Opinion ID: 1433442
Heading Depth: 1
Heading Rank: 1

Heading: The Breach of Contract Issue

Text: Dr. Schoedinger is one of more than fifty physicians employed by Signature, one of the largest health care provider organizations in the St. Louis metropolitan area. United is a nation-wide health care insurer and claims administrator. Each year, Signature submits thousands of claims to United for treatment provided to patients covered by a health care plan administered by United. Before a patient covered by a United plan is treated by Dr. Schoedinger or another Signature physician, the patient signs an assignment of plan benefits form that Signature later submits to United with its claim for payment. United's claim submission procedures are described on its website and in an administrative guide distributed to providers. Like most plan administrators, United maintains a network of participating providers who agree by written contract to accept, as full payment for services provided to patients covered by a United plan, an agreed amount that is typically lower than the billed charges. Dr. Schoedinger terminated his in-network agreement with United effective April 15, 2003. The claims at issue in this case were for patient treatment after that date, when Dr. Schoedinger was an out-of-network provider. Most Signature physicians remained in United's provider network. United's claim procedures appear to be the same for in-network and out-of-network providers. At trial, United conceded that the patients' assignments of plan benefits provided a contractual basis for the ERISA and non-ERISA claims at issue. But Plaintiffs argued that the claims procedures published by United on its website, in the administrative guide, and in insurance cards distributed to plan participants constituted an offer of an independent contract in which United promised to properly and promptly compensate Dr. Schoedinger every time he treated a United plan member. Finding no Missouri law addressing the issue in this context, the district court logically looked to Missouri cases determining whether an employee handbook created a contract between employer and employee. See Johnson v. McDonnell Douglas Corp., 745 S.W.2d 661, 662 (Mo. banc 1988). The court found that none of United's documents contain language which could be interpreted as a manifestation of willingness to enter into a bargain. Thus, there was no offer and no contract. After careful review of the record, we conclude that the court's findings of no offer and no contract are not clearly erroneous. See Kansas City Power & Light Co. v. Burlington N. R.R., 707 F.2d 1002, 1003 (8th Cir.1983) (standard of review). At trial, Dr. Schoedinger testified that he had contracts with patients, not with United. United's website explains how to verify a patient's eligibility and submit health care claims, provides tips for faster claims processing, and describes how health care coverage decisions are made. A provider using the website who wishes to review United's reimbursement policy is first brought to a webpage entitled Reimbursement Policy Agreement which states that the policy is intended to serve only as a general reference resource, and that United may modify this reimbursement policy from time to time. The viewer must click, I Agree, to then review detailed policies regarding matters such as Co-Surgeon Services and Multiple Procedure Reductions. Though more detailed than the website, we agree with the district court that United's administrative guide is an instruction manual, not a contract offer. The insurance cards United provides to plan beneficiaries expressly state, This card does not prove membership nor guarantee coverage.