The opinion
Case: 24-30775 Document: 144-1 Page: 1 Date Filed: 06/12/2026
United States Court of Appeals
for the Fifth Circuit United States Court of Appeals
Fifth Circuit
____________ FILED
June 12, 2026
No. 24-30775 Lyle W. Cayce
____________ Clerk
Mark Wightman, Doctor of Dental Surgery; Courtney
Wightman, Doctor of Dental Surgery; Wightman Family Dental,
L.L.C.,
Plaintiffs—Appellants,
versus
Ameritas Life Insurance Corporation,
Defendant—Appellee.
______________________________
Appeal from the United States District Court
for the Eastern District of Louisiana
USDC No. 2:19-CV-11628
______________________________
Before Elrod, Chief Judge, and Higginbotham and Graves, Circuit
Judges.
James E. Graves, Jr., Circuit Judge:
Mark and Courtney Wightman own a small clinic called Wightman
Family Dental. They made a deal with DenteMax to discount their services
to its subscribers in exchange for access to new patients. But unbeknownst to
the Wightmans, DenteMax also made a deal with Ameritas to allow it to pay
DenteMax’s network providers, like the Wightmans, at the same discounted
rates. They discovered this after Ameritas refused to reimburse them at their
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standard rates. So, the Wightmans sued DenteMax and Ameritas, alleging
violations of Louisiana’s PPO Act, unjust enrichment, and more. The
district court granted summary judgment to Ameritas, concluding that the
Wightmans abandoned their non-PPO Act claims in a previous appeal and
that they cannot sue under the PPO Act because dental services are not
covered by its definition of healthcare. The Wightmans appeal.
I. Background
A. Factual History
The Wightmans contracted with DenteMax, a Preferred Provider
Organization (“PPO”) that owns a Preferred Provider Network. This
agreement allowed DenteMax to offer the Wightmans’ services at
discounted rates to its network subscribers and in return gave the Wightmans
access to a larger client pool. Wightman v. Ameritas Life Ins. Corp., No. 21-
30148, 2023 WL 2940241, at *1 (5th Cir. Apr. 13, 2023).
In 2012, Ameritas Life Insurance Corp. and DenteMax entered into a
separate agreement which allowed Ameritas to access DenteMax’s network
and reimburse providers, like the Wightmans, at discounted rates. See id.
Thus, Ameritas was able to offer its customers DenteMax’s rates for the
Wightmans’ services.
But the Wightmans did not know about this agreement. When patients
paid for services using Ameritas’ benefit cards, the Wightmans believed they
would be reimbursed at their standard rates. Id. The cards made no mention
of a discount. Id. However, the Wightmans were reimbursed at a discounted
rate and contacted Ameritas, which informed them of the agreement between
it and DenteMax. Id.
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B. Procedural History
The Wightmans sued Ameritas and DenteMax, alleging breach of
contract and violations of Louisiana’s PPO Act. Id. The district court
partially dismissed the Wightmans’ claims, but they filed two amended
complaints and transformed the case into a putative class-action suit. Id. The
district court again dismissed the Wightmans’ claims for statutory violations
and unjust enrichment, concluding that Louisiana law prescribed the suit and
that “but for prescription, they would have had a” claim under the Louisiana
statute. Id. at *2. On appeal, this court certified the question “Are claims
arising under the Louisiana’s Preferred Provider Organization Act, La. R.S.
40:2203.1, delictual or contractual for prescriptive purposes” to the
Louisiana Supreme Court. Id. The Louisiana Supreme Court concluded that
they were contractual and so the Wightmans’ claims were not prescribed. Id.
So we reversed the district court’s dismissal of Ameritas. Id. Meanwhile,
DenteMax settled with the Wightmans.
On remand, the district court granted Ameritas summary judgment.
Specifically, it concluded that dental services are not considered healthcare
services under the PPO Act, so the Wightmans’ claims under the statute
failed. It also concluded that the Wightmans had abandoned their non-PPO
Act claims on the first appeal. Finally, it denied the Wightmans’ request to
amend their complaint and denied a motion for reconsideration.
II. The PPO Act Claims
We turn first to the district court’s grant of summary judgment in
favor of Ameritas on the PPO Act claims.
