Dallas – The law firm of Thompson & Knight LLP secured a final judgment awarding the Firm’s client Encompass Office Solutions (“Encompass”) more than $9.5 million in Encompass Office Solutions v. BlueCross BlueShield of Louisiana. Last June, following a four-day trial, the jury entered a verdict in favor of Encompass on certain claims for more the $7.5 million in damages. The District Judge took certain claims relating to BlueCross BlueShield of Louisiana’s (“BCBSLA”) failure to pay Encompass for services provided to patients with employer-sponsored insurance, for which a jury trial is not available, under consideration at the close of the trial.
BCBSLA filed a number of post-verdict motions seeking to overturn the jury’s verdict and seeking judgment in its favor on the claims not submitted to the jury. On June 26, 2017, the Court denied those post-verdict motions and ruled in Encompass’s favor on the non-jury claims. In so doing, the Court made clear that all of the health insurance policies that BCBSLA administers covered Encompass’s services and that BCBSLA violated those policies by not covering the services Encompass provided to patients.
“This judgment brings to a conclusion a hard-fought victory for Encompass,” said Jennifer Rudenick Ecklund, a Trial Partner at Thompson & Knight. “The verdict and judgment represent an important win for providers who render healthcare on behalf of patients and seek payment from insurance carriers, anticipating that the carriers will comply with their coverage obligations.”
Encompass is a healthcare provider of mobile ambulatory surgery services which enable doctors to safely perform surgeries in their offices under anesthesia. Encompass’s business is primarily focused on women’s health, allowing patients to have sensitive gynecological procedures done in the comfort and safety of their doctor’s offices without sacrificing the necessary anesthesia care required to make those procedures less painful. The business also offers an alternative to the infection rates associated with hospitals and ambulatory surgery centers, and provides both doctors and patients with a more efficient and cost-effective means of delivering medically necessary surgical care.
The lawsuit was a breach of contract case for unpaid claims. Despite admitting and acknowledging that those services were covered by BCBSLA’s health benefit plans, BCBSLA argued that its payment to the doctors was “all-inclusive,” and thus it was not obligated to pay Encompass’s out-of-network claims as the provider of ambulatory care. Both the jury and the court rejected that argument and ruled that BCBSLA must cover the services that Encompass provided to its patients.
Encompass also brought defamation and tortious interference claims related to a letter BCBSLA sent to its network OB-GYNs. The letter contained several false statements about Encompass’s eligibility for reimbursement and whether the services were covered, and threatened doctors who continued to work with Encompass with termination of their network contracts. The letter resulted in the total loss of Encompass’s business in Louisiana.
Encompass was represented by Thompson & Knight Trial Partners Jennifer Rudenick Ecklund and Andrew Cookingham and Associate Reed Randel.