Dental Services Are “Health Care” Under Louisiana’s PPO Act; PPO Act and Network Leasing Act Harmonized

Case: Wightman v. Ameritas Life Ins. Corp., No. 24-30775 (5th Cir. June 12, 2026)
Court: United States Court of Appeals for the Fifth Circuit

I. Introduction

Mark and Courtney Wightman (dentists) and their clinic, Wightman Family Dental, L.L.C. (collectively, the “Wightmans”), joined the DenteMax preferred provider network, agreeing to discounted fees for network subscribers in exchange for patient volume. Unbeknownst to the Wightmans, DenteMax separately contracted with Ameritas Life Insurance Corporation (“Ameritas”), permitting Ameritas to access DenteMax’s network and pay participating providers at DenteMax’s discounted rates.

The dispute erupted when Ameritas reimbursed the Wightmans at discounted rates despite benefit cards that, according to the Wightmans, did not clearly identify the PPO/discount arrangement. The Wightmans sued Ameritas (and initially DenteMax, which later settled), asserting claims including violations of Louisiana’s Preferred Provider Organization Act (“PPO Act”), La. Stat. Ann. § 40:2203.1, and non-statutory claims such as unjust enrichment.

On remand after a prior appeal concerning prescription, the district court granted summary judgment to Ameritas, holding (i) dental services are not “health care” under the PPO Act and (ii) the Wightmans had abandoned non-PPO Act claims in the earlier appeal. The Fifth Circuit reversed in significant part, clarifying statutory scope, remand obligations, and limits on a district court’s ability to declare appellate forfeiture.

II. Summary of the Opinion

  • PPO Act coverage: The Fifth Circuit held that dental services qualify as “health care” under Louisiana’s PPO Act, meaning dentists are “providers” within La. Stat. Ann. § 40:2202(6). Summary judgment for Ameritas on that ground was erroneous.
  • Network Leasing Act (“NLA”): The court rejected the notion that the later-enacted NLA implied dentists were unprotected under the PPO Act. The PPO Act and NLA address different conduct and can be read harmoniously in pari materia.
  • Judicial estoppel: The district court abused its discretion by applying judicial estoppel without articulating and applying the governing standard and without adequate findings to permit appellate review; remanded for fuller analysis.
  • Non-PPO Act claims: The district court erred by refusing to consider non-PPO Act claims on the theory the Wightmans “abandoned” them on appeal. Determining forfeiture in the court of appeals is for the appellate court, and the district court also violated the mandate rule.
  • Leave to amend: The denial of leave to amend was affirmed given the late stage and procedural history.

III. Analysis

A. Precedents Cited (and How They Shaped the Decision)

1. Prior proceedings in this litigation

  • Wightman v. Ameritas Life Ins. Corp., No. 21- 30148, 2023 WL 2940241 (5th Cir. Apr. 13, 2023)
    The panel relied on the earlier appeal for the case’s factual and procedural posture and, crucially, for the scope of what had (and had not) been decided previously. The 2023 panel reversed on prescription and expressly declined to reach “additional arguments,” stating it made “no determination” whether they were properly before it. That explicit limitation became central to the mandate-rule analysis on remand.

2. Standards governing summary judgment and legal questions

  • Kerns v. First State Bank of Ben Wheeler (In re Kerns), 130 F.4th 455 (5th Cir. 2025)
    Cited for de novo review of summary judgment, framing the appellate posture: the Fifth Circuit independently assessed whether Ameritas was entitled to judgment as a matter of law.
  • Hillman v. Loga, 697 F.3d 299 (5th Cir. 2012)
    Reinforced the obligation to view evidence and draw inferences in favor of the nonmovant (the Wightmans), important given the district court’s threshold statutory ruling.
  • Maxim Crane Works, L.P. v. Zurich Am. Ins. Co., 11 F.4th 345 (5th Cir. 2021)
    Supported the proposition that statutory interpretation is a legal issue appropriate for resolution at summary judgment—allowing the Fifth Circuit to directly correct the district court’s construction of “health care.”