A. Standard of Review
We review grants of summary judgment de novo. Kerns v. First State
Bank of Ben Wheeler (In re Kerns), 130 F.4th 455, 459 (5th Cir. 2025). “The
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court shall grant summary judgment if the movant shows that there is no
genuine dispute as to any material fact and the movant is entitled to judgment
as a matter of law.” Fed. R. Civ. P. 56(a). We draw all inferences in favor
of the non-moving party and view the record in the light most favorable to it.
Hillman v. Loga, 697 F.3d 299, 302 (5th Cir. 2012). Issues of law, such as
statutory interpretation, are appropriately dealt with at summary judgment.
See Maxim Crane Works, L.P. v. Zurich Am. Ins. Co., 11 F.4th 345, 350 (5th
Cir. 2021).
B. Statutory Framework
The district court granted Ameritas summary judgment on the
Wightmans’ PPO Act claims because it concluded that dental services are
not healthcare under Louisiana law. We disagree.
Louisiana’s PPO Act states that “[a]ny group purchaser may contract
with any provider . . . to form a preferred provider organization.” La. Stat.
Ann. § 40:2203(A). A provider is an entity that offers “health care services
and shall include but not be limited to hospitals, individuals, or groups of
physicians, individuals or groups of psychologists, nurse midwives,
ambulance service companies, and other health care entities.” Id.
§ 40:2202(6). “Any health care entity which is specifically covered by a
group purchaser’s insurance policy . . . shall be construed to be a ‘provider’”
under this Act. Id.
A PPO often allows a group purchaser to reimburse providers at
discounted rates, but it may not do so “unless such organization is clearly
identified on the benefit card issued by the group purchaser or other entity
accessing a group purchaser’s contractual agreement . . . and presented to
the participating provider when medical care is provided.” Id.
§ 40:2203.1(B). A group purchaser is liable to the provider for failure to
comply with this section. Id. § 40:2203.1(G).
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The Wightmans assert that since the benefit cards issued by Ameritas
did not comply with the PPO Act, there is little dispute that Ameritas is liable
if the Act applies. Thus, whether Ameritas is liable to the Wightmans under
the PPO Act turns, in part, on the threshold question of whether dental
services qualify as healthcare under the Act.
C. Rules of Statutory Interpretation
To answer that question, we must interpret the statute. “When
applying state law, we interpret the state statute the way we believe the state
Supreme Court would, based on prior precedent, legislation, and relevant
commentary.” Vielma v. Eureka Co., 218 F.3d 458, 462 (5th Cir. 2000)
(citation modified). Thus, “we use the same methods of statutory
interpretation used by the” Louisiana Supreme Court. Camacho v. Ford Motor
Co., 993 F.3d 308, 311 (5th Cir. 2021).
Under Louisiana’s “civilian methodology,” its “Constitution, codes,
and statutes are of paramount importance.” Jorge-Chavelas v. La. Farm
Bureau Cas. Ins. Co., 917 F.3d 847, 851 (5th Cir. 2019) (citation modified). As
elsewhere, “the interpretation of any statutory provision starts with the
language of the statute itself.” Guerrera v. United Fin. Cas. Co., 161 F.4th 913,
916 (5th Cir. 2025) (citation modified) (quoting Caldwell Par. Sch. Bd. v. La.
Mach. Co., 2012-1383 (La. 1/29/13), 110 So. 3d 993, 996). “When a law is
clear and unambiguous, and its application does not lead to absurd
consequences, it shall be applied as written, with no further interpretation
made in search of the legislative intent.” 84 Lumber Co. v. Cont’l Cas. Co.,
914 F.3d 329, 334 (5th Cir. 2019) (citation modified). But “if the language of
the law is susceptible [to] different meanings, it must be interpreted as having
the meaning that best conforms to the purpose of the law.” Seguin v.
Remington Arms Co., 31 F.4th 311, 316 (5th Cir. 2022) (citation modified).
