United States District Court, S.D. Texas, Houston Division
ORDER AND OPINION
MELINDA HARMON, UNITED STATES DISTRICT JUDGE.
the Court are Defendants' Motion to Dismiss (Document No.
25), Plaintiffs Response to Defendants' Motion to Dismiss
(Document No. 28), Defendants' Reply in Support of its
Motion to Dismiss (Document No. 31), Plaintiffs Motion for
Attorney's Fees (Document No. 35), and Defendants'
Response in Opposition to Plaintiffs Motion for
Attorney's Fees (Document No. 37). After considering
these documents, the facts in the record, and the applicable
law, the Court concludes that Defendants' Motion to
Dismiss (Document No. 25) is MOOT and Plaintiffs Motion for
Attorney's Fees (Document No. 35) is DENIED. Further,
because the Court holds that there is no longer a case or
controversy at issue in this case, the case is DISMISSED as
Red Oak Hospital, LLC, filed this action alleging that
Defendants Macys, Inc. and Macys, Inc. Welfare Benefit Plan
(collectively “Defendants”) violated the Employee
Retirement Income Security Act (ERISA) by failing to
compensate Plaintiff after Plaintiff provided medical
services to one of Defendants' plan beneficiaries.
to the First Amended Complaint (Document No. 18), Macys
provides medical benefits through its Welfare Benefit Plan to
its employees. Macys contracted Cigna Healthcare as a
third-party administrator to administer the benefits of the
Plan and to take advantage of Cigna's network of
healthcare providers. Plaintiff has not entered into an
agreement with Cigna, so Plaintiff is considered an
out-of-network provider of medical services. As a result of
Plaintiffs status as an out-of-network provider, the Plan
does not necessarily cover services provided by Plaintiff.
March 2016, a Plan Beneficiary (the Patient) received medical
services from Plaintiff. Plaintiff alleges that those
services qualified as emergency services under the Emergency
Medical Treatment and Active Labor Act (EMTALA) and that
those services were worth $38, 413.92. Before providing the
services, Plaintiff had the Patient sign a Legal Assignment
of Benefits and Designation of Authorized Representative
providing the services to the Patient, Plaintiff submitted
its healthcare claims to Defendants through Cigna for $38,
413.92. Plaintiff argues that Defendants reduced Plaintiffs
“Billed Amount” through Viant, a third-party
company. On April 30, 2016, Cigna issue a check to Plaintiff
for $14, 849.50. Plaintiff received the check on May 6, 2016.
When Plaintiff attempted to deposit the check on May 13,
2016, however, the check was returned because Cigna stopped
payment on the check.
contacted Cigna and told the company that it was going to
issue a bill to the Patient for the amount of the services
provided. According to Plaintiff, Cigna asked Plaintiff not
to bill the Patient and told Plaintiff that it would reissue
the payment. Plaintiff claims that it did not receive payment
before filing this lawsuit. Further, Plaintiff claims that
when the Plan sent an explanation of benefits to the Patient,
the explanation stated that the Plan had paid $0.00 and that
the Patient owed $0.00 for the services provided by
not receiving payment, Plaintiff sent an appeal letter to
Defendants and the Department of Labor on June 3, 2016.
Plaintiff also filed a complaint with the Texas Department of
Insurance. Several weeks later, on June 21, 2016, Plaintiff
filed this lawsuit.
Plaintiff filed its First Amended Complaint seeking relief
under 29 U.S.C. § 1132(a)(1)(B), Defendants filed their
Motion to Dismiss under Fed.R.Civ.P. 12(b)(6), arguing that
Plaintiff failed to state a claim because coverage for the
medical services provided by Plaintiff was excluded under the
the Motion to Dismiss was pending in this Court, the parties
conducted discovery. Through that discovery, Plaintiff
discovered that Cigna had reprocessed its claim and issued a
check for $14, 849.50 in response to a Texas Department of
Insurance complaint. Plaintiff now seeks attorney's fees
under 29 U.S.C. § 1132(g)(1).
III of the Constitution grants the Judicial Branch authority
to adjudicate 'Cases' and 'Controversies.' In
our system of government, courts have 'no business'
deciding legal disputes or expounding on law in the absence
of such a case or controversy.” Already, LLC v.
Nike, Inc., 568 U.S. 85, 90 (2013) (quoting
DaimlerChrysler Corp. v. Cuno, 547 U.S. 332, 341
(2006)). A case or controversy must be present at all stages
of a case. K.P. v. LeBlanc, 729 F.3d 427, 438 (5th
Cir. 2013). “Generally, any set of circumstances that
eliminates actual ...