Spectera, Inc. v. Wilson

Spectera is a vision care insurer that provides eye care benefits coverage to Georgia residents. Appellee Steven M. Wilson is a licensed optometrist who provides eye care services in Lowndes County as Wilson Eye Center ("WEC"). Appellees Cynthia McMurray, Jodie E. Summers, and David Price are also licensed optometrists that work for WEC. Prior to 2010, Spectera had entered provider contracts ("Patriot contracts") with Wilson and McMurray and they became members of Spectera's panel of eye care providers. In 2010, Spectera decided to terminate its Patriot contracts and replace them with independent participating provider (IPP) agreements. Under the new agreement "[appellees] would no longer receive the reimbursement for materials from Spectera and would no longer be entitled to retain the materials co[-]pays from Spectera insureds." Appellees sued Spectera contending that Spectera's proposed IPP agreement violated various subsections of Georgia's Patient Access to Eye Care Act. While the case was pending, the trial court issued a temporary injunction prohibiting Spectera from forcing its panel of independent participating providers in Georgia to abide by the IPP agreement. After the trial court temporarily enjoined Spectera from enforcing its IPP agreement, Spectera sought to remove appellees Wilson, Summers, and McMurray from its approved panel of providers altogether; but the trial court enjoined Spectera from taking such action. Although appellee Price was not on Spectera's provider panel, he alleged Spectera violated the Act by denying him membership on its panel because of his refusal to sign the IPP agreement. The trial court granted the appellees' motions for summary judgment, denied Spectera's motion for summary judgment and issued a permanent injunction precluding Spectera from enforcing the restrictions contained in the IPP agreement as to "any other licensed eye care provider on [Spectera's] provider panel" or those who had applied to be on the panel. Spectera appealed the trial court's decision to the Court of Appeals which affirmed in part and reversed in part. The Court of Appeals found that the covered materials requirement in the IPP agreement violated subsections (c)(2) and (c)(5) of the Act in regard to independent optometrists. The issue before the Supreme Court was whether the Court of Appeals correctly construed OCGA 33-24-59.12 (c) of the Act. Because the IPP agreement did not create the type of impermissible discrimination between classes of licensed eye care providers contemplated by subsection (c)(5), the Court of Appeals was incorrect in its conclusion that the IPP agreement violated that subsection of the Act. Accordingly, the Court reversed that portion of the Court of Appeals' decision. The Act does not preclude insurers from terminating contracts with its existing eye care providers. "While Spectera's terminating its contracts with appellees Wilson, McMurray, and Summers may be an unpopular or ill-advised course of action, it cannot be said such action violates the Act." Therefore, that portion of the permanent injunction against Spectera was vacated. View "Spectera, Inc. v. Wilson" on Justia Law