Courts must consider “the entire statute and all other statutes on the same
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subject matter, and a construction should be placed on the provision in
question which is consistent with the express terms of the statute and with
the obvious intent of the Legislature in its enactment of the statute.” ABL
Mgmt., Inc. v. Bd. of Sup’rs of S. Univ., 2000-0798 (La. 11/28/00), 773 So. 2d
131, 135.
D. Definition of Healthcare Under the PPO Act
The district court initially determined that dental services are
healthcare under the PPO Act, but subsequently reversed course largely
based on the passage of the Network Leasing Act (“NLA”). It reasoned that,
because the NLA governed “fair and transparent dental network
contracting,” the same general subject governed by the PPO Act, it can be
“presume[ed] that dental providers lacked protection” offered by the PPO
Act.
We conclude that dental services are healthcare under the PPO Act
for two reasons. First, the Act’s broad language and healthcare’s historical
usage suggest that dentists are covered under the Act. Second, the NLA
governs different conduct than the PPO Act and so this reading would not
render the two provisions redundant.1
Under the terms of the PPO Act, healthcare providers are entities
that offer healthcare services and “shall include but not be limited to
hospitals, individuals, or groups of physicians, individuals or groups of
psychologists, nurse midwives, ambulance service companies, and other
health care entities.” La. Stat. Ann. § 40:2202(6). When considering
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1
The Louisiana Department of Insurance (“LDI”) and Louisiana Dental
Association filed amicus briefs in support of the Wightmans. Both amici stress the broad
language of the PPO Act, but the LDI also stresses that the PPO Act and NLA do not
overlap because the NLA applies at the time of contracting and the PPO Act applies at the
point of care.
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whether dentists are included within this definition, we must remember that
general terms in a statute are given their general meaning. Antonin
Scalia & Bryan Garner, Reading Law 101 (2012). Healthcare is
“the services provided, usu[ally] by medical professionals, to maintain and
restore health.” Healthcare, Black’s Law Dictionary (12th ed.
2024). So, if a dentist is a medical professional, they likely are healthcare
providers. And medicine is broadly defined as “[t]he scientific study and
practice of preserving health and treating disease or injury.” Medicine,
Black’s Law Dictionary (12th ed. 2024).
A dentist is “one who is skilled in and licensed to practice the
prevention, diagnosis, and treatment of diseases, injuries, and malformations
of the teeth, jaws, and mouth.” Dentist, Webster’s Ninth New
Collegiate Dictionary (1990). This fits squarely within the ordinary
meaning of healthcare services discussed above. As the Wightmans point out,
dentists “diagnos[e] and treat[] diseases that affect the gums and teeth,”
“perform[] surgical procedures,” and “conduct[] visual examinations,
diagnostic tests, and x-rays.” Ameritas responds by arguing that the PPO
Act should be narrowly construed and that the absence of terms like
“dentist” and “dental” are dispositive. But we cannot ignore the general
meanings that fit within the general terms of the statute. And because the
provision is open-ended and does not contain any exceptions, it seems
unlikely that the legislature intended to exclude dentists from such a broad
definition.
An opinion from the Louisiana Attorney General agrees. In 1994, the
Attorney General explicitly stated “that dentists are covered by the
definition of ‘provider’” under La. Stat. Ann. § 40:2202(6).2 La. Att’y
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2
Ameritas notes that the Attorney General opinion was adopted five years before
the enactment of La. Stat. Ann. § 40:2203.1 and argues that it is therefore outdated.
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Gen. Op. No. 94-315 (Sept. 22, 1994), 1994 WL 553063, at *2. The
Wightmans also compile numerous examples of how dentists are governed
like ordinary medical doctors under Louisiana’s broader statutory
framework. This evidence, coupled with the ordinary definition of the terms
in the statute, demonstrates that dentists are covered by the PPO Act.
The subsequent adoption of the NLA does not convince us otherwise.
The NLA allows a “contracting entity [to] grant a third party access to a
provider network contract or a provider’s dental services or contractual
discounts pursuant to a provider network contract” provided certain
requirements are met, including that the contract explicitly states that the
contracting entity may do this. La. Stat. Ann. § 22:1172(A), (A)(1).
While the PPO Act contains a private right of action, the NLA is enforced
only by the Louisiana Commissioner of Insurance. Id. § 22:1172(E).
