Rachel Condry v. Unitedhealth Group, Inc., 20-16823

Background

Plaintiffs sued UnitedHealthcare under the ACA and ERISA after being denied reimbursement for out-of-network lactation services and receiving allegedly inadequate denial letters explaining the denials.
The ACA and HRSA guidelines require coverage of comprehensive lactation services, but regulations permit plan administrators to decline reimbursement for out-of-network lactation care when in-network providers are available.
The district court issued partial summary judgment rulings and certified two classes (a "Denial Letter Class" and a "Claims Reprocessing Class"); Teresa Harris sought to intervene late in the proceedings.
After those rulings, parties entered a partial settlement that resolved several named plaintiffs’ reimbursement claims and preserved an appeal; the settlement converted several interlocutory rulings into final, appealable orders.
On appeal the Ninth Circuit considered: appellate jurisdiction, Harris’s intervention, summary judgment on reimbursement claims, Article III standing and mootness for full-and-fair-review claims, class certification for the Denial Letter and Claims Reprocessing classes, and the permanent injunction issued for the Denial Letter Class.

Issues

Issue	Plaintiff's Argument	Defendant's Argument	Held
Appellate jurisdiction over cross-appeals	Parties may appeal because the partial settlement resolved all claims, making prior interlocutory rulings final	Settlement did not manufacture jurisdiction; appeals are proper under §1291	Court has jurisdiction: settlement rendered the interlocutory rulings final under §1291.
Harris’s motion to intervene (permissive and as of right)	Harris sought permissive intervention and intervention as of right to pursue claims	Permissive intervention would prejudice United; appeal of denial as of right was untimely	Denial of permissive intervention was not an abuse of discretion (appeal dismissed); appeal of as-of-right denial untimely (no jurisdiction).
Reimbursement claims (Condry & Barber)	ACA/HRSA require coverage and reimbursement for lactation services	Plaintiffs used out-of-network providers while in-network specialists were available; regs do not require reimbursement in that circumstance	Affirmed summary judgment for United; no reimbursement obligation.
Full-and-fair-review (Condry & Barber) — standing	Denial letters were cursory/confusing, violating ERISA claims-processing rules and preventing meaningful challenge	Even a procedural deficiency cannot be redressed because plaintiffs are not entitled to reimbursement	No Article III standing; vacate and remand with instruction to dismiss Count 1 for lack of standing.
Full-and-fair-review (Bishop, Hoy, Endicott) — mootness	Plaintiffs’ claims sought reimbursement tied to denial letters	Partial settlement reimbursed or dismissed reimbursement claims, removing any stake	Claims mooted by settlement; vacate summary judgment and remand to dismiss as moot.
Denial Letter Class certification	Class should be certified based on uniform denial codes/letters	Determination requires individualized review of communications; lack of typicality and common proof	Certification was an abuse of discretion; vacate certification and dismiss class claim as moot.
Claims Reprocessing Class certification	Class for reprocessing improperly decided claims	United took non-uniform approaches; named plaintiffs’ claims were not typical of class	District court properly denied certification; class claim dismissed as moot.

Key Cases Cited

Dannenberg v. Software Toolworks Inc., 16 F.3d 1073 (9th Cir. 1994) (interlocutory appeals context)
Microsoft Corp. v. Baker, 137 S. Ct. 1702 (2017) (limits on converting interlocutory class rulings into immediate appeals)
Perry v. Proposition 8 Official Proponents, 587 F.3d 947 (9th Cir. 2009) (review standard for denial of permissive intervention on appeal)
Brown v. Cinemark USA, Inc., 876 F.3d 1199 (9th Cir. 2017) (addressing gamesmanship in creating appellate jurisdiction)
United States v. City of Oakland, 958 F.2d 300 (9th Cir. 1992) (timeliness rules for appeals of intervention denials)
Hamer v. Neighborhood Housing Servs. of Chi., 138 S. Ct. 13 (2017) (appeal-timeliness principles)
Lewis v. Cont'l Bank Corp., 494 U.S. 472 (1990) (standing requires redressable injury)
Spokeo, Inc. v. Robins, 136 S. Ct. 1540 (2016) (procedural violations alone may be insufficient for Article III injury)
TransUnion LLC v. Ramirez, 141 S. Ct. 2190 (2021) (concrete injury requirement for standing)
Thole v. U.S. Bank N.A., 140 S. Ct. 1615 (2020) (no ERISA exception to Article III)
Genesis Healthcare Corp. v. Symczyk, 569 U.S. 66 (2013) (settlement can moot an action for lack of personal stake)
United States v. Munsingwear, Inc., 340 U.S. 36 (1950) (vacatur and remand when a case becomes moot)
Franks v. Bowman Transp. Co., Inc., 424 U.S. 747 (1976) (class claims survive mooting of named plaintiffs only if certification was proper)
Harlick v. Blue Shield of Cal., 686 F.3d 699 (9th Cir. 2012) (ERISA claims-processing review considers the whole course of communications)
Saffon v. Wells Fargo & Co. Long Term Disability Plan, 522 F.3d 863 (9th Cir. 2008) (same)
U.S. Parole Comm'n v. Geraghty, 445 U.S. 388 (1980) (effect of mooted individual claims on class litigation)
Budinich v. Becton Dickinson & Co., 486 U.S. 196 (1988) (finality despite reservation of attorney's fees)