Optum, Inc. v. Optum Wellness PLLC, txedc:4:2020cv00583

Hospital admission counseling services; patient healthcare support services in the nature of health care decision support counseling and health care planning for individuals at risk of needing intensive treatment; medical case management and disease management services, namely, disease-specific information and medical care resources to assist patients in managing their own health care and to reinforce the treatment plan; providing information in the field of health care;

Health care advocacy services to members of health benefit plans; individualized health care coordination services, namely, facilitating an array of services, namely, medical care services, behavior health services, and health care management;

[printed materials, namely, pamphlets, magazines, brochures regarding physical and mental health, substance abuse, legal and financial issues, and daily living problems];

employee assistance services, namely, providing online, telephonic, and in-person consultation, information, assessment, and referral services for physical, and mental health, and substance abuse; and referral services for legal and financial issues and work and family problems;

Nurse information services, namely, nurse triage and nurse call centers providing information regarding the identification of specific health related concerns and general health issues;

employee assistance services; namely, telephonic assessment and referral services for mental health, substance abuse and daily living problems;

[ Catalog ordering service featuring medical equipment, medical supplies, health products, home care products, diabetic testing supplies, and durable medical equipment; ] On-line ordering services featuring medical equipment, [ medical supplies, ] health products, home care products, diabetic testing supplies, and durable medical equipment; telephone ordering service featuring medical equipment, medical supplies, health products, home care products, diabetic testing supplies, and durable medical equipment [ ; arranging of managed care contractual services in the fields of home health care and durable medical equipment; providing consumer information in the field of durable medical equipment ];

Providing information in the fields of sleep apnea and related sleep disorders, and diabetes;

[ Printed materials, namely, pamphlets, magazines, and brochures regarding physical and mental health, substance abuse, legal and financial issues, and daily living problems; newsletters in the fields of health care and employee assistance services ];

[ Referral services for legal and financial issues and work and family problems; employee assistance services, namely, telephonic assessment and referral services for mental health, substance abuse, daily living problems, and personal problems; health care utilization and review services; managed care services, namely, utilization review and pre-certification services;] medical cost management; [ medical case management and disease management services, namely, medical referral of individuals to appropriate health management programs; organizing and administering networks of health care providers; health care cost management and review services, namely, assessing appropriateness of medical procedures and providing opinions and options related to same; organizing and administering networks of health care provider specialists in the areas of chronic and complex diseases, catastrophic illness and surgery; providing medical business directory information services regarding health care professionals and health care provider organizations; promoting the medical services of others by dissemination of prior effectiveness record information indicating that the providers meet certain criteria; development and administration of group purchasing programs as a value-added employee benefit; medical and health-care cost/price analysis; administration of a discount program for enabling participants to obtain health care services from a network of health care providers; health care cost management services for health benefit plans of others; business management consultation, namely, development of health care delivery systems for independent practice associations, medical clinics and other forms of physician organizations; business consultation to the health care industry in the fields of the development and implementation of policies, practices, and quality assurance; promoting the sale of credit card and debit card accounts through the administration of a discount program for enabling participants to obtain discounts on goods and services through use of discount membership cards and purchasing with a credit card or debit card; promoting the goods and services of others through the distribution of discount membership cards; accounts receivable services; administration and reconciliation of accounts on behalf of others; administration of business payroll for others; providing computerized database and telephone communication management services, namely, aggregating and organizing electronic transmissions of voice mail, electronic mail and facsimile messages, and providing telephone answering services; providing health-related consumer information and information about health providers via a global computer network ];