The Wightmans assert that the NLA and PPO Act can be
harmonized because the PPO Act governs actions at the point of care (by
mandating that certain information appear on benefit cards presented to
providers). But, they say, the NLA only governs contract formation.
Ameritas contends that the NLA does apply to post-contract activity (such as
providing notice when a new third party has been granted access to a
network) and that, since it covers the same type of conduct covered under
the PPO Act but for dentists, it is proof that the PPO Act never applied to
dentists in the first place.
We agree with the Wightmans. “[A]ll statutes on the same subject
matter should be read together and interpreted as a whole to effect the
_____________________
But this overlooks the fact “that a word used in different parts of the statute should be
construed to have the identical meaning throughout the entire statute.” United States v.
Est. of Parsons, 367 F.3d 409, 416–17 (5th Cir. 2004) (citation modified).
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legislative intent and should be construed in such a way as to reconcile, if
possible, apparent inconsistencies or ambiguities so that each part is given
effect.” Anthony Crane Rental, L.P. v. Fruge, 2003-0115 (La. 10/21/03), 859
So. 2d 631, 634. While the NLA and PPO Act cover slightly different
interactions, they both fundamentally govern the ability of insurance
companies to contract with third parties to offer discounts on providers’
services. And since Louisiana law has generally treated dentists as healthcare
providers, we, as the Wightmans suggest, read the statutes in pari materia.
Thus, while the NLA imposes certain contracting requirements on entities
like DenteMax, the PPO Act governs what information must be produced on
benefit cards presented at the point of care. These statutes may have similar
goals, but they cover different conduct, so the adoption of the NLA does not
necessarily demonstrate that dentists were not covered under the PPO Act.
Accordingly, we conclude that dental services are healthcare under
the PPO Act, so the district court erred by granting Ameritas summary
judgment on that ground.
E. Remaining Summary Judgment Issues
1. Alternative Grounds for Affirming
The parties make other arguments regarding whether we may affirm
summary judgment of the Wightmans’ PPO Act claims on other grounds.
However, the district court based its ruling on whether the Wightmans were
providers under the Act and largely avoided addressing other issues. “As a
well-established general rule, this court will not reach the merits of an issue
not considered by the district court.” PHH Mortg. Corp. v. Old Republic Nat’l
Title Ins. Co., 80 F.4th 555, 563 (5th Cir. 2023) (citation modified). So, “we
follow that well-traveled path and remand for consideration in the first
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instance.”3 Students for Fair Admissions, Inc. v. Univ. of Tex. at Aus., 142 F.4th
819, 828 (5th Cir. 2025).
2. Judicial Estoppel
The district court did, however, conclude that the Wightmans were
judicially estopped from arguing that the contract between DenteMax and
Ameritas established a PPO, but it did so without articulating a legal
standard and cited only one case.
“We review a district court’s judicial estoppel determination for
abuse of discretion.” In re Superior Crewboats, Inc., 374 F.3d 330, 334 (5th
Cir. 2004). “A court abuses its discretion when it (i) fails to identify and
apply the correct legal standards; or (ii) fails to provide sufficient reasons for
its decision to enable appellate review.” United States v. Ahsani, 76 F.4th 441,
447 (5th Cir. 2023).
“The doctrine of judicial estoppel is equitable in nature and can be
invoked by a court to prevent a party from asserting a position in a legal
proceeding that is inconsistent with a position taken in a previous
proceeding.” Galaz v. Katona (In re Galaz), 841 F.3d 316, 326 (5th Cir. 2016)
(citation omitted). Courts must consider whether: “(1) the party against
whom judicial estoppel is sought has asserted a legal position which is plainly
inconsistent with a prior position; (2) a court accepted the prior position; and
(3) the party did not act inadvertently.” Reed v. City of Arlington, 650 F.3d
571, 574 (5th Cir. 2011) (en banc) (citation modified). But the elements “are
neither inflexible nor exhaustive and numerous considerations may inform
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3
We note that after oral argument, the parties submitted supplemental letters
addressing some of these arguments. But we express no view on them.
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the doctrine’s application in specific factual contexts.” Galaz, 841 F.3d at
326.
