Full opinion text
MEMORANDUM OF DECISION GRANTING IN PART DEFENDANT’S MOTION FOR JUDGMENT ON THE ADMINISTRATIVE RECORD [DKT. #38] AND REMANDING FOR FURTHER PROCEEDINGS VANESSA L. BRYANT, District Judge. The Plaintiff, Tiffany L. Halo (“Halo”), who at all times relevant to this proceeding was a student at Yale University and an insured under Yale Health Plan (“YHP”), brings this action pro se against the Defendant, YHP, under the Employee Retirement Income Security Act of 1974 (“ERISA”). Plaintiff alleges that Defendant violated the provisions of 29 C.F.R. § 2560.503-1, which governs the timing of notification of benefit determinations, and that YHP acted in an arbitrary and capricious manner in denying her coverage for out-of-network urgent or emergency care. On August 19, 2011, YHP moved for judgment on the administrative record. See [Dkt. # 14]. Halo submitted a twenty-eight page objection to YHP’s motion, citing Federal Rule of Civil Procedure 56 and applicable case law, see [Dkt. #20, Pl.’s Resp. in Opp’n, at 1-2, 17-19], but did not file affidavits or other admissible evidence supporting her benefit claim. This Court treated YHP’s motion as one for summary judgment and, relying on the administrative record upon which YHP based its decision, granted judgment on the administrative record in YHP’s favor, on March 9,2012. [Dkt. #28]. On April 9, 2012, Halo appealed this Court’s judgment. [Dkt. # 29]. On October 11, 2013, the Second Circuit vacated and remanded the judgment. [Dkt. # 34]. In its Summary Order, the Second Circuit held that Halo did not receive proper notice of the consequences of failing to respond to a motion for summary judgment. See [Dkt. # 34, Mandate of USCA, at 5]. Further, in response to the amicus curiae brief filed by the Department of Labor in support of Halo’s appeal, in addition to the merits of Halo’s claims, the Second Circuit directed this Court to consider whether YHP violated the procedural requirements for claim administration under 29 C.F.R. § 2560.503-1, and if so, whether Halo is entitled to civil penalties and to de novo review of her claims. [Id. at 6-7]. On December 27, 2013, YHP renewed its motion for judgment on the administrative record to affirm YHP’s coverage decisions. [Dkt. # 38]. On February 24, 2014, Halo filed her Opposition to YHP’s motion. [Dkt. #43]. On March 21, 2014, YHP filed its Reply to Halo’s Opposition. [Dkt. #46]. On April 24 and September 2, 2014, Halo filed supplemental evidence and briefing. [Dkt. ## 20, 52 and 53]. After consideration of the record and the mandate of the Second Circuit, for the reasons stated hereinafter, the Defendant’s motion for judgment on the administrative record is granted, in part, and denied in part. Background Facts a. Plaintiff’s Health Coverage As an enrolled student attending Yale at least half time and working towards a Yale degree, Halo was a member of the Yale Health Plan and received ‘YHP Basic” coverage at no charge. [Dkt. # 38-3, Ex. A Yale Health Plan Student Handbook) at 11]. YHP Basic coverage included: Primary care through Yale’s Student Medicine or Internal Medicine Departments, gynecology services, preventative medicine services, such as routine eye exams, flu shots, and skin cancer screening, laboratory services, access to 24-hour urgent care through the Urgent Care Department, mental health services, nutritional counseling, and some use of Yale’s Inpatient Care Facility. [Id.]. In addition to the YHP Basic plan, Halo purchased YHP Hospitalization/Specialty Coverage (the “Specialty Plan”). [Dkt. #43, Opp. at 12], The Specialty Plan offers three types of coverage “at 100%”: (i) outpatient specialty care received through the YHP health care network, (ii) approved inpatient care at YHP-approved inpatient facilities, and (iii) limited out-of-network care. [Dkt. # 38-3, Ex. A at 58]. Under the Specialty Plan, “[e]mergeney care and pre-authorized follow-up care for emergency conditions is covered at 100%' regardless of location.” [Id. at 62], YHP defines an “emergency condition” as “a major acute medical problem or major acute trauma that requires immediate medical attention or a condition that could lead to serious harm or death if care is no received or is delayed.” [M], Emergency coverage includes “emergency facility fees, laboratory expenses, radiological expenses, emergency physicians’ fees, ambulance transportation, and pre-authorized short-term follow-up care.” [Id.]. In the event of an emergency condition, YHP instructs covered beneficiaries to “contact the YHP Care Coordination Department within 48 hours (or 2 business days) of receiving emergency outpatient treatment or being admitted to an emergency facility.” [M]. After receiving notification of emergency care, the Care Coordination Department “will (1) notify YHP clinical staff of [the beneficiary’s] condition so that they can coordinate [the beneficiary’s] care as appropriate ... and (2) preauthorize any necessary follow-up care.” [Id.]. The Specialty Plan expressly warns that any “[f]ollow-up care that is not pre-authorized may be denied.” [M]. The Specialty Plan also provides 100% coverage for “[u]rgent care at any medical facility” when a beneficiary is “away from New Haven County.” [Id. at 63]. YHP defines an “urgent condition” as “the sudden and unexpected onset of an acute medical problem or trauma that requires immediate medical attention.” [Id.]