Andrea Lieberman v. United Healthcare Ins. Co., No. 10-12942 (11th Cir. 2011)
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[DO NOT PUBLISH] IN THE UNITED STATES COURT OF APPEALS FOR THE ELEVENTH CIRCUIT ________________________ FILED U.S. COURT OF APPEALS ELEVENTH CIRCUIT Nos. 10-12942 ; 10-13222 FEB 4, 2011 Non-Argument Calendar JOHN LEY ________________________ CLERK D.C. Docket No. 9:09-cv-81050-KAM ANDREA LIEBERMAN, individually and on behalf of all others similarly situated, lllllllllllllllllllllPlaintiff - Appellant, versus UNITED HEALTHCARE INSURANCE CO., lllllllllllllllllllllDefendant - Appellee. ________________________ Appeals from the United States District Court for the Southern District of Florida ________________________ (February 4, 2011) Before TJOFLAT, CARNES, and WILSON, Circuit Judges. PER CURIAM: This is an ERISA case. Andrea Lieberman s complaint alleges that United Healthcare Insurance Company ( United ) inappropriately denied her claim for out-of-network benefits under her employer s group health insurance plan. The district court disagreed and granted United s motion to dismiss Lieberman s complaint pursuant to Rule 12(b)(6) for failure to state a claim upon which relief may be granted.1 See Fed. R. Civ. P. 12(b)(6). Lieberman now appeals. Lieberman challenges the method United used to calculate a non-network benefit for a medical procedure received by her daughter from a doctor who had not agreed to join United s provider network or to accept the discounted rates United pays network providers. Although the Plan permits Lieberman to obtain reimbursement for healthcare services she and her family receives from a nonparticipating provider, the Certificate of Coverage specifically confers on United the discretion to choose from among four specified methodologies for calculating the eligible expenses. In Lieberman s view, United improperly and arbitrarily picked a reimbursement methodology that operated to minimize its financial responsibility, and as a result, she was left financially responsible for $9,763.16 of a $10,000 service. However, we agree with the district court that the Certificate expressly affords United the discretion to calculate reimbursement based on a 1 The court denied Lieberman s motion to alter or amend judgment, or for leave to file an amended complaint. We find no error in the court s ruling. 2 percentage of the relevant Medicare rate and that United had no obligation to select an alternative reimbursement methodology that would have yielded a higher reimbursement to Lieberman. As the district court correctly stated, Lieberman is asking the Court to rewrite the Certificate and prevent [United] from exercising the discretion granted to it under the Plan. Therefore, after carefully reviewing the briefs and the record, we find meritless Lieberman s challenge to the dismissal with prejudice of Counts I and IV of her complaint, and we dismiss as moot United s cross-claim that Lieberman failed to exhaust her administrative remedies. AFFIRMED AND DISMISSED. 3
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