergency patients who are treated by out-of-network physicians. According to NEMS, the surprise billing statute required insurers to pay the highest of three allowable rates set by the statute without passing shared costs to patients.

  Harvard Pilgrim removed the case to Connecticut federal court, where Judge Nagala trimmed the matter to a declaratory judgment action, in essence boiling the claims down to a question of whose version of the surprise billing statute’s mechanics was the correct interpretation.

  NEMS is represented by Kristen L. Zaehringer and Timothy C. Cowan of Hurwitz Sagarin Slossberg & Knuff LLC and by in-house counsel Simon I. Allentuch.

  Harvard Pilgrim is represented by Elizabeth P. Retersdorf and Jeffrey Mueller of Day Pitney LLP.

  The case is NEMS PLLC v. Harvard Pilgrim Health Care of Connecticut Inc., case number 3:21-cv-01169, in the U.S. District Court for the District of Connecticut.

  The certified question is NEMS PLLC v. Harvard Pilgrim Health Care of Connecticut Inc., case number SC 20914, in the Connecticut Supreme Court.

  

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  Connecticut Judge Wants More Info In Doctors' Billing Row - Law360

  A Connecticut federal judge on Friday declined to immediately dismiss a medical staffing company's lawsuit against Harvard Pilgrim Health Care of Connecticut Inc. after the state's highest court answered three certified questions in the insurer's favor, asking for briefs after … Continue reading

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