CENTER FOR RESTORATIVE BREAST SURGERY, L.L.C. v. BLUE CROSS BLUE SHIELD OF LOUISIANA

Civil Action No. 11-806.

CENTER FOR RESTORATIVE BREAST SURGERY, L.L.C., ET AL., Plaintiffs, v. BLUE CROSS BLUE SHIELD OF LOUISIANA, ET AL., SECTION: "E" (5), Defendants.

United States District Court, E.D. Louisiana.

August 10, 2016.


Attorney(s) appearing for the Case

Center For Restorative Breast Surgery, L.L.C., Plaintiff, represented by Charles O. Taylor , Chehardy,Sherman,Ellis,Murray,Recile,Griffith,Stakelum&Hayes, Benjamin Thomas Sanders , Jacqueline G. Griffith, APLC, Julian R. Murray, Jr. , Chehardy,Sherman,Ellis,Murray,Recile,Griffith,Stakelum&Hayes, Karen Sarradet McInnis , McInnis Law Firm, LLC, Paul A. Lea, Jr. , Paul A. Lea, Jr., APLC & Ryan Paul Monsour , Chehardy,Sherman,Ellis,Murray,Recile,Griffith,Stakelum&Hayes.

St. Charles Surgical Hospital, Plaintiff, represented by Charles O. Taylor , Chehardy,Sherman,Ellis,Murray,Recile,Griffith,Stakelum&Hayes, Benjamin Thomas Sanders , Jacqueline G. Griffith, APLC, Julian R. Murray, Jr. , Chehardy,Sherman,Ellis,Murray,Recile,Griffith,Stakelum&Hayes, Karen Sarradet McInnis , McInnis Law Firm, LLC, Paul A. Lea, Jr. , Paul A. Lea, Jr., APLC & Ryan Paul Monsour , Chehardy,Sherman,Ellis,Murray,Recile,Griffith,Stakelum&Hayes.

Blue Cross Blue Shield Federal, Defendant, represented by Richard John Tyler , Jones Walker.

Blue Cross Blue Shield Hawaii Medical Service Association, Defendant, represented by Richard John Tyler , Jones Walker.

HighMark Blue Shield, Defendant, represented by Richard John Tyler , Jones Walker & Michael C. Drew , Jones Walker.

Blue Cross Blue Shield of Florida, Defendant, represented by Richard John Tyler , Jones Walker, Michael C. Drew , Jones Walker & Tyler J. Rench , Jones Walker.

Blue Cross Blue Shield of Illinois, Defendant, represented by Richard John Tyler , Jones Walker, Covert J. Geary , Jones Walker, Daniel John Hofmeister, Jr. , Reed Smith, LLP, pro hac vice, Joseph C. Davis , Jones Walker, Kevin Dale Tessier , Reed Smith, LLP, pro hac vice, Martin James Bishop , Reed Smith, LLP, pro hac vice, Michael C. Drew , Jones Walker & Tyler J. Rench , Jones Walker.

Blue Cross Blue Shield of Michigan, Defendant, represented by Kelly Frances Walsh , Brown Sims, PC, Richard John Tyler , Jones Walker, G. Christopher Bernard , Bodman LLP, pro hac vice, James J. Walsh , Bodman LLP, pro hac vice, Michael Regis Colasanti , Bodman LLP, pro hac vice, Michael C. Drew , Jones Walker & Tyler J. Rench , Jones Walker.

Blue Cross Blue Shield of Kentucky, Defendant, represented by Richard John Tyler , Jones Walker & Michael C. Drew , Jones Walker.

Blue Cross Blue Shield of Idaho, Defendant, represented by Richard John Tyler , Jones Walker & Michael C. Drew , Jones Walker.

Blue Cross Blue Shield of Mississippi, Defendant, represented by Richard John Tyler , Jones Walker, Covert J. Geary , Jones Walker, Joseph C. Davis , Jones Walker, Michael C. Drew , Jones Walker & Tyler J. Rench , Jones Walker.

Blue Cross Blue Shield of Hawaii, Defendant, represented by Richard John Tyler , Jones Walker.

Blue Cross Blue Shield of Massachusetts, Defendant, represented by Richard John Tyler , Jones Walker.

Blue Cross Blue Shield of New York, Defendant, represented by Richard John Tyler , Jones Walker & Tyler J. Rench , Jones Walker.