. “Urgent conditions” do not include “chronic conditions, maintenance care, and routine care.” [M]. As is the case with emergency care, beneficiaries are instructed to “contact the YHP Care Coordination Department within 48 hours (or 2 business days) of any care received out of area for an urgent condition to ensure that YHP clinical staff are aware of your condition and to request the Care Coordination Department to preauthorize follow-up care.” [Id.]. YHP also warns that “[f]ollow-up care that is not pre-authorized may be denied.” [Id.]. Finally, YHP Informs its beneficiaries that, “[i]f, in the judgment of YHP, the illness or injury does not meet the plan definition of an emergency or urgent condition, coverage will be denied. This includes all elective admissions or treatments. Coverage will also be denied for conditions that could have been treated at YUHS but were not while the student or enrolled dependent was in area.” [Id.]. b. Claims and Appeals Process YHP’s Student Handbook describes the procedures governing the submission of claims for coverage: Claims for reimbursement of covered services should be accompanied by itemized bills for services rendered (charge card receipts and balance due statements are not acceptable). Bills for services must include diagnosis and procedure codes for determination of coverage. Claim forms are available in the Claims Department. Please submit claims to: Yale Health Plan Claims Department 55 Whitney Avenue (2nd floor) P.O. Box 208217 New Haven, CT 06520-8217 [Id. at 39]. YHP also advises that “[e]laims for covered services are honored for one year from the date of service.” [/&]. In the event a claim is denied, beneficiaries “have a right to appeal the decision.” [Id. at 41]. YHP provides for a two-level appeals process. The first level “requires a request for reconsideration in writing within 180 days from the date of receipt of the initial determination.” [Id.]. Once a beneficiary has received written notice that their first appeal was unsuccessful, they may request a second level appeal. “Second level appeals must be requested in writing within 60 days of receipt of the first level claim appeal determination and mailed to the Yale Health Plan Patient Representative.” [Id.]. This second review “will be completed within 30 days of receipt of the [second] appeal.” [Id.]. c. Plaintiff’s In-Network Treatment The series of incidents involving Plaintiffs eye condition began on May 31, 2008, when Halo developed a visual disturbance in her left eye. She went to the Yale University Health Services Urgent Care Department and was referred to Yale New Haven Hospital for an inpatient consultation. [Dkt. # 38-4, Ex. B, at 1-2]. She was examined by Dr. Joan Cho, who identified a “[fjocal visual field abnormality” and recommended that the Plaintiff “be evaluated by ophthalmology today.” [Id. at 2]. Later that day, Halo went to Yale-New Haven hospital, an in-network care provider, for an eye consultation. [Dkt. #43, Opp. at 9]. Halo was examined by Dr. Huffman. During his examination of Plaintiffs retina, Dr. Huffinan detected “retinal folds” and a possible “small hole.” [Dkt. # 38-4, Ex. B, at 3]. At Dr. Huffman’s direction, Halo returned to the hospital the following morning, June 1, 2008, for a new patient evaluation. [Dkt. #43, Opp. at 9]. There, Dr. Kempton examined Plaintiffs eyes and determined that Halo had a “[r]etinal hole.” [Dkt. # 38-4, Ex. B, at 6], Accordingly, Dr. Kempton recommended that Halo undergo a scleral buekle/eryotherapy procedure that day, June 1, with Dr. Liggett. [I'd] Dr. Kempton also concluded that Halo “will need laser [r]etinopexy ... this week.” [Id.] Plaintiff alleges in her Opposition that Dr. Kempton stated that “a retinal break is an eye emergency requiring immediate medical attention to prevent vision loss.” [Dkt. #43, Opp. at 9-10]. The medical records prepared at the time of Halo’s visit on June 1, 2008 do not describe her condition as “an eye emergency,” nor do they state that her condition “requir[es] immediate medical attention to prevent vision loss.” [Dkt. # 38-4, Ex. B, at 4-6], On June 1, 2008, Dr. Kempton performed surgery on Halo’s left eye. [Dkt. # 38-4, Ex. B, at 7-9]. The surgery was supervised by Dr. Peter Liggett, a specialist in retinal detachment. [Dkt. # 43, Opp. at 10]. Follow up appointments were scheduled for June 2 and 9, 2008 with Dr. Huang at Yale New Haven Hospital. [Id.]. During the latter of these two appointments, Dr. Huang determined that the surgery had not repaired the retina. [Id.]. Halo further alleges that at this June 9 appointment, Dr. Huang stated that “a retinal break is an eye emergency.” [IcL; Dkt. # 43-8, Ex. W (Aff. of Candace Halo) at ¶ 4]. Halo has not submitted a contemporaneous treatment note or other statement from Dr. Huang indicating that her treatment was of an emergency nature. On June 11, 2008, Halo was referred to Dr. Liggett for a second opinion with New England Retina Associates (“NHRA”), an in-network care provider. [Dkt. # 43, Opp. at 10]. The report documenting Plaintiffs examination that day states that “[t]he adhesion (cryo) used doesn’t work as well on thin retinas (takes about a week to seal well).” [Dkt. #38-4, Ex. B, at 14]. The report further notes that, “[a]t some point, [Halo] should have laser [surgery] to secure lattice areas” and that Plaintiffs “OS is detached[.] [Surgery] on Friday [June 