3. Erie/State-law methodology and Louisiana interpretive principles

  • Vielma v. Eureka Co., 218 F.3d 458 (5th Cir. 2000) and Camacho v. Ford Motor Co., 993 F.3d 308 (5th Cir. 2021)
    Together, these anchored the court’s approach: interpret Louisiana statutes as the Louisiana Supreme Court would, using Louisiana’s methods.
  • Jorge-Chavelas v. La. Farm Bureau Cas. Ins. Co., 917 F.3d 847 (5th Cir. 2019)
    Emphasized Louisiana’s civilian methodology, in which constitutional and codal/statutory text is “paramount,” steering the court toward textual analysis.
  • Guerrera v. United Fin. Cas. Co., 161 F.4th 913 (5th Cir. 2025) (quoting Caldwell Par. Sch. Bd. v. La. Mach. Co., 2012-1383 (La. 1/29/13), 110 So. 3d 993)
    Provided the baseline rule: interpretation starts with statutory language, supporting the court’s use of ordinary meaning to decide whether dentistry falls within “health care.”
  • 84 Lumber Co. v. Cont'l Cas. Co., 914 F.3d 329 (5th Cir. 2019) and Seguin v. Remington Arms Co., 31 F.4th 311 (5th Cir. 2022)
    These framed the “clear and unambiguous” rule and, if ambiguous, the “best conforms to purpose” rule; the Fifth Circuit used these to justify relying on ordinary meaning and statutory purpose rather than inferring exclusions.
  • ABL Mgmt., Inc. v. Bd. of Sup'rs of S. Univ., 2000-0798 (La. 11/28/00), 773 So. 2d 131
    Supported holistic construction—reading the entire statutory scheme—underpinning the court’s harmonization of the PPO Act with the NLA.

4. Harmonization canons and “same word, same meaning”

  • United States v. Est. of Parsons, 367 F.3d 409 (5th Cir. 2004)
    Invoked for the interpretive canon that a word used in different parts of a statute should have the same meaning throughout. The court used this to rebut Ameritas’s attempt to narrow readings based on selective statutory context.
  • Anthony Crane Rental, L.P. v. Fruge, 2003-0115 (La. 10/21/03), 859 So. 2d 631
    Anchored the in pari materia approach: related statutes should be read together and reconciled where possible, which supported the conclusion that the NLA did not impliedly carve dentists out of PPO Act protections.

5. Appellate restraint and remand-first principles

  • PHH Mortg. Corp. v. Old Republic Nat'l Title Ins. Co., 80 F.4th 555 (5th Cir. 2023) and Students for Fair Admissions, Inc. v. Univ. of Tex. at Aus., 142 F.4th 819 (5th Cir. 2025)
    These supported the court’s choice not to affirm summary judgment on alternative grounds not adequately addressed below, instead remanding for first-instance consideration.

6. Judicial estoppel: elements, review standard, and the need for findings

  • In re Superior Crewboats, Inc., 374 F.3d 330 (5th Cir. 2004)
    Provided the abuse-of-discretion standard for reviewing judicial estoppel determinations.
  • United States v. Ahsani, 76 F.4th 441 (5th Cir. 2023)
    Supplied the definition of abuse of discretion relevant here: failure to identify/apply correct standards or failure to give sufficient reasons for appellate review.
  • Galaz v. Katona (In re Galaz), 841 F.3d 316 (5th Cir. 2016) and Reed v. City of Arlington, 650 F.3d 571 (5th Cir. 2011) (en banc)
    These set the core framework for judicial estoppel (inconsistent position; court acceptance of prior position; not inadvertent), while recognizing flexibility. The Fifth Circuit faulted the district court for not working through this framework.
  • Albemarle Paper Co. v. Moody, 422 U.S. 405 (1975)
    Cited for the principle that “discretionary choices” must be guided by “sound legal principles,” rejecting unreasoned equitable discretion.
  • Carmichael v. Balke (In re Imperial Petroleum Recovery Corp.), 84 F.4th 264 (5th Cir. 2023) and Occidental Petroleum Corp. v. Wells Fargo Bank, N.A., 117 F.4th 628 (5th Cir. 2024)
    Used to emphasize context-specific application and the need for an articulated rationale enabling meaningful appellate review.

