United States District Court, D. New Jersey
LINDA S. SKELCY, Plaintiff,
UNITEDHEALTH GROUP, INC. et al, Defendants.
MEMORANDUM OPINION AND ORDER
DOUGLAS E. ARPERT, Magistrate Judge.
This matter comes before the Court on the informal application of Plaintiff Linda S. Skelcy to compel Defendants UnitedHealth Group, Inc. and Oxford Health Insurance (collectively "UHG") to provide certain discovery. See letter from Plaintiff's counsel dated January 10, 2014 ("Pltf. Ltr."). Defendants have opposed Plaintiff's application. See letter from Defendants' counsel dated January 17, 2014 ("Deft. Ltr."). Oral argument was conducted on March 17, 2014. For the reasons that follow, Plaintiff's application is GRANTED.
I. Factual Background
Plaintiff is the surviving spouse and administrator of the Estate of James T. Skelcy. She alleges, among other things, that UHG wrongfully delayed approval of health benefits which deprived her husband of necessary and timely treatment of his medical condition thereby causing his death. See Plaintiff's Complaint [dkt. no. 31-1].
In July 2007, Mr. Skelcy was diagnosed with dermatomyositis, a connective tissue disease, as well as interstitial lung disease. In August 2009, his treating physician prescribed treatment using the drug Rituximab. At that time, Mr. Skelcy was insured under a different health insurance plan administered by United Healthcare which approved coverage of the treatment. Following this treatment, Mr. Skelcy's condition improved markedly. Unfortunately, after approximately one year, Mr. Skelcy's symptoms reemerged. In response, his physician prescribed additional treatment with Rituximab.
Prior to the scheduled administration of the drug, UHG denied coverage for the treatment and requested documentation supporting its medical necessity. Mr. Skelcy's physician responded providing office notes, medical records and a letter describing the medical necessity of the prescribed treatment. Thereafter, Mr. Skelcy's physician appealed UHG's determination.
On July 15, 2010, UHG transmitted the appeal to Defendant Medical Evaluation Specialists, Inc. ("MES") for a peer review assessment. MES' reviewing physician, Dr. Beighe concluded that the use of Rituximab is not "standard of care" for Mr. Skelcy's condition. However, he added, "IVIG would be standard of care at this point." Pltf. Ltr. at page 2. On this basis, UHG denied approval of the treatment. Plaintiff maintains that UHG failed to communicate that it considered IVIG to be an appropriate treatment option. Id.
Following further communications between Mr. Skelcy's physician and UHG, on August 9, 2010 UHG approved the Rituximab treatment. Thereafter, arrangements were made to administer the treatment on August 16, 2010. Sadly, on August 11, 2010, Mr. Skelcy died. Id. at page 3.
UHG denies any causal connection between the delay in approving treatment and Mr. Skelcy's death on August 11, 2010. UHG maintains that the use of Rituximab to treat dermatomyositis is an "off label use". Deft. Ltr. at page 1. Further, UHG maintains, Mr. Skelcy's physician never submitted a pre-authorization request to approve treatment with IVIG, another prescription drug. Id. at page 2. Nonetheless, UHG notes, "less than a month after the initial denial, [it] reversed its decision, and on August 9, it approved the prior authorization for [Rituximab]." Id. at page 2.
II. Discovery Dispute
In August 2013, Plaintiff served Interrogatories and Requests for Production of Documents ("RFP's") on Defendants. Despite the parties' best efforts, a dispute remains with respect to Plaintiff's interrogatory numbers 38 through 44 and RFP numbers 43 through 47. In sum, Plaintiff wants to know how many requests for Rituximab treatment associated with relevant medical conditions UHG has received in the last five years, how many such requests were approved and how many were denied; how many requests for IVIG treatment were received, how many were approved and how many were denied; and how many requests for Rituximab treatment were initially denied "due to insufficient documentation of medical necessity".
Generally, UHG objected to each of Plaintiff's interrogatories stating:
Defendants object to this interrogatory on the grounds that it is irrelevant and not reasonable calculated to lead to the discovery of admissible evidence. Defendants also object on the ground that the interrogatory is overly broad, and requiring a response would be unduly burdensome.
Plaintiff's RFP's essentially track the interrogatories and seek production of "any and all documents, writings, materials, electronically stored information and/or objects" that relate to the subject of each interrogatory. UHG's objected to each RFP ...