Blue Cross Blue Shield CareFirst, Defendant, represented by Richard John Tyler , Jones Walker.

Louisiana Health Service & Indemnity Company, Defendant, represented by Richard John Tyler , Jones Walker, Charles Andrew O'Brien, III , Charles Andrew O'Brien, Attorney at Law, Covert J. Geary , Jones Walker, Joseph C. Davis , Jones Walker, Michael C. Drew , Jones Walker & Tyler J. Rench , Jones Walker.

Regence Blue Shield, Defendant, represented by Richard John Tyler , Jones Walker, Covert J. Geary , Jones Walker, Joseph C. Davis , Jones Walker, Michael C. Drew , Jones Walker & Tyler J. Rench , Jones Walker.

Blue Cross and Blue Shield of Texas, Defendant, represented by Richard John Tyler , Jones Walker, Covert J. Geary , Jones Walker, Daniel John Hofmeister, Jr. , Reed Smith, LLP, pro hac vice, Joseph C. Davis , Jones Walker, Kevin Dale Tessier , Reed Smith, LLP, pro hac vice, Martin James Bishop , Reed Smith, LLP, pro hac vice, Michael C. Drew , Jones Walker & Tyler J. Rench , Jones Walker.

Blue Cross and Blue Shield of Florida, Defendant, represented by Richard John Tyler , Jones Walker, Covert J. Geary , Jones Walker, Joseph C. Davis , Jones Walker, Michael C. Drew , Jones Walker & Tyler J. Rench , Jones Walker.

Blue Cross & Blue Shield of Illinois, Defendant, represented by Richard John Tyler , Jones Walker, Covert J. Geary , Jones Walker & Daniel John Hofmeister, Jr. , Reed Smith, LLP, pro hac vice.

Blue Cross & Blue Shield of Illinois, incorrectly named as BlueCross BlueShield of Illinois, Defendant, represented by Kevin Dale Tessier , Reed Smith, LLP, pro hac vice, Martin James Bishop , Reed Smith, LLP, pro hac vice, Michael C. Drew , Jones Walker & Tyler J. Rench , Jones Walker.

Blue Cross & Blue Shield of Mississippi, incorrectly named as BlueCross BlueShield of Mississippi, Defendant, represented by Richard John Tyler , Jones Walker, Covert J. Geary , Jones Walker, Michael C. Drew , Jones Walker & Tyler J. Rench , Jones Walker.

Blue Cross and Blue Shield of Alabama, incorrectly named as BlueCross BlueShield of Alabama, Defendant, represented by Richard John Tyler , Jones Walker, Covert J. Geary , Jones Walker, Joseph C. Davis , Jones Walker, Michael C. Drew , Jones Walker & Tyler J. Rench , Jones Walker.

Regence BlueCross BlueShield of Oregon, incorrectly named as BlueCross BlueShield of Oregon, Defendant, represented by Richard John Tyler , Jones Walker, Covert J. Geary , Jones Walker, Joseph C. Davis , Jones Walker, Michael C. Drew , Jones Walker & Tyler J. Rench , Jones Walker.

Blue Cross and Blue Shield of Oklahoma, incorrectly named as BlueCross BlueShield of Oklahoma, Defendant, represented by Richard John Tyler , Jones Walker, Covert J. Geary , Jones Walker, Daniel John Hofmeister, Jr. , Reed Smith, LLP, pro hac vice, Joseph C. Davis , Jones Walker, Kevin Dale Tessier , Reed Smith, LLP, pro hac vice, Martin James Bishop , Reed Smith, LLP, pro hac vice, Michael C. Drew , Jones Walker & Tyler J. Rench , Jones Walker.

Wellmark, Inc., incorrectly named as BlueCross BlueShield of Iowa doing business as Wellmark Blue Cross and Blue Shield of Iowa, Defendant, represented by Richard John Tyler , Jones Walker, Covert J. Geary , Jones Walker, Joseph C. Davis , Jones Walker, Michael C. Drew , Jones Walker & Tyler J. Rench , Jones Walker.

Blue Cross and Blue Shield of Nebraska, Inc., incorrectly named as BlueCross BlueShield of Nebraska, Defendant, represented by Richard John Tyler , Jones Walker, Covert J. Geary , Jones Walker, Joseph C. Davis , Jones Walker, Michael C. Drew , Jones Walker & Tyler J. Rench , Jones Walker.

