Court Dismisses Complaint Seeking Payment for MUA Procedures

Abstract

Montvale Surgical Center LLC, an outpatient ambulatory surgery center, performed three "medically necessary" spinal manipulations under anesthesia (MUA) procedures on New Jersey resident Gerald Tyska at its facility. Tyska subscribed to a fully-funded group health insurance plan maintained by Coventry Health Care Inc, and assigned his rights under the plan to Montvale. Montvale submitted requests for reimbursement to the plan, which denied the claims after it found the "MUA treatment administered to Tyska to be experimental and investigational, as well as not the national standard of care for the diagnosis given." Montvale sued Coventry for violating ERISA and for breach of contract under state law. Coventry moved to dismiss.