7. Forfeiture, the mandate rule, and the limits on a district court’s role

  • Est. of Lisle v. Comm'r, 341 F.3d 364 (5th Cir. 2003)
    Cited for the proposition that the court of appeals may decline (or choose) to consider issues not raised in an initial brief—highlighting that forfeiture on appeal is an appellate, not trial-court, judgment call.
  • Deutsche Bank Nat'l Tr. Co. v. Burke, 902 F.3d 548 (5th Cir. 2018) (per curiam)
    Provided the mandate-rule principle: on remand, a district court must effect the appellate mandate “and do nothing else.” The district court violated this by treating the prior appeal as conclusively abandoning claims the Fifth Circuit expressly declined to decide.

8. Leave to amend

  • Rosenzweig v. Azurix Corp., 332 F.3d 854 (5th Cir. 2003)
    Supplied the abuse-of-discretion standard for denial of leave to amend; applied to affirm the district court given timing and procedural history.

B. Legal Reasoning

1. The core statutory holding: dentistry falls within “health care services”

The decisive legal question was whether the Wightmans are “providers” under La. Stat. Ann. § 40:2202(6), which covers entities offering “health care services” and includes a non-exhaustive list (hospitals, physicians, psychologists, nurse midwives, ambulance service companies, and “other health care entities”). The district court treated the absence of “dentists” as effectively excluding them—especially in light of the later NLA.

The Fifth Circuit instead adopted an ordinary-meaning, text-forward approach. It relied on general definitions:

  • “healthcare” as services by medical professionals to maintain and restore health (Black’s Law Dictionary);
  • “medicine” as preserving health and treating disease/injury (Black’s Law Dictionary);
  • “dentist” as licensed to prevent, diagnose, and treat diseases/injuries/malformations of teeth, jaws, and mouth (Webster’s).

Because the statutory definition is broad (“include but not be limited to”), and because dentistry fits comfortably within the ordinary concept of medical care, the court rejected Ameritas’s argument for a narrow, list-bound construction. The court also found persuasive corroboration in La. Att'y Gen. Op. No. 94-315 (Sept. 22, 1994), 1994 WL 553063, which explicitly stated dentists are covered as “provider[s]” under § 40:2202(6).

2. Relationship between the PPO Act and the NLA: harmonization, not displacement

The district court inferred that because Louisiana enacted the NLA to regulate “fair and transparent dental network contracting,” dentists must not have been protected under the PPO Act. The Fifth Circuit rejected that inference as a matter of statutory construction.

The court’s harmonization turned on function:

  • The PPO Act (including La. Stat. Ann. § 40:2203.1) targets point-of-care transparency—e.g., prohibiting discounted reimbursement unless the PPO/discount arrangement is clearly identified on the benefit card presented when care is provided.
  • The NLA (La. Stat. Ann. § 22:1172) regulates network-leasing permissions and disclosures in contracting—i.e., when a contracting entity can grant third parties access to a provider network contract and under what contractual prerequisites—and it is enforced by the Commissioner of Insurance, not via a private right of action.

Because the statutes can “be read together” and each given effect without redundancy, the court declined to treat the NLA as an implied limitation on the PPO Act. The opinion also noted amici (Louisiana Department of Insurance and Louisiana Dental Association) supporting the view that the statutes operate at different stages (contract formation versus point of care), reinforcing the court’s reconciliation.

3. Appellate restraint: remand rather than affirm on alternative grounds

Although the parties pressed additional grounds to affirm or defeat the PPO Act claims, the Fifth Circuit observed the district court had “largely avoided addressing other issues.” Applying its usual practice (PHH Mortg. Corp. v. Old Republic Nat'l Title Ins. Co.), it remanded for first-instance consideration rather than decide issues not squarely ruled on below.

