Cookson v. Ramge , 299 Neb. 128 ( 2018 )


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    03/09/2018 08:14 AM CST
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    Nebraska Supreme Court A dvance Sheets
    299 Nebraska R eports
    COOKSON v. RAMGE
    Cite as 
    299 Neb. 128
    A manda E. Cookson et al., appellants,
    v. Bruce R. R amge, director,
    Nebraska Department of
    Insurance, appellee.
    ___ N.W.2d ___
    Filed February 23, 2018.   No. S-17-521.
    1.	 Summary Judgment. Summary judgment is proper when the pleadings
    and evidence admitted at the hearing disclose that there is no genuine
    issue as to any material fact or as to the ultimate inferences that may be
    drawn from those facts and that the moving party is entitled to judgment
    as a matter of law.
    2.	 Declaratory Judgments: Statutes: Appeal and Error. When a declar-
    atory judgment action presents a question of law, such as statutory inter-
    pretation, an appellate court has an obligation to reach its conclusion
    independently of the conclusion reached by the trial court with regard
    to that question.
    3.	 Statutes: Legislature: Intent. In discerning the meaning of a statute,
    a court must determine and give effect to the purpose and intent of the
    Legislature as ascertained from the entire language of the statute con-
    sidered in its plain, ordinary, and popular sense, as it is the court’s duty
    to discover, if possible, the Legislature’s intent from the language of the
    statute itself.
    4	 ____: ____: ____. In order for a court to inquire into a statute’s legisla-
    tive history, the statute in question must be open to construction, and a
    statute is open to construction when its terms require interpretation or
    may reasonably be considered ambiguous.
    5.	 Insurance: Physician and Patient: Words and Phrases. A copayment
    is generally understood as the amount an insured must pay in order to
    receive a medical service.
    6.	 Statutes: Appeal and Error. An appellate court will not read into a
    statute a meaning that is not there.
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    COOKSON v. RAMGE
    Cite as 
    299 Neb. 128
    7.	 Statutes: Legislature: Intent. The intent of the Legislature may be
    found through its omission of words from a statute as well as its inclu-
    sion of words in a statute.
    Appeal from the District Court for Lancaster County: John
    A. Colborn, Judge. Affirmed.
    Mark D. Hill, Marnie A. Jensen, and Kamron T.M. Hasan,
    of Husch Blackwell, L.L.P., and, on brief, L. Steven Grasz,
    for appellants.
    Douglas J. Peterson, Attorney General, and David A. Lopez
    for appellee.
    John C. Hewitt and Jonathan J. Papik, of Cline, Williams,
    Wright, Johnson & Oldfather, L.L.P., for amicus curiae
    America’s Health Insurance Plans, Inc.
    Heavican, C.J., Miller-Lerman, Cassel, Stacy, K elch, and
    Funke, JJ.
    Cassel, J.
    INTRODUCTION
    Health insurance policyholders brought a declaratory judg-
    ment action to determine whether a statute1 allows insurance
    policies to impose higher copayments on policyholders when
    they obtain a covered service from a chiropractor rather than
    from a medical doctor. The district court concluded that it
    does. Because the plain language of the statute does not
    require insurance policies to charge identical copayments
    for a covered service regardless of the type of provider,
    we affirm.
    BACKGROUND
    Currently, health insurance policies in Nebraska are permit-
    ted to charge a policyholder a higher copayment if covered
    1
    
    Neb. Rev. Stat. § 44-513
     (Reissue 2010).
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    COOKSON v. RAMGE
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    services are obtained from a chiropractor rather than from a
    medical doctor. Three Nebraska residents and a nonprofit cor-
    poration (collectively Policyholders) filed a declaratory judg-
    ment action against the director of the Nebraska Department
    of Insurance. Policyholders requested an order declaring that
    § 44-513 precludes future approval of an insurance policy in
    Nebraska which requires a higher payment from a policyholder
    if the policyholder receives care for a covered service from
    a chiropractor rather than from a medical doctor, where both
    practitioners are in-network preferred providers and both are
    legally authorized to perform the service. Policyholders subse-
    quently moved for summary judgment.
    The district court overruled the motion for summary judg-
    ment and dismissed Policyholders’ complaint. The court rea-
    soned that the language of § 44-513 did not require insurers
    to pay the same dollar amount to all providers or to set equal
    copayments for policyholders. The court explained that the
    Legislature could have imposed equal copayment requirements
    if it wished to do so, and the court identified other statutes
    where the Legislature expressly invoked “‘copayments’ and
    other cost-sharing restrictions.”
    Policyholders filed a timely appeal, and we granted their
    petition to bypass review by the Nebraska Court of Appeals.
