Opinion ID: 4518258
Heading Depth: 2
Heading Rank: 2

Heading: The Medical-Supply Fee

Text: In its January 18, 2017 letter, BCBSND explained that it denied the claim for a medical-supply fee because the charge for intravenous fluids was included within the base rate for air-ambulance services. The district court found this interpretation to be “consistent with the language of the plan, which includes services, supplies or treatments used to treat an illness or injury . . . within the Plan’s definition of Ambulance Services.” Mitchell, 2018 WL 3463260, at . However, the district court concluded that, although this interpretation was reasonable, it could not be used 4 The administrative record contains documents related to the Allowed Charges for air-ambulance services in 2014 and 2015. The Mitchells argue that, because the 2015 documents describe BCBSND’s “rationale for air ambulance payment methodology” but the 2014 documents do not, BCBSND’s 2014 interpretation was unreasonable. However, “[i]n 2015 air ambulance rates [we]re just over 150% of Medicare.” This consistency supports BCBSND’s interpretation. -15- to support BCBSND’s decision because it was a post-hoc rationale that was not “thoroughly provided” to the Mitchells until January 18, 2017. Id. We agree that BCBSND’s interpretation is consistent with the Plan’s language. But we do not agree that it was an “after-the-fact plan interpretation devised for purposes of litigation.” Id. The 2014 EOB explains that the medical-supply charge was denied because “[t]his service is included in the payment made for a related procedure.” The record indicates that BCBSND consistently took this position throughout the claims process. We are again troubled by BCBSND’s failure to provide a more thorough explanation to the Mitchells at an earlier stage of the claims process. But we cannot say that BCBSND’s consistent interpretation of the Plan’s language was an abuse of discretion.