Class Action Accusing HCSC and BCBSIL of Failing to Adequately Cover Comprehensive Lactation Services Moves Forward

Class Action Accusing HCSC and BCBSIL of Failing to Adequately Cover Comprehensive Lactation Services Moves Forward

On December 5, 2017, United States District Judge John Robert Blakey denied, in part, and granted, in part, Defendants’ Motion to Dismiss in Briscoe, et al. v. Health Care Service Corporation, et al., Case Number: 1:16-cv-10294 (U.S.D.C. N.D. Ill.), a putative class action filed against Health Care Service Corporation (“HCSC”) (a holding company for Blue Cross Blue Shield Plans in Illinois, Montana, New Mexico, Oklahoma, and Texas) and one of its operating divisions, Blue Cross Blue Shield of Illinois’ (“BCBSIL”) (collectively referred to as “Defendants”), charging Defendants with violations of ERISA, the plaintiffs’ insurance contracts and the Affordable Care Act (ACA) for their failure to provide coverage for Comprehensive Lactation Benefits as a mandated preventive health service.

Among other things, the Court held that the allegations of the amended complaint were sufficient to “state a plausible claim” that Defendants’ failed to “provide meaningful coverage” for breastfeeding services and that “Defendants violated the ACA for improperly imposing cost sharing for lactation services.” The Court noted that based on the Plaintiffs’ allegations the Defendants’ “ alleged administrative barriers” made finding an in-network provider for lactation services tantamount to looking for a “needle in the haystack”. The Court also cited to Judge Chhabria’s holding in a similar matter, Condry v. UnitedHealth Grp., Inc., No. 17-cv-00183-VC (N.D. Cal. Aug. 15, 2017), in which the court rejected analogous arguments by defendant UnitedHealth as “absurd”.

Based on these findings, the Court denied Defendants’ motion as to the breach of fiduciary duty (Count II) and breach of contract claims (Count V). The Court did grant dismissal of the claim for discrimination under the ACA, 42 U.S.C. §18116(a) (Count IV) and the unjust enrichment claim (Count VI) with prejudice, but dismissed, with leave to amend, the claims for breach of fiduciary duty (Count I) and breach of co-fiduciary duty (Count III).