    ASSIGNMENT OF ERROR
    Policyholders assign that the district court erred in holding
    that § 44-513 allows insurance policies to discriminate against
    policyholders by charging a higher copayment if a policy-
    holder obtains a covered service from a chiropractor rather
    than from a medical doctor.
    STANDARD OF REVIEW
    [1] Summary judgment is proper when the pleadings
    and evidence admitted at the hearing disclose that there
    is no genuine issue as to any material fact or as to the
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    COOKSON v. RAMGE
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    ultimate inferences that may be drawn from those facts and
    that the moving party is entitled to judgment as a matter
    of law.2
    [2] When a declaratory judgment action presents a ques-
    tion of law, such as statutory interpretation, an appellate
    court has an obligation to reach its conclusion independently
    of the conclusion reached by the trial court with regard to
    that question.3
    ANALYSIS
    [3,4] The dispute centers on the meaning of § 44-513. In
    discerning the meaning of a statute, a court must determine
    and give effect to the purpose and intent of the Legislature as
    ascertained from the entire language of the statute considered
    in its plain, ordinary, and popular sense, as it is the court’s
    duty to discover, if possible, the Legislature’s intent from the
    language of the statute itself.4 In order for a court to inquire
    into a statute’s legislative history, the statute in question must
    be open to construction, and a statute is open to construction
    when its terms require interpretation or may reasonably be con-
    sidered ambiguous.5
    We begin by examining the statutory language. Section
    44-513 provides:
    Whenever any insurer provides by contract, policy,
    certificate, or any other means whatsoever for a service,
    or for the partial or total reimbursement, payment, or cost
    of a service, to or on behalf of any of its policyholders,
    group policyholders, subscribers, or group subscribers or
    any person or group of persons, which service may be
    2
    Doty v. West Gate Bank, 
    292 Neb. 787
    , 
    874 N.W.2d 839
     (2016).
    3
    See 
    id.
    4
    
    Id.
    5
    Stewart v. Nebraska Dept. of Rev., 
    294 Neb. 1010
    , 
    885 N.W.2d 723
    (2016).
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    legally performed by a person licensed in this state for
    the practice of osteopathic medicine and surgery, chi-
    ropractic, optometry, psychology, dentistry, podiatry, or
    mental health practice, the person rendering such service
    or such policyholder, subscriber, or other person shall be
    entitled to such partial or total reimbursement, payment,
    or cost of such service, whether the service is performed
    by a duly licensed medical doctor or by a duly licensed
    osteopathic physician, chiropractor, optometrist, psychol-
    ogist, dentist, podiatrist, or mental health practitioner.
    This section shall not limit the negotiation of preferred
    provider policies and contracts under sections 44-4101
    to 44-4113.
    To overly simplify: Whenever an insurer provides for a serv­
    ice, in whole or in part, the insured may obtain such service
    from one of the duly-licensed providers listed, so long as it is
    within the scope of the provider’s license.
    Policyholders argue that § 44-513 requires copayment par-
    ity, pointing to the statute’s language stating that if a policy
    covers the “partial . . . cost of a service,” the policyholder is
    “entitled to such partial . . . cost of such service.”
    [5,6] But the statute does not use the word “copayment”—
    a term often found in health insurance plans. A copayment is
    generally understood as the amount an insured must pay in
    order to receive a medical service6—not, as mentioned in the
    statute, an amount payable to or on behalf of an insured. An
    appellate court will not read into a statute a meaning that is
    not there.7 Thus, we cannot read the statute as requiring an
    equal copayment.
    6
    See, 
    Neb. Rev. Stat. § 44-3296
     (Reissue 2010); “co-payment,” Oxford
    English Dictionary Online, http://www.oed.com/view/Entry/250769 (last
    visited Feb. 16, 2018).
    7
    See Kerford Limestone Co. v. Nebraska Dept. of Rev., 
    287 Neb. 653
    , 
    844 N.W.2d 276
     (2014).
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    [7] The absence of “copayment” in § 44-513 is signifi-
    cant. The word “copayment” appears in 22 statutes8 located
    in chapter 44 of the Nebraska Revised Statutes, governing
    “Insurance.” Only the plural form of the word “copayment”
    appears in 11 additional statutes in the same chapter.9 The
    intent of the Legislature may be found through its omission
    of words from a statute as well as its inclusion of words in a
    statute.10 The omission of “copayment” in this insurance statute
    provides strong support for the position that the statute does
    not require equal copayments.
