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Fresenius Medical Care Midwest Dialysis LLC v. Humana Insurance Co.

United States District Court, E.D. Wisconsin

February 5, 2018

FRESENIUS MEDICAL CARE MIDWEST DIALYSIS LLC, ., Plaintiffs,
v.
HUMANA INSURANCE COMPANY, et al., Defendants.

          DECISION AND ORDER

          WILLIAM E. DUFFIN U.S. Magistrate Judge.

         I. Background

         On September 5, 2017, the court denied plaintiffs' and defendants' cross motions for summary judgment. Fresenius Med. Care Midwest Dialysis LLC v. Humana Ins. Co., No. 16-CV-711, 2017 U.S. Dist. LEXIS 142970 (E.D. Wis. Sep. 5, 2017). The plaintiffs (collectively referred to as Fresenius) moved the court to reconsider that decision. (ECF No. 61.)

         “A court has the power to revisit prior decisions of its own or of a coordinate court in any circumstance, although as a rule courts should be loathe to do so in the absence of extraordinary circumstances such as where the initial decision was ‘clearly erroneous and would work a manifest injustice.'” Christianson v. Colt Indus. Operating Corp., 486 U.S. 800, 817 (1988) (quoting Arizona v. California, 460 U.S. 605, 618, n. 8 (1983)); see also DeKeyser v. ThyssenKrupp Waupaca Inc., No. 8-C-488, 2017 U.S. Dist. LEXIS 208217, at *7-8 (E.D. Wis. Dec. 19, 2017) (quoting Patrick v. City of Chicago, 103 F.Supp.3d 907, 911-12 (N.D. Ill. 2015) (“[M]otions for reconsideration under Rule 54(b) serve the limited function of correcting manifest errors of law or fact or to present newly discovered evidence.”)). “A manifest error of law or fact occurs ‘when there has been a significant change in the law or facts since the parties presented the issue to the court, when the court misunderstands a party's arguments, or when the court overreaches by deciding an issue not properly before it.'” Id. (quoting United States v. Ligas, 549 F.3d 497, 501-02 (7th Cir. 2008)). “In general, ‘litigants must fight an uphill battle in order to prevail on a motion for reconsideration.'” Williams v. Miscichoski, No. 06-C-1124, 2007 U.S. Dist. LEXIS 94831, at *3 (E.D. Wis. Dec. 14, 2007) (quoting United Air Lines, Inc. v. ALG, Inc., 916 F.Supp. 793, 795 (N.D. Ill. 1996)).

         II. Essential Health Benefit

         A short recap of the background of this case will help put the motion to reconsider in context. In simplified terms, the question presented by the parties' summary judgment motions was whether in 2013 the defendant health plans (whom the court will refer to collectively as Humana) could cap at $30, 000 per insured its coverage for dialysis that Fresenius provided to Humana's insureds. Fresenius contends that dialysis was an essential health benefit under the Patient Protection and Affordable Care Act (ACA), Pub. L. No. 111-148, and as such Humana had to provide at least $2 million in coverage for each insured for dialysis in 2013, see 45 C.F.R. § 147.126(d)(1)(iii) (Oct. 1. 2013 ed.).

         “Essential health benefit” is a term of art under the ACA that Congress left to the Secretary of the Department of Health and Human Services (HHS) to define. 42 U.S.C. § 18022(b)(1). But Congress said that essential health benefits shall include at least the following general categories and the items and services covered within the categories:

(A) Ambulatory patient services.
(B) Emergency services.
(C) Hospitalization.
(D) Maternity and newborn care.
(E) Mental health and substance use disorder services, including behavioral health treatment.
(F) Prescription drugs.
(G) Rehabilitative and habilitative services and devices. (H) ...

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