Tenth Circuit -- Weight Loss Healthcare Centers v. Office of Personnel Management

Weight Loss Healthcare Centers v. Office of Personnel Management

Deference is due OPM's interpretation of federal health care plans - standard of review is 'arbitrary and capricious.'

Plaintiff argues that as the contracts are written in plain language, courts should be as free as the agency to interpret - court holds that contract language need not be arcane to require expertise in its interpretation.

Possible circuit split with the 4th.

Key interpretation question is whether plan's commitment to pay the average cost incurred nationally refers to the present procedure or average of all outpatient procedures - court holds that, given context, it is the latter. 

Reasonable insured standard does not displace contractual language.

Remanded to OPM with instructions to verify the insurers' numbers.  Supporting evidence needed, or, in the alternative, a reason why it is not needed.