13, 2008].” [Id.] Finally, the report states that the doctor “discussed” “head positioning” with Halo, and that a “[c]ata-ract will develop ... [and] will require extraction within [two years].” [Id.] Plaintiff alleges that during his examination, Dr. Liggett stated that, “unless [Halo] had immediate surgery the retina would continue to peel off the back wall of her eye and that she would have permanent loss of vision.” [Dkt. #43, Opp. at 10; Dkt. # 43-8, Ex. W at ¶ 5]. Although Plaintiffs examination report does state that “[a]t some point she should have laser surgery to secure lattice areas, [noting that] OS is detached [and instructs her to] Return: Friday,” it does not make any reference to “permanent loss of vision” or state that she needs “immediate surgery.” [Dkt. # 38^4, Ex. B, at 13-14]. Two days later, on Friday, June 13, 2008, in accordance with his recommendation, Dr. Liggett performed a vitrectomy on Halo. [Dkt. #43, Opp. at 10]. She returned the next day, June 14, 2008, for a follow-up visit. The report of this visit states that Halo “slept well,” that she exhibited “[m]ild [s]welling” in her eyes, and that she was experiencing “pain” in her left eye, but that the pain was “resolved as of today.” [Dkt. #38-4, Ex. B, at 15]. Plaintiff was also given a cell phone number to call over the weekend if there were any further complications, and was instructed to return in two days. [Id. at 16; Dkt. # 43, Opp. at 10-11]. On the morning of Monday, June 16, 2008, the day Halo was scheduled to return to NHRA for a consultation, Halo and her mother allege that they made several calls to NHRA and to the cell phone number Halo had been given. See [Dkt. # 43, Opp. at 11; Dkt. #43-6, Ex. S (Verizon Telephone Records) at A-210; Dkt. # 43-7, Ex. S at A-220]. Later that day, Halo went in to NHRA for her scheduled appointment, and was examined by Dr. Haff-ner. Dr. Haffner’s report states that Halo had been suffering “severe pain [in her left eye] since 7:30 this [morning].” [Dkt. # 38-4, Ex. B, at 17]. The report notes that the pain had “gotten worse throughout] the day,” but that Halo “was ok[ay] this weekend.” [Id.] Dr. Haffner concluded that an increase in intra-ocular pressure in Halo’s left eye was the cause of her severe pain. [Id. at 17-19; Dkt. #43, Opp. at 11]. Dr. Haffner performed a procedure to release this pressure and instructed Halo to return in two days. [Dkt. # 38-4, Ex. B, at 18]. d. Plaintiff Receives Approval for Second Opinion with Out-of-Network Physician and Undergoes Procedures On June 16, 2008, the same day Halo was examined by Dr. Haffner, Halo’s mother made a request by telephone to YHP for a second opinion on Halo’s condition. See [Dkt. #88, Mot. for J., at 8; Dkt. # 48, Opp. at 13]. Plaintiffs mother spoke with Vicki Eisler, of Yale Member Services. The parties agree that during this call, Halo’s mother stated that Halo wanted to see Dr. D’Amico, a world-renowned eye specialist, that she felt Halo’s “post-op care” was “awful,” and that Halo did not “feel comfortable going back to Dr. Liggett.” [Dkt. # 38-4, Ex. B at 19; Dkt. #43, Opp. at 13]. Plaintiff also alleges that during this call, her mother informed Ms. Eisler of Halo’s “urgent care [sic] and the fact that [Halo] was still in severe pain.” [Dkt. # 43-8, Ex. W at ¶ 7], Within 24 hours, Dr. Forster, Chief of Ophthalmology at Yale University Health Services, called and approved the referral for a second opinion with Dr. D’Amico of Weill Cornell Ophthalmology Associates (‘Weill”), an out-of-network doctor. [Dkt. # 38, Mot. for J., at 8; Dkt. # 43, Opp. at 13]. That same day, on June 17, 2008, YHP sent Halo a letter reiterating its verbal authorization of an out-of-network second opinion and reminding her that any additional services beyond her visit for a second opinion must be further approved before they would be covered under the plan. [Dkt. #38, Def.’s Mot. for J. at 8; Dkt. # 38-5, Ex. C]. On June 17, 2008, Dr. D’Amico saw Halo and determined that immediate treatment was necessary. Halo received treatment the same day. Halo further alleges that, while she was at Weill, her father contacted YHP and informed them of her “emergency treatment.” [Dkt. # 43, Opp. at 14]. The Weill treatment record of Halo’s June 17, 2008 visit states, “Patient will move to her parents in N.J. and would like to transfer her care to W[eill].” [Dkt. # 38-4, Ex. B, at 22], Without seeking or obtaining prior authorization from YHP, Halo went to see Dr. D’Amico the next day for a follow-up. [Dkt. #38, Mot. for J., at 9; Dkt. #43, Opp. at 14], Halo alleges that, either on June 17 or June 18, her father received a telephone call from Vicki Eisler, of YHP, who told him that Halo’s “circumstances were emergency in nature” and that authorization to extend the referral to include medical benefits was granted for Halo’s care with Dr. D’Amico through June 30, 2008. The Weill treatment record of this visit noted that Halo was “feeling much better today after anterior para-centesis yesterday,” that Halo was “much improved,” and that Dr. D’Amico “[w]ill continue] to monitor” Halo. [Dkt. # 38-4, Ex. B, at 25-26]. The Weill record does not state that Halo received emergency or urgent treatment of an acute medical condition. Id. e. Plaintiff Seeks and, Ultimately Receives Coverage For Her June 17 and June 18,2008 Procedures The bills for the visits on June 17 and June 18, 2008 were received by YHP’s Claims Department on July 8, 2008. [Dkt. #38-6, Ex. D.] The bills were itemized and included procedure codes, diagnosis pointers, and the Claims Department address. [Id.] In a form entitled “Explanation of Benefits,” dated July 30, 2008, YHP denied all but one of Halo’s claims. [Dkt. # 38-7 at Ex. E]. The form stated that the denials were because the “service[s] [were] not authorized.” [Id.] Halo alleges that she received this form on August 6, 2008. See [Dkt. # 1, Compl. at 4; Dkt. # 38-8, Ex. F at 2]. The next day, August 7, 2008, Halo sent a letter to Connie Rollinson, YHP’s Manager of Claims, which Halo explained was “to serve as a formal ‘first level claim appeal.’ ” [Dkt. # 38-8 at Ex. F]. In her letter, Halo described the events beginning on May 31, 2008, when she “went to the Yale University health Services Emergency Room,” through August 6, 2008, when she spoke with YHP’s Vicki Eisler after receiving the denial form. [Id. at 1-2], Halo informed Ms. Rollinson that on the same day she met with Dr. D’Amico for the first time, June 17, 2008, she and her mother “consulted Dr. Susan Forster, the physician handling [Halo]’s case at Yale Health Services, about the ‘emergency situation.’ ” [Id. at 2]. She further explained that, during this conversation, “Dr. Forster approve[d] the referral for a second opinion and informed] Tiffany that she must consult with Ms. Vicki Eisler ... for any further, ‘emergency coverage.’ ” [Id.]. Halo’s August 7, 2008 letter next recounted her conversation with Ms. Eisler that day (June 17), who allegedly told Halo that her “circumstances were, ‘emergency in nature’ and that authorization for extended referral and coverage of benefits would be given for [Halo]’s care with Dr. D’Amico until [June 30, 2008].” [Id.]. There is' no evidence in the record before the administrator which would form the basis of a conclusion that Halo’s circumstances were emergency in nature. There is nothing in the claim file on June 17, 2008, on which Ms. Eisler could have drawn the conclusion that Halo qualified for out-of-network emergency care through June 30, 2008. None of the treatment notes, nothing in the claim file, and no exhibit filed in support of any of the briefing by either party indicates that, at the time Ms. Eisler allegedly extended YHP’s initial referral, any physician or other medical expert opined that Halo suffered from an acute medical condition requiring urgent or emergency medical care, necessitating treatment by a physician or hospital outside the YHP network. Eight days later, on August 15, 2008, YHP sent Halo a letter in response to her “appeal [of] a decision by Yale Health Plan to deny coverage for portions of the care [she] received out of network on June 17, 2008 at the office of Dr. Donald D’Amico.” [Dkt. #38-12, Ex. J at 1]. The letter explained that Halo’s “claim ha[d] been reviewed in detail by [YHP’s] Medical Director, Dr. Michael Rigsby along with the Chief of Ophthalmology, Dr. Susan Forster.” [Id.] It then stated that, although Halo “elected to leave the New Haven area” and “[t]he services provided by Dr. D’Amico went beyond consultation, resulting in charges that were not covered,” YHP decided to “attempt to negotiate with Cornell Opthamology Associates a payment based on usual and customary charges for the services provided,” because Halo “or Dr. Liggett may not have fully understood in advance the limited nature of the approved referral.” [Id. at 1-2]. Notwithstanding this attempt to negotiate the charges Halo had incurred, the letter stated that “the original decision to deny coverage for care with Dr. D’Amico beyond the visit on June 17th was correct.” [Id. at 2]. On September 8, 2008, Halo again wrote YHP’s Manager of Claims, regarding her “First Level Claim Appeal.” [Dkt. # 38-13, Ex. K, at 1]. Halo explained that her letter was “to serve as a formal response to [YHP’s] letter of August 15, 2008 in which [YHP] denied the appeal under the Yale Health Plan for care, coverage, and expenses that student and patient Tiffany Halo received ... with Dr. Donald J. D’Amico.” [/&]. Halo’s letter noted “several issues” with YHP’s letter of August 15, including that Dr. Rigsby and Forster, who reviewed Halo’s claim had not “ever physically examined [Halo].” [Id. (emphasis in original) ]. Halo also took issue with the letter’s assertion that Halo “received timely and appropriate care from Yale Health Plan, Yale Eye Center and New England Retina Associates,” [id.], and the assertion that Halo “elected to leave the New Haven area.” [Id. at 2]. Halo stated in her letter that her reason for pointing out these and other issues with YHP’s August 15 letter was “so that the Claims Review Committee [would be] fully informed of [Halo]’s situation upon secondary examination of her claim.” [Id.] The same day, September 8, 2008, Halo also sent a letter to YHP’s “Claims Review Committee” regarding her “Second Level Claim Appeal.” [Id. at 3]. This letter tracked the sequence of events Halo described in her August 7 letter. [Id. at 3-4]. On September 18, 2008, Moshe Siev, a co-chair of YHP’s Claims Committee, wrote Halo to inform her that the “Claims Committee voted to approve payment in full for the office visits on June 17, 2008 and June 18[ ], 2008.” ' [Dkt. # 38-14, Ex. L, at 1]. f. Halo Continues to Treat with Dr. D’Amico Without Prior Approval from YHP Throughout the period