services which are covered by a variety of insurance companies we brought to types of claims one are one set of claims are all derivative claims is the first four counts and those are claims that were brought solely by virtue of our having obtained assignments from patients to challenge the denial of coverage of the technology we also brought three counts that if you were to port or stashed or tort claims for defamation which are aimed at statements made in a publication that signal if you visit shin's with them our clients do business in which we believe were disparaging about the product and  claims were arbitrary one respectfully it's our position that not any of these claims or are subject to arbitration and that's for a host of reasons first of all there's the arbitration clause itself  this is a case where there's a an alternative dispute resolution provision there's there's two sections that in a relate to one another they those provisions make clear that the subject of disputes between the parties regarding the performance or interpretation of the contract the word dispute is used five different times four times the context is absolutely the connecticut general used in case they went on record told court that there's just no doubt that this clause is a narrow clause that it's constrained to disputes that involve which contract cases doesn't reach toward cases doesn't rea of why why don't you or your claims arise out of the agreement as opposed to out of the performance and interpretation you're going i'm sorry right why don't your claims arise out of the great as opposed to the performance arbitration provision were not alleging that they breached the contract in any way as masters of the complaint we don't see a contract breach here in order to we don't have in order to bring this case and have standing to bring this case on the arm what i will call the central issue which arbitration because the claims the principal claims will bring our section five of coverage claims under a risk they involve whether or not the there are claims that we were talking about your not talking first about the derivative claims you want me to focus on the court claims the tort claims are not subject to arbitration because they have nothing to do with the contract we would bring the same claims about the statements about the technology that we make in conjunction with other companies whether we were a contract provider or not a contract provider after five years of covering the product direct proud of these technologies recognizing that they were medically important and significant cigna had a change of heart and issued a policy saying they will never cover the technology because it's experimental and unproven and they issued that statement in a bulletin that went to hundreds of thousands of physicians that the or the port like claims that are aimed at that the simulation that statement don't arise under the contract there's no provision of the contract that deals with what they may or may not say about the product the harm that we face telemetry services were experimental and unproven services and that that's the basis for that is so it wasn't a statement that sigma made cardio and that was bad guys talked about the services cells which were part of the provider they talked about services which are covered by the which for which we get paid under the provider direct but the claim does not allege that they've reached the provider agreement in making those statements they can say whatever they want that's so as far as the dispersion claims are concerned products are sold to pay for are provided to patients and are covered by insurers whether you're in that work or out of network so regardless of whether we have a contract with cigna if there's a statement made to patients that are products it's considered unproven and experimental were harmed by that it has nothing to do with the contract and under the factual underpinnings test which is the notion by this court i think in the med tronic case the issue really been has been disparaged to the doctors that order the diagnostic services but i would really like to focus if i could principally on the derivative claims because that's that's that's the the the agreement is to set a rate of payment and terms under which they test the services that we provide that are covered services so you think you're covered services are all for somebody else for a participant in some plan if if we provided them with say a holter monitor and they paid us we claim we were owed one hundred dollars versus ninety dollars that would be disputed under the contract a payment dispute the this court in past that has pointed out that majority of disputes between a provider and a plan would be covered and egremont those disputes involve the timing of pain at the amount of payment whether or not the utilization review has been done in accordance with the contractors the majority of disputes between insurers and plans tend to be arbitrary claims under the agreement a derivative claim in this case is not a clear it's not our ox if you will that's being gored it's the patients the patients will now allow us the money for the services because cigna has said they're not covered they're saying these are the equivalent of cosmetics or surgery they're not covered by the sale jani any passer voces or future service the claims that we're bringing on behalf of the beneficiaries include monies that would be owed for past services that they've consumed but for would cigna has refused to reimburse the sort of the reimbursement climb it's repass reimbursement and it's prospective claim on and we have an assignment from the patients that enables us to stand in their shoes as you or i recognized in the med try case we are proceeding in the shoes of the as the of the beneficiaries that assigned us those cla and those claims could not be brought into the contract because the claims fundamentally seek a declaration of and coverage of services under health benefit plans we as a provider have no standing to bring that claim that's a claim by the patient saying that all of these claims are subject to arbitration the plaintiffs in this case your honor are two in network medical providers in the cigna network and that means when you're an in network medical provider you have a contract with net and in the contract between cardio net and cigna there is an arbitration clause and the only thing judge really no set is claims that are within the scope of that arbitration clause that the plaintiffs are bringing have to be arbitrated whether they are assigned claims or direct claims as long as they are within the scope if a plant participant brought his or her own suit they would not be parties to  heart of these contracts is the concept of what is or is not covered service right but it doesn't speak to claims that it's training assignment or standing in the shoes of somebody else i think it speaks to any claim that the provider is bringing if it's within the scope and so i guess the question on area is whether a claim that the providers received by assignment is automatically outside the scope or tracing clause or not judge reno's conclusion which i think is correct and which is consistent with the conclusions reached by a variety of other district courts is that medical providers in the position of these plaintiffs who are in effect challenging planned participant what they claim himself that plan participant would not be under a similar limitation and neither you nor judge for being a cite anything other than other district courts for that proposition believe i'm not aware of what the courts in each instance have looked at is that the claims that are to shoot the claims that are being pursued by the provider go to the heart of the contract that is between the provider and the insurer but how is that so they're merely