    Other statutes demonstrate the Legislature’s understanding
    of copayment parity. For example, one statute provides that
    a medical benefit contract “shall not impose upon any per-
    son who is a party to or beneficiary of the contract a fee or
    copayment not equally imposed upon any party or beneficiary
    utilizing a mail-order pharmacy.”11 Another dictates that the
    cost of an orally administered anticancer medication “shall not
    exceed the coinsurance or copayment that would be applied
    to any other cancer treatment involving intravenously admin-
    istered or injected anticancer medications.”12 And yet another
    provides that coverage for an autism spectrum disorder shall
    not be “subject to dollar limits, deductibles, copayments, or
    8
    See 
    Neb. Rev. Stat. §§ 44-3
    ,159(2) (Cum. Supp. 2016); 44-513.02(2)(a),
    44-784, 44-785(2), 44-790(6)(a), 44-796(1)(a), 44-798(2)(a), and 44-7,102(2)
    (Reissue 2010); 44-7,104(2) and (3) (Cum. Supp. 2016); 44-32,110 (Reissue
    2010); 44-4220.02(2) (Cum. Supp. 2016); and 44-4709(1)(b), 44-4717(5),
    44-5418(20), 44-6827(13), 44-6829(3), 44-7003(11), 44-7103(14),
    44-7203(12), 44-7303(21), and 44-8311(2)(c)(i) (Reissue 2010). See, also,
    § 44-3296.
    9
    See 
    Neb. Rev. Stat. §§ 44-789
     and 44-792(4) (Reissue 2010); 44-7,106(3)
    (Cum. Supp. 2016); and 44-32,105, 44-32,120(3), 44-32,129(6),
    44-4705(1)(c)(i), 44-5242.03, 44-6909.01, 44-7106(2)(b) and (n), and
    44-7108(2) (Reissue 2010).
    10
    Kerford Limestone Co. v. Nebraska Dept. of Rev., 
    supra note 7
    .
    11
    § 44-513.02(2)(a).
    12
    § 44-7,104(2).
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    coinsurance provisions that are less favorable to an insured
    than the equivalent provisions that apply to a general physi-
    cal illness under the policy.”13 Had the Legislature intended in
    § 44-513 to require an equal copayment regardless of the type
    of provider, it would have used language similar to that in the
    above statutes to evidence such an intent.
    It appears that the statute was enacted to prevent discrimi-
    nation in coverage by the insurer rather than discrimination
    in copayments charged to an insured. Policyholders argue
    that an insurance policy could effectively deny coverage for
    a chiropractor’s services by requiring a copayment equal to
    the cost of the service. To begin with, that is not the situation
    before us. While this hypothetical danger may be conceiv-
    able, it does not allow us to read a meaning into a statute
    that is not there. Statutory language requiring an insurer to
    pay for a service regardless of provider is not the same as
    requiring an insured to pay an identical copayment regardless
    of provider. If an insurer attempted to impose a copayment
    of the full cost of a service as a subterfuge to avoid cover-
    age, the gravamen of a complaint under the existing statute
    would be denial of equal coverage rather than inequality
    of copayments.
    Because the statute is clear, we do not rely upon legisla-
    tive history. But for the sake of completeness, we note that
    an examination of the history does not elucidate the matter.
    What is clear is that if an insurer provided for a service, then
    the policyholder was to have the right to use the services
    of one of the listed providers.14 The legislative history did
    not manifest an intent to mandate copayment parity. It cited
    “insurance equality”15 in one instance and contained several
    13
    § 44-7,106(3).
    14
    See Committee Statement, L.B. 487, Banking, Commerce and Insurance
    Committee, 77th Leg., 1st Sess. (Apr. 12, 1967).
    15
    Introducer’s Statement of Purpose, L.B. 196, Banking, Commerce and
    Insurance Committee, 80th Leg., 1st Sess. (Jan. 16, 1969).
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    references to prohibiting discrimination.16 But throughout
    the entirety of the legislative history, the word “copayment,”
    whether in singular or plural form, was not spoken. Because
    the statute’s plain language defeats Policyholders’ arguments,
    the issue of equality of copayments remains in the legisla-
    tive arena.
    CONCLUSION
    The plain language of § 44-513 does not prohibit an insurer
    from requiring different copayments for different types of pro-
    viders. We affirm the judgment of the district court.
    A ffirmed.
    Wright, J., not participating.
    16
    Banking, Commerce and Insurance Committee Hearing, L.B. 196, 80th
    Leg., 1st Sess. 10 (Jan. 27, 1969); Introducer’s Statement of Purpose, L.B.
    190, Banking, Commerce and Insurance Committee, 84th Leg., 1st Sess.
    (Jan. 27, 1975); Floor Debate, L.B. 190, 84th Leg., 1st Sess. 420 (Feb. 4,
    1975).