Halo sought reimbursement for her first two appointments with Dr. D’Amico (on June 17 and June 18, 2008), she continued to treat with him. She attended follow-up visits on June 20 and June 26, 2008. The report concerning her June 20, 2008 visit stated that Halo was experiencing “no pain,” that the “[v]isit [t]ype” was a “[f]ollow [u]p [v]isit,” and that she had experienced “no pain” the previous day. [Dkt. # 38-4, Ex. B, at 28]. However, the report did note that there remained a number of “abnormalities],” [id. at 29-30], and recommended that Halo “[r]eturn in about 7 days (around 6/27/2008).” [Id. at 31]. Halo’s report from her June 26, 2008 visit similarly noted that she was “not having pain any longer.” [Id. at 32]. However, Dr. D’Amico did observe that “there is a high chance of permanent cataract [in Halo’s left eye], and the state of the retina cannot yet be clearly determined.” [Id. at 34]. Accordingly, he recommended a follow-up appointment in two weeks. [Id..] Neither of these treatment notes states that Halo had an acute medical condition necessitating urgent or emergency medical treatment. Id. Rather than come back in two weeks, Halo did not return to Dr. D’Amico’s office until more than a month later, on August 5, 2008. The report from this visit notes that, on July 10, 2008, Halo reported “no change or problems since [her] last visit.” [Id. at 35]. At her visit on August 5, Halo noted a “round spot” on her left eye and that her right eye was “feeling ‘tight’.” [M] After examining her, Dr. D’Amico recommended that she “[r]eturn in about 7 days (around 8/12/2008)” to undergo certain procedures. [Id. at 38]. Dr. D’Ami-co’s treatment note did not state that the follow-up visit was scheduled to treat an acute medical condition requiring urgent or emergency medical treatment. Id. The parties dispute whether Halo submitted claims for reimbursement of the cost of her June 20 and June 26, 2008 appointments. In any event, the parties agree that Halo was informed in November 2008 that YHP had “rejected]” any claims for service stemming from Halo’s June 20 and June 26 appointments, as “[n]ot [authorized.” [Dkt. #38-19, Ex. Q]. There is no evidence that Halo ever appealed any denial of these claims. In addition, Halo does not seriously challenge YHP’s contention that she “never filed a claim with Yale Health Plan” for her August 5, 2008 treatment. [Dkt. # 38, Mot. for J., at 10]. g. Plaintiff Undergoes Procedure on August 13, 2008 Coverage for Which YHP Declines In her letter dated August 7, 2008, Halo informed YHP that she had scheduled a surgery “for next Wednesday, August 13, 2008 with Dr. D’Amico at Cornell Weill Department of ophthalmology.” [Dkt. # 38-8, Ex. F at 2], On August 11, 2008, Dr. Forster, of YHP, called Halo to advise her to stay in network in order for the plan to cover her medical expenses, and she indicated that YHP would not pre-authorize the August 13 scheduled surgery. [Dkt. # 38-10 at Ex. H; Dkt. # 43, Opp. at 17]. For purposes of this decision, the Court will treat Halo’s notification as a request for pre-approval of out-of-network medical care and Dr. Forster’s response as an informal denial of approval. Halo alleges that she told Dr. Foster that, as a result of her condition, she was unable to return to New Haven and that she had experienced a decrease in vision. [Dkt. #43, Opp. at 17]. In addition, she now alleges for the first time that she “told Dr. Forster about the lack of access [to] emergency treatment at Yale.” [Id.]. Dr. Forster’s contemporaneous notes of this conversation make no reference to any “emergency treatment,” whether in or out-of-network, but they do state that Halo “was advised to the YHP need to have her stay in network where equivolent [sic] care could be given,” that Halo “was unhappy with this,” and that she “plan[ned] to go through with sergery [sic] with [Dr.] D’Amico in NYC inspite [sic] of the YHP denial of coverage.” [Dkt. # 38-10, Ex. H], Notwithstanding her conversation with Dr. Forster, Halo elected to undergo surgery on August 13, 2008 with Dr. D’Amico at New York Presbyterian Hospital. [Dkt. #43, Opp. at 19; Dkt. #88-A, Ex. B, at 43-45]. However, it is unclear whether Halo ever submitted a written claim for this procedure. See [Dkt. # 38, Mot. for J., at 33]. Two days later, on ■ August 15, 2008, YHP responded in writing to Halo’s letter of August 7, in which Halo initially disclosed her intent to undergo surgery on August 13. [Dkt. # 38-12 at Ex. J]. In its letter, YHP once again stated that it had already provided “clear and explicit” communication to Halo that “further visits and follow-up surgery with Dr. D’Amico would be denied.” [Id. at 2]. Halo does not dispute YHP’s contention that this letter confirmed YHP’s oral denial of Halo’s claim for her August 13, 2008 procedure. [Dkt. # 38, Mot. for J., at 12]. The parties agree that Halo appealed this denial on September 8, 2008, [Dkt. # 43, Opp. at 19; Dkt. # 38, Mot. for J., at 34], and YHP upheld the denial the next day. [Dkt. # 43, Opp. at 19; Dkt. # 38, Mot. for J., at 35; see also Dkt. # 38-14 at Ex. L]. Halo sought a second appeal of the denial of her August 13 claim on September 29, 2008. [Dkt. # 38-15 at Ex. M]. A week later, YHP informed Halo that it had denied her second appeal. [Dkt. # 38-16 at Ex. N]. h. Plaintiff Undergoes a Final Surgery in September 2008 Which YHP Declines to Cover Following