NOT FOR PUBLICATION
MICHAEL A. SHIPP, District Judge.
This matter comes before the Court on Cross Motions for Summary Judgment. Defendant Amalgamated Local 298 ("Defendant") filed a Motion for Summary Judgment (ECF No. 65), and Plaintiffs Professional Orthopedic Associates, PA and Jason Cohen, M.D., F.A.C.S. (collectively, "Plaintiffs") filed a Cross Motion for Summary Judgment
In an earlier decision in this matter, the Court determined that "Defendant did not substantially comply with the notice requirements" under 29 C.F.R. § 2560.503-1. (June 17, 2016 Bench Decision Tr. 7:14-15, ECF No. 58.) In reaching its previous decision, the Court first acknowledged that "Plaintiffs did not receive the second [Explanation of Benefits (`EOB')] for an additional 506 days," upon receiving additional medical records from Plaintiffs. (Id. at 7:17-19.) The Court further determined that "this [procedural] irregularity coupled with the lack of information provided in either EOB and change in the benefit's determination between the EOBs cast[ed] doubt on Defendant's substantive conclusion." (Id. at 7:24-8:2.) The Court, accordingly, remanded the case "to the plan administrator to provide Plaintiffs with an [EOB] that complies with the statute and regulations." (Id. at 9:3-6.) In response to the Court's Order, Defendant delivered a new EOB to Plaintiffs. (Cutro Aff. Ex. I, ECF No. 65-9.) Plaintiffs now argue that that the new EOB again fails to comply with the applicable regulations. (See generally Pls.' Moving Br., ECF No. 66-1; Pls.' Reply Br., ECF No. 70.)
Here, in light of Defendant's benefit determination to pay $23,091.74 of Plaintiffs' claim for $205,357.00, the requirements under 29 C.F.R. § 2560.503-1(g)(1) apply to the new EOB.
In deciding this matter, the Court finds persuasive the Honorable Freda L. Wolfson, U.S.D.J.'s recent decision in C.E. v. Excellus Blue Cross Blue Shield, No. 14-6950, 2017 WL 593492 (D.N.J. Feb. 14, 2017). In Excellus, Judge Wolfson determined that an EOB provides an adequately specific reason for an adverse determination "when it specifically explains, for example, . . . [that] the charges exceeded the reasonable and customary fees." Id. at *10 (internal quotations omitted). Accordingly, the new EOB has satisfied this requirement. Additionally, the Court finds that Plaintiffs have failed to demonstrate any additional information the EOB should have identified as being relevant to Plaintiffs' claim.
The Court, however, agrees with Plaintiffs that the new EOB is deficient because it fails to reference specific Plan provisions and include adequate information with respect to the Captiva rate. As in Excellus, the new EOB merely contains general references to "the Plan" or the "terms of the Plan" and lacks reference to specific Plan provisions. See Excellus, 2017 WL 593492, at *10; (Cutro Aff. Ex. I, at 1-5.) Additionally, "[w]hile [Defendant] is not required to divulge all of the calculations utilized to determine the local fees, . . . it was required to identify, at the very least, what fee schedule was used as the local rates." Excellus, 2017 WL 593492, at *10. Defendant, therefore, was not required to identify the data underlying its formulation of the rates (i.e., the Context 4 HealthCare database) or methodology for calculating the rates, but was required to state that it applied the Captiva rate in the EOB. Accordingly, Defendant's failure to comply with Section 2560.503-1(g)(1) "negatively impacted . . . [Plaintiffs'] ability to have a full and fair review." Id.
For the foregoing reasons, the Court again remands to the plan administrator to issue a compliant EOB. The Court, therefore, DENIES Defendant's Motion for Summary Judgment and GRANTS Plaintiffs' Motion for Summary Judgment.