Highmark Inc, incorrectly named as BlueCross BlueShield of Highmark, Defendant, represented by Richard John Tyler , Jones Walker, Covert J. Geary , Jones Walker, Michael C. Drew , Jones Walker & Tyler J. Rench , Jones Walker.

Blue Cross of California, incorrectly named as BlueCross BlueShield Anthem, Defendant, represented by Richard John Tyler , Jones Walker, Allison M. Holt , Hogan Lovells US LLP, pro hac vice, Covert J. Geary , Jones Walker, Michael C. Drew , Jones Walker & Peter R. Bisio , Hogan Lovells US LLP, pro hac vice.

Premera Blue Cross, incorrectly named as BlueCross BlueShield Premera, Defendant, represented by Richard John Tyler , Jones Walker, Covert J. Geary , Jones Walker, Joseph C. Davis , Jones Walker, Michael C. Drew , Jones Walker & Tyler J. Rench , Jones Walker.

Blue Cross and Blue Shield of North Carolina, incorrectly named as BlueCross BlueShield of North Carolina, Defendant, represented by Richard John Tyler , Jones Walker, Covert J. Geary , Jones Walker, Joseph C. Davis , Jones Walker, Michael C. Drew , Jones Walker & Tyler J. Rench , Jones Walker.

Arkansas Blue Cross and Blue Shield, a Mutual Insurance Company, incorrectly named as BlueCross BlueShield of Arkansas, Defendant, represented by Harry Joseph Philips, Jr. , Taylor, Porter, Brooks & Phillips LLP, Richard John Tyler , Jones Walker, Benjamin R. Dryden , Jones Walker, pro hac vice, Mary Lenore Feeney , Taylor, Porter, Brooks & Phillips LLP, Michael C. Drew , Jones Walker, Michael A. Naranjo , Jones Walker, pro hac vice & Tyler J. Rench , Jones Walker.

Blue Cross and Blue Shield of Tennessee, incorrectly named as BlueCross BlueShield of Tennessee, Defendant, represented by Richard John Tyler , Jones Walker, Covert J. Geary , Jones Walker, Michael C. Drew , Jones Walker & Tyler J. Rench , Jones Walker.

Anthem Health Plans, Inc., incorrectly named Blue Cross Blue Shield of Connecticut and Anthem Blue Cross and Blue Shield of Connecticut doing business as Anthem Blue Cross and Blue Shield, Defendant, represented by Carolyn A. DeLone , Hogan Lovells US LLP, pro hac vice, Richard John Tyler , Jones Walker, Allison M. Holt , Hogan Lovells US LLP, pro hac vice, Covert J. Geary , Jones Walker, Michael C. Drew , Jones Walker & Peter R. Bisio , Hogan Lovells US LLP, pro hac vice.

Anthem Plans of Maine, Inc., incorrectly named BlueCross BlueShield of Maine and Anthem Blue Cross and Blue Shield of Maine doing business as Anthem Blue Cross and Blue Shield, Defendant, represented by Richard John Tyler , Jones Walker, Allison M. Holt , Hogan Lovells US LLP, pro hac vice, Covert J. Geary , Jones Walker, Michael C. Drew , Jones Walker & Peter R. Bisio , Hogan Lovells US LLP, pro hac vice.

Community Insurance Company, Incorrectly named BlueCross BlueShield of Ohio; and Blue Cross and Blue Shield of Ohio doing business as Anthem Blue Cross and Blue Shield, Defendant, represented by Richard John Tyler , Jones Walker, Covert J. Geary , Jones Walker & Michael C. Drew , Jones Walker.

Anthem Health Plans of Virginia, Inc., doing business as Anthem Blue Cross and Blue Shield of Virginia, Defendant, represented by Richard John Tyler , Jones Walker, Allison M. Holt , Hogan Lovells US LLP, pro hac vice, Covert J. Geary , Jones Walker, Michael C. Drew , Jones Walker, Peter R. Bisio , Hogan Lovells US LLP, pro hac vice & Tyler J. Rench , Jones Walker.

