CONNECTICUT PODIATRIC MEDICAL ASSOCIATION et al. v. HEALTH NET OF CONNECTICUT, INC., SC 18267

Judicial District of Waterbury

 Insurance; CUIPA; General Statutes § 38a-816 (10); Discrimination; Whether Trial Court Properly Found that Insurer did not Violate CUIPA by Reimbursing Podiatrists at Lower Rates than Medical Doctors for Same Medical Services. The named plaintiff and three doctors of podiatric medicine, who are network providers of podiatric services under a contract with the defendant insurer, filed a class action against the defendant, alleging a violation of the Connecticut Unfair Insurance Practices Act (CUIPA).  The plaintiffs alleged that the defendant reimbursed podiatrists at lower rates than medical doctors for the same foot-related health care services.  They claimed that this practice constituted unfair discrimination in violation of General Statutes § 38a-816 (10) of CUIPA, which provides in part: "[W]henever [any] insurance policy or certificate or service contract provides for reimbursement for any services which may be legally performed by any practitioner of the healing arts licensed to practice in this state, reimbursement . . . shall not be denied because of race, color or creed nor shall any insurer make or permit any unfair discrimination against particular individuals or persons so licensed."  The defendant filed a motion for summary judgment, which the trial court granted.  In reaching its decision, the court found that the meaning of § 38a-816 (10) was ambiguous.  Consulting the legislative history of the statute, the court found that the legislature intended to protect patients by allowing them to be treated by the "practitioner of the healing arts" of their choice and to have the cost of such treatment covered under health insurance policies.  The court also found that the purpose of the statute was to protect these practitioners by requiring insurance companies to reimburse them for patient care, not to mandate payment parity among the classes of practitioners.  It concluded, consequently, that the defendant's acts in not reimbursing the plaintiffs and medical doctors the same amounts for the same treatments did not constitute "unfair discrimination" in violation of CUIPA.  The plaintiffs appeal, challenging the trial court's interpretation of § 38a-816 (10).  The defendant claims, as an alternate ground to affirm the trial court's judgment, that the individual plaintiffs' alleged harm was too remote to provide them with standing to sue for damages because the reimbursement amounts were not paid to any of the plaintiffs directly, but, rather, to their podiatry practice groups.