her surgery on August 13, Halo returned to Weill on September 10, 2008 for a follow-up visit. See [Dkt. # 38-4, Ex. B, at 46-48], Halo’s examination report states that since her last retina appointment, she was experiencing vision problems. See [id. at 46]. Halo was ultimately diagnosed with a recurrent retinal detachment, but surgery was not performed on that date. [Id. at 48]. Surgery was scheduled for a week later, September 17, 2008. [M]. Halo did not communicate with YHS about this surgery prior to undergoing it. [Dkt. # 38, Mot. for J., at 13-14]. Halo filed a post-service claim for the charges associated with this treatment, which YHP received on October 3, 2008. See [Dkt. # 38-18 at Ex. P], YHP denied Halo’s claim on November 7, 2008, reiterating that the reason for the denial was “SERVICE[S] NOT AUTHORIZED.” [Dkt. # 38-19 at Ex. Q]. There is nothing in the record establishing that YHP had received any information from a medical professional stating that this surgery was performed because Halo had a sudden and unexpected onset of an acute medical problem or trauma that required immediate medical attention. Halo never appealed this denial. See [Dkt. # 38, Mot. for J., at 13-14]. i. ERISA Regulations The parties agree that the administration of the Yale Health Plan is subject to ERISA and the regulations promulgated thereunder. 29 C.F.R. § 2560.503-1 governs an administrator’s claims procedures and “sets forth minimum requirements for employee benefit plan procedures pertaining to claims for benefits by participants and beneficiaries.” 29 C.F.R. § 2560.503-1(a). For the purposes of ERISA, “a claim for benefits is a request for a plan benefit or benefits made by a claimant in accordance with a plan’s reasonable procedure for filing benefit claims.” 29 C.F.R. § 2560.503-1(e). Pursuant to 29 C.F.R. § 2560.503-l(f)(iii), in connection with pre-service claims, [T]he plan administrator shall notify the claimant of the plan’s benefit determination (whether adverse or not) within a reasonable period of time appropriate to the medical circumstances, but not later than 15 days after receipt of the claim by the plan. This period may be extended one time by the plan for up to 15 days, provided that the plan administrator both determines that such an extension is necessary due to matters beyond the control of the plan and notifies the claimant, prior to the expiration of the initial 15-day period, of the circumstances requiring the extension of time and the date by which the plan expects to render a decision. 29 C.F.R. § 2560.503-l(f)(iii)(A). In connection with post-service claims, [T]he plan administrator shall notify the claimant, in accordance with paragraph (g) of this section, of the plan’s adverse benefit determination within a reasonable period of time, but not later than 30 days after receipt of the claim. This period may be extended one time by the plan for up to 15 days, provided that the plan administrator both determines that such an extension is necessary due to matters beyond the control of the plan and notifies the claimant, prior to the expiration of the initial 30-day period, of the circumstances requiring the extension of time and the date by which the plan expects to render a decision. 29 C.F.R. § 2560.503-l(f)(iii)(B). Regarding urgent care claims, [T]he plan administrator shall notify the claimant of the plan’s benefit determination (whether adverse or not) as soon as possible, taking into account the medical exigencies, but not later than 72 hours after receipt of the claim by the plan, unless the claimant fails to provide sufficient information to determine whether, or to what extent, benefits are covered or payable under the plan. In the case of such a failure, the plan administrator shall notify the claimant as soon as possible, but not later than 24 hours after receipt of the claim by the plan, of the specific information necessary to complete the claim. The claimant shall be afforded a reasonable amount of time, taking into account the circumstances, but not less than 48 hours, to provide the specified information. 29 C.F.R. § 2560.503-1(f)(2)(i). Under 29 C.F.R. § 2560.503-l(g), the administrator is required to provide a written or electronic notification of any adverse benefit determination, and the notification must set forth “in a manner calculated to be understood by the claimant (i) [t]he specific reason or reasons for the adverse determination [and] (ii) [Reference to the specific plan provisions on which the determination is based.” Id. In addition, 29 C.F.R. § 2560.503-l(h) provides that the administrator shall provide a “full and fair” review on an appeal of adverse benefit determinations that “takes into account all comments, documents, records, and other information submitted by the claimant relating to the claim.” Administrators of group health plans which provide for two appeals of an adverse determination, like YHP’s policy, must provide notification “with respect to any one of such two appeals, not later than 30 days after receipt by the plan of the claimant’s request for review of the adverse determination.” 