Spectera Inc. v. Wilson

The Court of Appeals erred in defining the phrases "any class of providers" and "classes of eye care providers" too broadly, inasmuch as it relied on the general dictionary definition of the word "class", as to O.C.G.A. § 33-24-59.12 c 5.

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This appeal is from the grant of a petition for a writ of certiorari from a decision issued by the Court of Appeals in Spectera, Inc. v. Wilson, 317 Ga. App. 64 730 SE2d 699 2012. The record shows that appellant Spectera is a vision care insurer providing eye care benefits coverage to Georgia residents. To provide eye care coverage for its insureds, Spectera contracts with different types of vision care providers including independent participating providers and retail chain providers. Appellee Steven M. Wilson is a licensed optometrist employed by Steven M. Wilson, O.D., P.C., providing eye care services in Lowndes County as Wilson Eye Center “WEC”. Appellees Cynthia McMurray, Jodie E. Summers, and David Price are also licensed optometrists employed by WEC. Prior to 2010, Spectera had entered provider contracts known as “Patriot contracts” with Wilson and McMurray and they became members of Spectera’s panel of eye care providers. Summers likewise was on Spectera’s panel of eye care providers. Under the Patriot contract, independent participating providers such as appellees could use their own materials lenses, frames, contacts or materials obtained from any other source to service Spectera insureds who came to them for their eye care needs. Appellees’ business practice was to keep an inventory of materials that it obtained from third parties. Under the Patriot contract, Spectera would reimburse appellees for the materials Spectera insureds used from WEC’s inventory by paying appellees a fee for their materials’ costs and by having Spectera insureds remit a materials co-payment to appellees. See Spectera, Inc. v. Wilson, supra, 317 Ga. App. at 68.

In 2010, Spectera decided to terminate its Patriot contracts and replace them with independent participating provider IPP agreements. Spectera’s IPP agreement describes “Covered Vision Services” as follows:

Spectera Inc. v. Wilson

The Court of Appeals erred in defining the phrases "any class of providers" and "classes of eye care providers" too broadly, inasmuch as it relied on the general dictionary definition of the word "class", as to O.C.G.A. § 33-24-59.12 c 5.

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