Court Opinion

ID: 9371891
Source: CourtListenerOpinion
Date Created: 2023-02-17 01:00:18.994737+00
Date Added: 2024-06-11T17:16:30.881869
License: Public Domain

Case: 21-20168    Document: 00516648657        Page: 1    Date Filed: 02/16/2023

           United States Court of Appeals
                for the Fifth Circuit
                                                                   United States Court of Appeals
                                                                            Fifth Circuit

                                                                          FILED
                                                                   February 16, 2023
                                No. 21-20168                         Lyle W. Cayce
                                                                          Clerk

   ACS Primary Care Physicians Southwest, P.A.; Hill
   County Emergency Medical Associates, P.A.; Longhorn
   Emergency Medical Associates, P.A.; Central Texas
   Emergency Associates, P.A.; Emergency Associates of
   Central Texas, P.A.; Emergency Services of Texas, P.A.,

                                                         Plaintiffs—Appellees,

                                    versus

   UnitedHealthcare Insurance Company;
   UnitedHealthcare of Texas, Incorporated,

                                                     Defendants—Appellants.

                 Appeal from the United States District Court
                     for the Southern District of Texas
                          USDC No. 4:20-CV-1282

   Before King, Graves, and Ho, Circuit Judges.
   King, Circuit Judge:
         We previously certified a question to the Texas Supreme Court asking
   whether the Texas Insurance Code’s Emergency Care Statutes authorize a
   private cause of action. After receiving a response in the negative, we
   REVERSE the judgment below.
Case: 21-20168     Document: 00516648657          Page: 2   Date Filed: 02/16/2023

                                   No. 21-20168

                                        I.
         In Texas, hospital employees may not deny individuals emergency
   care due to their inability to pay. Tex. Health & Safety Code Ann.
   §§ 241.027(b)(5), 241.028(c)(2), 311.022(a)–(b). This raises the prospect
   that physicians will treat patients who are either uninsured or whose
   insurance does not cover such treatment. To ease the economic burdens
   associated with this care, the Texas Insurance Code requires that insurance
   companies insuring patients who receive emergency treatment by out-of-
   network healthcare providers reimburse those providers at their “usual and
   customary rate” or an agreed rate (the “Emergency Care Statutes”). Tex.
   Ins. Code Ann. §§ 1271.155(a), 1301.0053(a), 1301.155(b).
         Since January 2016, Plaintiffs-Appellees, emergency care physician
   groups in Texas (the “Plaintiff Doctors”), have provided various emergency
   medical services to patients enrolled in health insurance plans insured by
   Defendants-Appellants     UnitedHealthcare       Insurance   Company     or
   UnitedHealthcare of Texas, Incorporated (collectively, “UHC”). The
   Plaintiff Doctors are not within UHC’s provider network. In their operative
   complaint, the Plaintiff Doctors allege (among other claims) that UHC has
   failed to remit the “usual and customary rate” for the emergency care that
   the Plaintiff Doctors provide to patients insured by UHC in violation of the
   Emergency Care Statutes. UHC moved to dismiss the Plaintiff Doctors’
   complaint, which was denied in part by the district court. Specifically, the
   court rejected UHC’s argument that the Emergency Care Statutes did not
   authorize a private cause of action. The court also held that the Plaintiff

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Case: 21-20168        Document: 00516648657              Page: 3      Date Filed: 02/16/2023

                                         No. 21-20168

   Doctors’ claim under the Emergency Care Statutes was not otherwise
   preempted by the Employee Retirement Income Security Act (“ERISA”). 1
           UHC immediately sought interlocutory review of two issues: (1)
   whether the Emergency Care Statutes authorize an implied private cause of
   action, and (2) whether the Plaintiff Doctors’ claim under the Emergency
   Care Statutes is otherwise preempted by ERISA. Both the district court and
   this circuit granted UHC’s request for interlocutory review. The Plaintiff
   Doctors subsequently moved to certify the first issue—whether the
   Emergency Care Statutes provide for a private cause of action—to the Texas
   Supreme Court. In February 2022, we granted the Plaintiff Doctors’ motion
   and certified the following question to the Texas Supreme Court:
           Do §§ 1271.155(a), 1301.0053(a), and 1301.155(b) of the Texas
           Insurance Code authorize Plaintiff Doctors to bring a private
           cause of action against UHC for UHC’s failure to reimburse
           Plaintiff Doctors for out-of-network emergency care at a
           “usual and customary” rate?
   ACS Primary Care Physicians Sw., P.A. v. UnitedHealthcare Ins. Co., 26 F.4th
   716, 720 (5th Cir. 2022). 2
                                              II.
           In January 2023, the Texas Supreme Court answered the certified
   question in the negative, holding that the Texas Insurance Code “does not
   create a private cause of action for claims under the Emergency Care
   Statutes.” Texas Med. Res., LLP v. Molina Healthcare of Tex., Inc., No. 21-

           1
             The district court, however, dismissed the Plaintiff Doctors’ other claims for
   breach of an implied-in-fact contract and quantum meruit, which are not at issue on appeal.
           2
            We withheld judgment on the second issue before us on interlocutory review:
   whether the Plaintiff Doctors’ claim under the Emergency Care Statutes was preempted
   by ERISA.

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Case: 21-20168     Document: 00516648657          Page: 4   Date Filed: 02/16/2023

                                   No. 21-20168

   0291, 2023 WL 176287, at *8 (Tex. Jan. 13, 2023). Therefore, the Plaintiff
   Doctors’ claim for violation of the Emergency Care Statutes must be
   dismissed. Because there is no private cause of action under the Emergency
   Care Statutes, the second issue before us—whether the Plaintiff Doctors’
   claim under the Emergency Care Statutes is otherwise preempted by
   ERISA—is now moot. Accordingly, we REVERSE the district court’s
   judgment denying UHC’s motion to dismiss the Plaintiff Doctors’ claim for
   violation of the Emergency Care Statutes and REMAND for further
   proceedings not inconsistent with this opinion.

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