Court Denies CareFirst’s Request to Dismiss Class Action that Seeks to Enforce Insureds’ Rights to Comprehensive Lactation Services as a Preventive Health Benefit

On July 17, 2017, United States District Judge Amit P. Mehta denied CareFirst’s Fed. R. Civ. P. 12(b)(1) Motion to Dismiss Ferrer et al., v. CareFirst, Inc., et al., Case No. 1:16-cv-02162-APM (D.D.C.), an action filed against CareFirst and its affiliates charging them with violations of ERISA, the 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 Order holds that the Ferrer complaint “easily establishes standing at the motion to dismiss stage” because: “each [p]laintiff alleges that CareFirst’s denial of full coverage resulted in each [p]laintiff having to pay hundreds of dollars out of pocket for lactation services, thereby easily meeting the injury-in-fact requirement”; and, “[p]laintiffs satisfy the element of causation, because they allege that CareFirst’s refusal to pay the full cost of out-of-network lactation services, when it offers no in-network providers, violated the ACA and gave rise to their economic harm.”