[ Insurance claims administration; insurance claims processing; administration of pre-paid health care plans in the fields of chiropractic, physical medicine, and complementary and alternative medicines; insurance services, namely, underwriting insurance and reinsurance for pre-paid health care and health insurance; insurance underwriting in the field of excess risk and medical insurance, and insurance administration related thereto including managed care services; insurance and financial services, namely, verifying insurance eligibility, processing and facilitating insurance copayment transactions, administration of employee benefits plans, banking services, credit card services, debit card services, issuing stored value cards, administering deposit and medical spending accounts, consumer lending services, electronic funds transfer, administration of defined contribution plans, administration of health care plans, health transaction clearinghouse services, management of revenue and expense transactions for providers of health and medical products and services; on-line services for health care practitioners, namely, providing transaction services to health care practitioners via an on-line computer network, namely, insurance eligibility and verification, referral authorizations, billing and payment in the insurance field; business banking services; credit and debit card transaction processing services; investment consultation, brokerage and management services; financial investment services in the fields of securities, mutual funds, certificates of deposit, and portfolio management; accounts payable services; mortgage banking services, mortgage lending services, mortgage brokerage services; consumer loans and checking and savings account services; commercial lending services; issuing letters of credit; foreign exchange services, namely, foreign exchange transactions; foreign exchange information services and providing for the exchange of foreign currency; financial consultation for educational financial assistance and student loan services; treasury management services; trust management services; cash management services; online banking services; online business banking services; bill payment services; electronic processing and transmission of bill payment data; providing information regarding banking, credit, money management, investing, investments and financial matters; counseling in the field of banking and financial services; provision of consolidated reports of banking and financial activity; financial services, namely, mortgage loan services, home equity financing and revolving lines of credit; insurance brokerage; administration, financial management and maintenance of health savings accounts, medical savings accounts, health reimbursement arrangements and flexible spending accounts; offering consumer-driven health care plans, namely, underwriting, administration, financing, and maintenance of consumer-driven health care plans and defined contribution health care plans; trustee services; employee assistance services, namely, providing online, telephonic and in-person consultation and information regarding daily living problems in the fields of retirement, life-event financial planning, and credit card and other debt ];

[ Instant messaging services and e-mail messaging services, namely, providing real time electronic messaging and electronic communications to individuals regarding their health and well-being concerns; providing multiple-use access to a global computer information network in the field of health care ];

Education services, namely, conducting seminars, courses, conferences, audio conferences, and online seminars in the fields of continuing medical education and health care and well-being, and distribution of course materials in connection therewith;

[ Database development services in the field of health care; computer services, namely, providing analysis of computer databases in the field of health care; providing temporary use of on-line non-downloadable software for health risk assessment and profiling for use in the field of preventative health; quality assurance services in the field of health care; providing temporary use of non-downloadable health database management software for use in evaluating a person or population's health status by analyzing answers to a questionnaire and generating a report that provides behavior modification suggestions to reduce health risks; and enabling practitioners to exchange clinical and laboratory information with laboratories and other healthcare participants; providing health information and analysis in the nature of the performance of and quality of care provided by hospitals, clinics and other health care providers via a global computer network ];

[ Hospital admission counseling services; patient health care support services in the nature of health care decision support counseling and health care planning for individuals at risk of needing intensive treatment; ]health care services, namely, disease management programs; medical case management and disease management services, namely, disease-specific information and medical care resources to assist patients in managing their own health care and to reinforce the treatment plan; providing health information; [ employee assistance services, namely, providing online, telephonic and in-person consultation and information regarding physical and mental health, and substance abuse; employee assistance services, namely, providing online, telephonic and in-person consultation and information in the fields of aging, chronic condition support, medications and drug interactions, special needs assistance, and pet care; employee assistance services, namely, providing online, telephonic and in-person consultation and information regarding daily living problems in the fields of parenting, childcare, and eldercare as they related to health and well being; providing information regarding the outcomes, structure, processes, and effectiveness of health care professionals and health care provider organizations to health plan members for use in evaluating and selecting health care professionals and health care provider organizations; nurse information services, namely, nurse triage and nurse call centers providing information regarding specific health-related concerns and general health issues; ] health care consulting and health care counseling services in the field of preventative health care and total health management, namely, establishing health risk assessment profiles to identify personal and group health risks, personal and group health risk counseling, health care counseling in the field of health risk intervention, health promotion, health risk and behavior modification, and preventative medical assessment and screening; [ health care services, namely, preventative medical assessment and screening; consulting services in the field of medical triage protocols, policies, and practices; online services for health care practitioners, namely, providing a database featuring news and information in the fields of medicine for practitioners ];

[ Health care advocacy services to members of health benefit plans; individualized health care coordination services, namely, facilitating an array of services, namely, medical care services, behavioral health services, and health care management ];