BCBSM, Inc., incorrectly named BlueCross BlueShield of Minnesota and Anthem Blue Cross and Blue Shield of Minnesota doing business as Blue Cross and Blue Shield of Minnesota, Defendant, represented by Richard John Tyler , Jones Walker, Covert J. Geary , Jones Walker, Michael C. Drew , Jones Walker & Tyler J. Rench , Jones Walker.

Anthem Health Plans of Maine, Inc., incorrectly named BlueCross BlueShield of Maine and Anthem Blue Cross and Blue Shield of Maine doing business as Anthem Blue Cross and Blue Shield, Defendant, represented by Richard John Tyler , Jones Walker, Allison M. Holt , Hogan Lovells US LLP, pro hac vice, Covert J. Geary , Jones Walker, Michael C. Drew , Jones Walker, Peter R. Bisio , Hogan Lovells US LLP, pro hac vice & Tyler J. Rench , Jones Walker.

Anthem BlueCross BlueShield of Colorado, Defendant, represented by Carolyn A. DeLone , Hogan Lovells US LLP, pro hac vice, Richard John Tyler , Jones Walker, Allison M. Holt , Hogan Lovells US LLP, pro hac vice, Covert J. Geary , Jones Walker, Michael C. Drew , Jones Walker, Peter R. Bisio , Hogan Lovells US LLP, pro hac vice & Tyler J. Rench , Jones Walker.

Antham BlueCross BlueShield of Connecticut, Defendant, represented by Carolyn A. DeLone , Hogan Lovells US LLP, pro hac vice, Richard John Tyler , Jones Walker, Allison M. Holt , Hogan Lovells US LLP, pro hac vice, Covert J. Geary , Jones Walker, Michael C. Drew , Jones Walker, Peter R. Bisio , Hogan Lovells US LLP, pro hac vice & Tyler J. Rench , Jones Walker.

Anthem BlueCross BlueShield of Kentucky, Defendant, represented by Carolyn A. DeLone , Hogan Lovells US LLP, pro hac vice, Richard John Tyler , Jones Walker, Allison M. Holt , Hogan Lovells US LLP, pro hac vice, Covert J. Geary , Jones Walker, Michael C. Drew , Jones Walker, Peter R. Bisio , Hogan Lovells US LLP, pro hac vice & Tyler J. Rench , Jones Walker.

Anthem BlueCross BlueShield of Maine, Defendant, represented by Carolyn A. DeLone , Hogan Lovells US LLP, pro hac vice, Richard John Tyler , Jones Walker, Allison M. Holt , Hogan Lovells US LLP, pro hac vice, Covert J. Geary , Jones Walker, Michael C. Drew , Jones Walker, Peter R. Bisio , Hogan Lovells US LLP, pro hac vice & Tyler J. Rench , Jones Walker.

Anthem BlueCross BlueShield of Nevada, Defendant, represented by Carolyn A. DeLone , Hogan Lovells US LLP, pro hac vice, Richard John Tyler , Jones Walker, Allison M. Holt , Hogan Lovells US LLP, pro hac vice, Michael C. Drew , Jones Walker, Peter R. Bisio , Hogan Lovells US LLP, pro hac vice & Tyler J. Rench , Jones Walker.

Anthem BlueCross BlueShield of Wisconsin, Defendant, represented by Carolyn A. DeLone , Hogan Lovells US LLP, pro hac vice, Richard John Tyler , Jones Walker, Allison M. Holt , Hogan Lovells US LLP, pro hac vice, Covert J. Geary , Jones Walker, Michael C. Drew , Jones Walker, Peter R. Bisio , Hogan Lovells US LLP, pro hac vice & Tyler J. Rench , Jones Walker.

BlueCross BlueShield of California, Defendant, represented by Richard John Tyler , Jones Walker & Michael C. Drew , Jones Walker.

BlueCross BlueShield of North Carolina, Defendant, represented by Richard John Tyler , Jones Walker, Michael C. Drew , Jones Walker & Tyler J. Rench , Jones Walker.

BlueCross BlueShield of Minnesota, Defendant, represented by Richard John Tyler , Jones Walker, Michael C. Drew , Jones Walker & Tyler J. Rench , Jones Walker.