29 C.F.R. § 2560.503—l(i)(2)(ill)(A). Lastly, under 29 C.F.R. § 2560.503—l(j), the administrator must provide the claimant with written or electronic notification of a plan’s benefit determination on appeal that sets forth “in a manner calculated to be understood by the claimant (i) [t]he specific reason or reasons for the adverse determination [and] (ii) [reference to the specific plan provisions on which the determination is based.” Legal Standard While a motion for judgment on the administrative record is a motion that “does not appear to be authorized in the Federal Rules of Civil Procedure,” courts treat such motions as motions for summary judgment. Muller v. First Unum Life Ins. Co., 341 F.3d 119, 124 (2d Cir.2003); see also Guglielmi v. Northwestern Mutual Life Ins. Co., No. 06-CV-3431, 2007 WL 1975480, at *3 (S.D.N.Y. July 6, 2007); Chitoiu v. UNUM Provident Corp., No. 05-CV-8119, 2007 WL 1988406, at *3 (S.D.N.Y. July 6, 2007); Pava v. Hartford Life and Accident Ins. Co., No. 03-CV2609, 2005 WL 2039192, at *6 (E.D.N.Y. August 24, 2005); Perezaj v. Bldg. Serv. 32B-J Pension Fund, No. CV-04-3768, 2005 WL 1993392 at *4 (E.D.N.Y. Aug. 17, 2005); Katzenberg v. First Fortis Life Ins. Co., 500 F.Supp.2d 177, 191-92 (E.D.N.Y.2007); Charles v. First Unum Life Ins. Co., No. 02-CV-0748E, 2004 WL 963907, at *1 (W.D.N.Y. March 26, 2004). Summary judgment should be granted “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). The moving party bears the burden of proving that no factual issues exist. Vivenzio v. City of Syracuse, 611 F.3d 98, 106 (2d Cir.2010). “In determining whether that burden has been met, the court is required to resolve all ambiguities and credit all factual inferences that could be drawn in favor of the party against whom summary judgment is sought.” Id., (citing Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 255, 106 S.Ct. 2505, 91 L.Ed.2d 202 (1986); Matsushita Electric Indus. Co. v. Zenith Radio Corp., 475 U.S. 574, 587, 106 S.Ct. 1348, 89 L.Ed.2d 538 (1986)). “If there is any evidence in the record that could reasonably support a jury’s verdict for the nonmoving party, summary judgment must be denied.” Am. Home Assurance Co. v. Hapag Lloyd Container Linie, GmbH, 446 F.3d 313, 315-16 (2d Cir.2006) (internal quotation marks and citation omitted). a. Standard of Review of Plan Administrator’s Denial ofBenefíts 1. YHP TFas Granted Discretionary Authority to Administer the Plan ERISA jurisprudence determines the standard and scope of review in connection with a challenge to a plan’s denial of benefits. Gannon v. Aetna Life Ins. Co., 2007 WL 2844869 at *6 (S.D.N.Y. 2007). “ERISA does not set out the applicable standard of review for actions challenging benefit eligibility determinations.” Zuckerbrod v. Phoenix Mut. Life Ins. Co., 78 F.3d 46, 49 (2d Cir.1996). However, after analyzing the legislative history of ERISA, the Supreme Court has held that a denial of benefits challenge is to be reviewed de novo unless the benefit plan gives the administrator discretionary authority to determine eligibility. Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 115, 109 S.Ct. 948, 103 L.Ed.2d 80 (1989); see also O’Shea v. First Manhattan Co. Thrift Plan & Trust, 55 F.3d 109, 111-12 (2d Cir.1995); Murphy v. IBM Corp., 23 F.3d 719, 721 (2d Cir.1994) (per curiam), cert. denied, 513 U.S. 876, 115 S.Ct. 204, 130 L.Ed.2d 134 (1994); Miles v. New York State Teamsters Conference Pension & Retirement Fund Employee Pension Benefit Plan, 698 F.2d 593, 599 (2d Cir.1983), cert. denied, 464 U.S. 829, 104 S.Ct. 105, 78 L.Ed.2d 108 (1983). In order to determine if a plan confers discretionary authority on its administrator(s), the Court must examine the language of the plan. The Second Circuit has held that discretionary authority can be granted without specific trigger words such as “discretion” or “deference,” as long as the benefit plan’s language is clear. Nichols v. Prudential Ins. Co. of America, 406 F.3d 98, 108 (2d Cir.2005). In general, objective standards do not grant discretion while subjective standards do. The Second Circuit has instructed that subjective phrases such as “resolve all disputes and ambiguities” or “in our judgment,” clearly confer discretionary authority. Id.; see also Krauss v. Oxford Health Plans, Inc., 517 F.3d 614, 622-23 (2d Cir.2008) (finding that terms such as “may adopt reasonable policies, procedures, rules, and interpretations” and “determine^ to be the reasonable charge” confer discretionary authority). However, the Second Circuit has explained that a requirement to “submit satisfactory proof of Total Disability” is ambiguous and does not clearly confer discretionary authority. Kinstler v. First Reliance Standard Life Ins. Co., 181 F.3d 243, 251-52 (2d Cir.1999). The Second Circuit explained that such a phrase is ambiguous because it is unclear whether the claimant must submit to the administrator satisfactory proof which would imply an objective standard of “satisfactory proof,” or the claimant must submit proof that is satisfactory to the administrator, which would imply a subjective standard of “satisfactory proof.” Id. It is the administrator’s burden to prove that discretionary authority has been granted. Id. at 249. In this ease, the plan clearly reserves discretion for the plan administrator. The plan provides that “YHP may adopt reasonable policies, procedures, rules and interpretations to promote the orderly and efficient administration of the policies and coverage plans described in this handbook.” [Dkt. #38-3, Ex. A at 76]. Whether a visit may be characterized as an emergency or not is also explicitly within YHP’s discretion, as the plan provides that, “[i]f, in the judgment of YHP, the illness or injury does not meet the plan definition of an emergency or urgent condition, coverage will be denied.” [Id. at 63.]