accepting by signing claims of other people play to sue could bring independent individual claims themselves to peers seeking payment for services they provide it that's what they're seeking  agreement to arbitrary with sigler you cannot pursue the assigned claims in federal court you can certainly sign your claims to card you're not and they can't pursue them it's just that they pursue them an arbitration because that's what they agreed to do couldn't you have protected yourself from the situation by having a provision in the provider agreement that makes it clear it's disputes between the parties as well as disputes that may be a sign you're on a third line which had been there i doubt we would be here today but our view is that the arbitration clause is broad enough the point is that the party that agreed to arbitrate is the party that brought the suit but let's go on it six point three says disputes that might arise between the parties why should we even view this as a dispute between the parties because that's where card united cardio notice the plaintiff and cardio net is the party that is bringing the dispute and cardio is seeking payment to itself that's what it's it doesn't seek payment to plan beneficiaries it seeks payment to itself pursuant to the rate in the contract that's the expressed prayer for relief in counts one and four that's the overall  policy of we want to promote the side of billet from patients to providers of claims so that it i guess makes it more likely patients will get services without having their financial  you know status considered before getting treatment is that a relevant public policy as we analyze the sustainability of these derivative claims well it's a relevant policy it's not relevant to this dispute because the ability of  participant to assign his or her claims to medical provider is not in any sense impaired the only thing we're talking about is whether the provider brings those claims in arbitration if it has agreed to do so or in a lawsuit if it has not and in this case cardio not well aware of the arbitration provisions in its contract with cigna except to the assignment and has it is in reynosa you and i think correctly so the the focus is not on the plan participants they are not in any sense injured or limited by just ripping us decision the only issue the judge ripping us decision addresses is in what isn't there something to be said about how being or for taking advantage of the expertise of card in that with these kinds of of claims and and the technical information that they have to present these claims for the ins as opposed to the individual plaintiffs having to get lawyers and and not having the financial resources present their own claims individual your honor none of that is affected by the question that by the decision the judge read on that the only judge will be no didn't say well it is in a way isn't it because what he is saying is you individual play to see if you want to present these claims you have to just go out and present them on your own you know since he was saying that well he can get think the policy that you are addressing is whether the plane the plan participants are somehow being limited or negatively impacted what i'm suggesting is that the only thing that the court  is address the question of the form in which those claims are presented and it has done that pursuant to another public policy well in shrine in federal law which is in force means of arbitration provisions and the you change your policy on reimbursement of these correct that's right or ok and it least as to the assignments that i'm looking at here all of them seem to been signed by the participants assigning their rights to cardio net in december of two thousand and twelve is the dispute in the claims that are the derivative claims over the coverage of whether or not your interpretation was correct well you and i would say two things whether or not they're actually liable to cardio and that is governed by the facts of each claiming there are provisions in the contract between cardio net cigna that address when and under what circumstances cardio net may recover from plan participants amounts billed for services that are deemed for example not medically necessary we don't know the circumstances plain but what i would say more broadly is the having assigned to claims the plan participants whether that whether the claims of one in federal court or even in arbitration the plan participants are not going to be part of the proceedings where the issue of coverage is addressed that's that's the same another scene in the question about the direct claim yes so the argument is that what is essentially a factual underpinning for there is the effect of disparagement when you all decided that the o c d services are now you whereas they hadn't been before and that has consequences for cardio net physicians in its network that essentially said we consider services of this type m e r u and not covered under plans that do not provide for payment for services that's what they said that's pursu essentially to the provisions of its contract to all of medical network providers that they know what's covered and what's not covered and and so the underlying facts were assigned claim and for the so called direct lanes or really just a change in coverage position and the communication of the changing coaches hypothetically if if notwithstanding that change in designation as to whether it's you or not if you continue to pay those claims for the services for whatever reason the plaintiff would still have all of that same allegations against you would know what it would argue i think the plain issue here is that when they have a claim as opposed to whether it's within the scope of government clause they can have a claim whether the services are paid or not the arbitration clause extends to the interpretation we're performance of the contract the the only be brought under section five to ever receive you can't frame it as a common law claim so what we did here is not some sort of chicanery it's basically following the dictates of the court decisions that bring the playing coverage claims in the only way we could which is connecticut court that which by the way was furious because they were they were taking positions that were internally inconsistent depending on which case they were in but the contract in this case is section one hundred six of the provider of the contract vision that with the coverage right to tell cigna what for example for the united auto workers what services it used to cover or not cover the only reason we're in court today or have or had been in court is because we have assignments which copies of which were judge rubina want to see which are in the record and which are signed documents by plan participants saying i hereby acknowledge my financial responsibility if this isn't covered and i also assigned to you the right to pursue claim to get this covered including specifically rights under coverage policy wrote automatically by computer to immediately deny these claims without looking at the plan language that claim relief to and insist on adherence to a plan i think it's under five varying turns and different resupply into different insurance contracts some of which may just say will cover will cover services that are approved by the f d a and are not used in a clinical experiment in which case they would have to cover the services but then they've declared them in the  bulletin to be experimental investigational and on proven and as a result of that applying that policy they're never covered he times one of our allegations is that we supplant terms or not are being dishonest by signature because cigna supplying a corporate no coverage policy in which we have a financial stake to be routinely deny services and not even look at the terms of the plan that