Anthem BlueCross BlueShield of California, Defendant, represented by Carolyn A. DeLone , Hogan Lovells US LLP, pro hac vice, Richard John Tyler , Jones Walker, Covert J. Geary , Jones Walker, Michael C. Drew , Jones Walker & Tyler J. Rench , Jones Walker.

Anthem BlueCross BlueShield of Mississippi, Defendant, represented by Carolyn A. DeLone , Hogan Lovells US LLP, pro hac vice, Richard John Tyler , Jones Walker & Michael C. Drew , Jones Walker.

BlueCross BlueShield of Arkansas, Defendant, represented by Richard John Tyler , Jones Walker, Michael C. Drew , Jones Walker & Tyler J. Rench , Jones Walker.

BlueCross BlueShield of Colorado, Defendant, represented by Richard John Tyler , Jones Walker & Michael C. Drew , Jones Walker.

BlueCross BlueShield of California Directors Guild of America, Defendant, represented by Richard John Tyler , Jones Walker.

BlueCross BlueShield of Connecticut, Defendant, represented by Richard John Tyler , Jones Walker, Michael C. Drew , Jones Walker & Tyler J. Rench , Jones Walker.

BlueCross BlueShield of Delaware, Defendant, represented by Richard John Tyler , Jones Walker, Covert J. Geary , Jones Walker & Michael C. Drew , Jones Walker.

BlueCross BlueShield of Georgia, Defendant, represented by Richard John Tyler , Jones Walker, Allison M. Holt , Hogan Lovells US LLP, pro hac vice, Michael C. Drew , Jones Walker, Peter R. Bisio , Hogan Lovells US LLP, pro hac vice & Tyler J. Rench , Jones Walker.

BlueCross BlueShield of Hawaii, Defendant, represented by Richard John Tyler , Jones Walker.

BlueCross BlueShield of Idaho, Defendant, represented by Richard John Tyler , Jones Walker & Michael C. Drew , Jones Walker.

BlueCross BlueShield of Indiana, Defendant, represented by Richard John Tyler , Jones Walker, Michael C. Drew , Jones Walker & Tyler J. Rench , Jones Walker.

BlueCross BlueShield of Iowa, Defendant, represented by Richard John Tyler , Jones Walker & Michael C. Drew , Jones Walker.

BlueCross BlueShield of Kentucky, Defendant, represented by Richard John Tyler , Jones Walker & Michael C. Drew , Jones Walker.

BlueCross BlueShield of Louisiana Office of Group Benefits, Defendant, represented by Richard John Tyler , Jones Walker.

BlueCross BlueShield of Maine, Defendant, represented by Richard John Tyler , Jones Walker & Michael C. Drew , Jones Walker.

BlueCross BlueShield of Maryland, Defendant, represented by Richard John Tyler , Jones Walker.

BlueCross BlueShield of Massachusetts, Defendant, represented by Richard John Tyler , Jones Walker.

BlueCross BlueShield of Michigan, Defendant, represented by Richard John Tyler , Jones Walker, Michael Regis Colasanti , Bodman LLP, pro hac vice, Michael C. Drew , Jones Walker, Thomas Paul Van Dusen , Bodman, PLC, pro hac vice & Tyler J. Rench , Jones Walker.

BlueCross BlueShield of Missouri, Defendant, represented by Richard John Tyler , Jones Walker, Allison M. Holt , Hogan Lovells US LLP, pro hac vice, Covert J. Geary , Jones Walker, Michael C. Drew , Jones Walker, Peter R. Bisio , Hogan Lovells US LLP, pro hac vice & Tyler J. Rench , Jones Walker.

BlueCross BlueShield of Montana, Defendant, represented by Richard John Tyler , Jones Walker, Covert J. Geary , Jones Walker, Daniel John Hofmeister, Jr. , Reed Smith, LLP, pro hac vice, Joseph C. Davis , Jones Walker, Kevin Dale Tessier , Reed Smith, LLP, pro hac vice, Martin James Bishop , Reed Smith, LLP, pro hac vice & Tyler J. Rench , Jones Walker.

BlueCross BlueShield of Mountain West Virginia, Defendant, represented by Richard John Tyler , Jones Walker.

BlueCross BlueShield of Nebraska, Inc., Defendant, represented by Richard John Tyler , Jones Walker, Michael C. Drew , Jones Walker & Tyler J. Rench , Jones Walker.