The district court abused its discretion by applying judicial estoppel
without providing sufficient analysis. It failed to articulate the governing
standard, though it seemed to conclude the positions taken by the Wightmans
are inconsistent. But it also made no finding on either the second or third
elements and offered only vague reasoning. And “discretionary choices are
not left to a court’s inclination, but to its judgment; and its judgment is to be
guided by sound legal principles.” Albemarle Paper Co. v. Moody, 422 U.S.
405, 416 (1975) (citation modified). Even if a court may exercise its discretion
equitably, like here, that “hardly means that it is unfettered by meaningful
standards or shielded from thorough appellate review.” Id.
Whether to apply judicial estoppel “is dictated by the specific factual
context.” Carmichael v. Balke (In re Imperial Petroleum Recovery Corp.), 84
F.4th 264, 273 (5th Cir. 2023) (citation modified). Since there is no
“demonstration of what facts and law the district court considered when
exercising its discretion, we are unable to conduct a fair and full appellate
review of the district court’s exercise of its discretion.” Occidental Petroleum
Corp. v. Wells Fargo Bank, N.A., 117 F.4th 628, 646–47 (5th Cir. 2024)
(Ramirez, J., concurring in part and dissenting in part) (citation modified).
We take no view on whether it would be appropriate to apply judicial
estoppel in this case. We only conclude that the district court failed to
adequately explain its reasoning. So, we remand for a more comprehensive
analysis.
III. The Non-PPO Act Claims
The district court next declined to consider any of the Wightmans’
non-PPO Act claims, including their claim for unjust enrichment, because
“in their briefing on appeal, [the Wightmans] only offered passing mention
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to other claims,” so it concluded they were abandoned. The Wightmans
argue “[t]hat conclusion disregarded the Fifth Circuit’s mandate, the
procedural posture on remand, and intervening legal developments requiring
renewed factual and legal determinations.”
The district court’s refusal to consider the Wightmans’ non-PPO Act
claims is problematic for two reasons.
First, this court, not the district court, has the authority to determine
whether to consider issues that may have been forfeited on appeal. After all,
while “we may in our discretion decline to consider issues not raised in an
initial brief,” we may also choose to address them. Est. of Lisle v. Comm’r,
341 F.3d 364, 384 (5th Cir. 2003). Though the district court may properly
decide which issues have been forfeited in the district court, it is inappropriate
for it to decide the same for us.
Second, the district court violated the mandate rule, which “requires
a district court on remand to effect our mandate and to do nothing else.”
Deutsche Bank Nat’l Tr. Co. v. Burke, 902 F.3d 548, 551 (5th Cir. 2018) (per
curiam) (citation modified). While Ameritas certainly argued before this
court that the Wightmans abandoned their unjust enrichment claim, the
Wightmans disputed this. But the panel refused to take a position and simply
reversed “the district court’s grant of partial summary judgment and
dismissal of Ameritas.” Wightman, 2023 WL 2940241, at *2. It
“recognize[d] that the parties [made] additional arguments” but because
“prescription is the dispositive issue for purposes of this summary
judgment[, it] decline[d] to address any additional issues . . . and [made] no
determination as to whether they are properly before this court.” Id. at *2
n.3. Since the panel simply reversed the district court’s order and refused to
decide any other issues, the district court erred by concluding that the
Wightmans had abandoned these claims on appeal. Instead, the district court
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should have reconsidered each of the Wightmans claims in light of our
court’s decision.
A district court may not decide whether issues are forfeited by the
parties in the court of appeals. So, we reverse the district court’s grant of
summary judgment on the non-PPO Act claims and remand for
consideration.
IV. Leave to Amend
Finally, the Wightmans appeal the district court’s denial of their
motion to seek leave to amend their complaint. We review for abuse of
discretion. Rosenzweig v. Azurix Corp., 332 F.3d 854, 863 (5th Cir. 2003).
Given the late stage of the litigation and the lengthy procedural history, we
cannot say the district court abused its discretion.
V. Conclusion
For the foregoing reasons, the district court is REVERSED in part
and AFFIRMED in part, and the case is REMANDED for further
consideration consistent with this opinion.
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