4. Judicial estoppel: requiring a real analysis, not a label

The district court’s judicial estoppel ruling failed because it did not (i) identify the controlling test or (ii) make findings on key elements (especially whether a prior court “accepted” the earlier position and whether the inconsistent position was “inadvertent”). Under United States v. Ahsani and the judicial-estoppel framework of Reed v. City of Arlington, the appellate court found the lack of articulated reasoning prevented meaningful review and constituted an abuse of discretion. The Fifth Circuit took “no view” on whether estoppel ultimately applies, emphasizing that the error was analytical and procedural.

5. Non-PPO Act claims: the district court exceeded its role and violated the mandate rule

The Fifth Circuit identified two independent problems with the district court’s refusal to consider unjust enrichment and other non-PPO Act claims:

  • Forfeiture on appeal is for the appellate court to decide: Citing Est. of Lisle v. Comm'r, the court stressed that while an appellate court may decline to consider inadequately briefed issues, it may also choose to consider them. The district court cannot retroactively decide what the Fifth Circuit would or should have deemed forfeited.
  • Mandate rule violation: Under Deutsche Bank Nat'l Tr. Co. v. Burke, the remand court must effect the mandate. The 2023 panel expressly declined to address “additional issues” and made “no determination” whether they were properly before it; therefore, the district court erred in treating those issues as abandoned and foreclosed on remand.

C. Impact

  • Expanded (or clarified) PPO Act reach for dentistry in federal litigation: The holding squarely supports that dentists and dental clinics are “providers” offering “health care services” under La. Stat. Ann. § 40:2202(6). This materially strengthens dental providers’ ability to invoke La. Stat. Ann. § 40:2203.1 when benefit cards fail to clearly identify discounted-network access at the point of care.
  • Statutory “harmonization” limits implied-repeal arguments: Insurers and network administrators may have argued that the NLA displaced older PPO Act protections for dental providers. The opinion signals that courts should avoid that inference where the statutes regulate different conduct and can each be given effect.
  • Procedural discipline on remand: The decision reinforces that district courts must adhere closely to appellate mandates and should not “decide for” the court of appeals what was waived or forfeited on appeal—an important constraint in complex, multi-appeal litigation.
  • Judicial estoppel requires findings: The remand instruction on estoppel should prompt more rigorous element-by-element analysis, reducing the risk of estoppel being used as a shorthand to dispose of claims without an adequate record.

IV. Complex Concepts Simplified

  • PPO Act (La. Stat. Ann. § 40:2203.1): A Louisiana law aimed at transparency when discounted “preferred provider” rates are applied. In this case, its key requirement is that the PPO/discount arrangement must be clearly identified on the benefit card presented when care is provided, before the payer can reimburse at a discounted rate.
  • Provider definition (“include but not be limited to”): When a statute lists examples but says the list is not limited to them, the list is illustrative, not exclusive. The Fifth Circuit used that structure to reject “dentists aren’t listed, so they’re out.”
  • In pari materia: A rule that statutes on the same subject should be interpreted together to make the overall legal scheme coherent. Here, it allowed the PPO Act and the NLA to coexist—one focused on point-of-care card disclosures, the other on network-leasing permissions in contracts.
  • Judicial estoppel: An equitable doctrine preventing a party from taking inconsistent positions across proceedings when the earlier position was accepted by a court and the inconsistency is not inadvertent. It is discretionary, but not “anything goes”; courts must apply recognized elements and explain their reasoning.
  • Mandate rule: After an appeal, the district court must follow what the appellate court actually decided (the “mandate”) and cannot add new limitations inconsistent with it.

V. Conclusion

Wightman v. Ameritas Life Ins. Corp. establishes a consequential interpretive rule for Louisiana’s PPO Act: dental services are “health care” and dentists are “providers” within La. Stat. Ann. § 40:2202(6). It further clarifies that the later-enacted Network Leasing Act does not impliedly remove dentistry from PPO Act protections; the statutes can be harmonized to regulate different stages of network discounting (contracting versus point-of-care disclosure).

Procedurally, the opinion serves as a corrective on remand practice: district courts must obey the mandate rule, avoid deciding appellate forfeiture questions, and provide a reviewable, element-based analysis before invoking judicial estoppel. The case returns to the district court with key statutory doors reopened and multiple claims restored for proper consideration.