Dallas – The law firm of Thompson & Knight LLP secured a victory this week in Encompass Office Solutions v. BlueCross BlueShield of Louisiana on behalf of the Firm’s client Encompass Office Solutions (“Encompass”). The trial began on Monday, June 20 and lasted for four days. The jury deliberated for almost six hours before settling on the award, finding for Encompass on all counts and awarding a total of $7.5 million in damages.
“This verdict is significant for patients, who pay for insurance coverage, and healthcare providers, who provide important services and care covered by insurance,” said Jennifer Rudenick Ecklund, a Trial Partner at Thompson & Knight. “Both sometimes struggle to obtain the benefits and reimbursement due under health benefit plans, despite the fact that coverage is clear. This verdict held BlueCross BlueShield of Louisiana accountable for its promises and its attempt to limit the options available to its members.”
Encompass is a healthcare provider of mobile ambulatory surgery services which enable doctors to safely perform surgeries in their offices under anesthesia. Encompass’ 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.
First, the lawsuit was a breach of contract case for unpaid claims. Despite admitting and acknowledging that those services were covered by BlueCross BlueShield of Louisiana’s (“BCBSLA”) health benefit plans, the company argued its payment to the doctors was “all-inclusive,” and thus BCBSLA was not obligated to pay Encompass’s out-of-network claims as the provider of ambulatory care.
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 Partner Jennifer Rudenick Ecklund and Associates Andrew Cookingham and Reed Randel.