BlueCross BlueShield of New Jersey, Defendant, represented by Richard John Tyler , Jones Walker.

BlueCross BlueShield of New Mexico, Defendant, represented by Richard John Tyler , Jones Walker, Covert J. Geary , Jones Walker, Daniel John Hofmeister, Jr. , Reed Smith, LLP, pro hac vice, Joseph C. Davis , Jones Walker, Kevin Dale Tessier , Reed Smith, LLP, pro hac vice, Martin James Bishop , Reed Smith, LLP, pro hac vice, Michael C. Drew , Jones Walker & Tyler J. Rench , Jones Walker.

BlueCross BlueShield of New York, Defendant, represented by Richard John Tyler , Jones Walker.

BlueCross BlueShield of Ohio, Defendant, represented by Richard John Tyler , Jones Walker, Michael C. Drew , Jones Walker & Tyler J. Rench , Jones Walker.

BlueCross BlueShield of Oregon, Defendant, represented by Richard John Tyler , Jones Walker & Michael C. Drew , Jones Walker.

BlueCross BlueShield of Pennsylvania, Defendant, represented by Richard John Tyler , Jones Walker & Michael C. Drew , Jones Walker.

BlueCross BlueShield of Rhode Island, Defendant, represented by Richard John Tyler , Jones Walker.

BlueCross BlueShield of Rochester New York, Defendant, represented by Richard John Tyler , Jones Walker.

BlueCross BlueShield of South Carolina, Defendant, represented by Richard John Tyler , Jones Walker.

BlueCross BlueShield of Tennessee, Defendant, represented by Richard John Tyler , Jones Walker, Covert J. Geary , Jones Walker, Joseph C. Davis , Jones Walker, Michael C. Drew , Jones Walker & Tyler J. Rench , Jones Walker.

BlueCross BlueShield of Utah, Defendant, represented by Richard John Tyler , Jones Walker.

BlueCross BlueShield of Vermont, Defendant, represented by Richard John Tyler , Jones Walker & Michael C. Drew , Jones Walker.

BlueCross BlueShield of Virginia, Defendant, represented by Richard John Tyler , Jones Walker, Michael C. Drew , Jones Walker & Tyler J. Rench , Jones Walker.

BlueCross BlueShield of Washington, Defendant, represented by Richard John Tyler , Jones Walker & Michael C. Drew , Jones Walker.

BlueCross BlueShield of West Virginia, Defendant, represented by Richard John Tyler , Jones Walker.

BlueCross BlueShield of Western New York, Defendant, represented by Richard John Tyler , Jones Walker.

Empire BlueCross BlueShield of New York, Defendant, represented by Richard John Tyler , Jones Walker, Allison M. Holt , Hogan Lovells US LLP, pro hac vice, Covert J. Geary , Jones Walker, Michael C. Drew , Jones Walker & Peter R. Bisio , Hogan Lovells US LLP, pro hac vice.

Highmark BlueCross BlueShield of Pennsylvania, Defendant, represented by Richard John Tyler , Jones Walker & Michael C. Drew , Jones Walker.

Highmark BlueCross BlueShield of West Virginia, Defendant, represented by Richard John Tyler , Jones Walker, Covert J. Geary , Jones Walker & Michael C. Drew , Jones Walker.

Premera BlueCross BlueShield of Washington, Defendant, represented by Richard John Tyler , Jones Walker & Michael C. Drew , Jones Walker.

Regence BlueCross BlueShield of Utah, Defendant, represented by Richard John Tyler , Jones Walker, Michael C. Drew , Jones Walker & Tyler J. Rench , Jones Walker.

Regence BlueCross BlueShield of Washington, Defendant, represented by Richard John Tyler , Jones Walker, Michael C. Drew , Jones Walker & Tyler J. Rench , Jones Walker.

Wellmark BlueCross BlueShield of Iowa, Defendant, represented by Richard John Tyler , Jones Walker & Michael C. Drew , Jones Walker.

Touro Infirmary, Movant, represented by Franklin David Beahm , Beahm & Green & Christopher Gerald Otten , Beahm & Green.


ORDER AND REASONS

Before the Court is Defendants' motion for partial summary judgment filed March 14, 2016.1 For the reasons below, the motion is GRANTED IN PART and DENIED IN PART.

BACKGROUND

The members of Plaintiff...

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