. The language of the plan plainly permits YHP to adopt reasonable interpretations and use their judgment in determining the outcome of particular claims. Accordingly the plan unambiguously grants discretionary authority to the plan administrator to determine eligibility. See Nichols, 406 F.3d at 108 (finding that “in our judgment” is a phrase clearly granting discretionary authority). 2. Arbitrary and Capricious Review is Appropriate Once it is clear that the administrator has discretionary authority, the standard of review ordinarily shifts from de novo to an arbitrary and capricious standard of review. Id.; see also McCauley v. First Unum Life Ins. Co., 551 F.3d 126, 131 (2d Cir.2008); Krauss, 517 F.3d at 622; Pastore v. Witco Corp. Severance Plan, 196 Fed.Appx. 18, 21 (2d Cir.2006); Brockett v. Reed, 78 Fed.Appx. 148, 150 (2d Cir.2003); Fay v. Oxford Health Plan, 287 F.3d 96, 104 (2d Cir.2002). However, the Second Circuit has held that, under certain circumstances, a plan administrator’s failure to comply with the letter of the claims procedures outlined in ERISA requires courts to eschew the more deferential arbitrary and capricious review normally applied to an administrator’s discretionary decisions in favor of a more searching de novo review. See Nichols v. Prudential Ins. Co., 406 F.3d 98, 109 (2d Cir.2005). As the Department of Labor noted in the amicus brief it submitted to the Second Circuit, the Nichols court “reasoned that when a plaintiffs benefit claim was ‘deemed denied’ because the plan had not decided her claim within the applicable time limits there was no ‘exercise of discretion’ to which to give ‘deferential review.’ ” Brief of the Acting Secretary of Labor, at 8, Halo v. Yale Health Plan, No. 12-CV-1447 (2d Cir. filed Jan. 31, 2013), 2013 WL 453955 at *20-21. However, Nichols arose under an extreme set of facts that are not applicable here. In Nichols, the plan administrator failed to even acknowledge the claimant’s appeal until after the time period specified by the regulations then in effect had expired. When the administrator did provide notice of the appeal, it informed the claimant that it would not resolve the appeal until the claimant submitted certain medical records. The claimant refused to comply with the request and filed suit in federal court. See Nichols, 406 F.3d at 101-02. Under this set of facts, the Second Circuit held that it “may give deferential review only to actual exercises of discretion, and that a ‘deemed denied’ claim is not denied by an exercise of discretion^] but by operation of law” on the day after the regulations require a decision be issued. Id. Given the unique facts under which the Second Circuit decided Nichols, when faced with the question of whether an administrator’s failure to comply with ERISA claims procedure is sufficient to trigger de novo review, district courts in this Circuit conduct a fact-specific inquiry to determine whether the plan administrator had acted in a dilatory or bad faith manner such that a claimant’s claim is “deemed denied,” or if the administrator made efforts to keep the beneficiary apprised of the claim assessment process and delivered reasonably timely and detailed decisions, which indicate that the administrator validly exercised its discretion. See, e.g., Topalian v. Hartford Life Ins. Co., 945 F.Supp.2d 294, 336-40 (E.D.N.Y.2013); Tsagari v. Pitney Bowes, Inc. Long-Term Disability Plan, 473 F.Supp.2d 334, 338-40 (D.Conn.2007); Wedge v. Shawmut Design & Constr. Grp. Long Term Disability Ins. Plan, No. 12 Civ. 5645(KPF), 2013 WL 4860157, at *9-11 (S.D.N.Y. Sept. 10, 2013); Duncan v. CIGNA Life Ins. Co. of N.Y., No. 10-CV-1164 (SJF)(ARL), 2011 WL 6960621, at *4-5 (E.D.N.Y. Dec. 30, 2011); Onge v. Unum Life Ins. Co. of Am., No. 3:07-CV-01249(AWT), 2010 WL 3802787, at *2-4 (D.Conn. Sept. 20, 2010); Robinson v. Metropolitan Life Ins. Co., No. 06 Civ. 7604, 2007 WL 3254397, at *2 (S.D.N.Y. Nov. 2, 2007); Pava v. Hartford Life & Accident Ins. Co., No. 03 CV 2609 SLT RML, 2005 WL 2039192, at *8-9 (E.D.N.Y. Aug. 24, 2005). Here, while YHP’s communications of its claim denials were not ideal (and in some instances failed to comply with ERISA regulations), the substance and timing of its denials of Halo’s claims were sufficient to indicate that YHP had exercised its discretion, such that this Court will review its denials of Halo’s claims under an arbitrary and capricious standard. See Topalian, 945 F.Supp.2d 294, 337 (E.D.N.Y.2013) (“[T]he weight of authority in the Second Circuit supports the application of arbitrary and capricious review where ... the plan administrator remains in regular contact with the benefits claimant and issues a decision prior to the commencement of federal litigation.”) With regard to Halo’s first two out-of-network treatments, on June 17 and June 18, 2008, YHP communicated with Halo throughout the claim process. YHP spoke ■with Halo on June 17 before she underwent the procedures. See [Dkt. # 38, Mot. for J., at 8; Dkt. #43, Opp. at 13], YHP reaffirmed the scope of its out-of-network referral in writing the same day (June 17). See [Dkt. # 38-5 at Ex. C]. Plaintiff alleges that YHP spoke with her father on either June 17 or 18. See [Dkt. #38-8, Ex. F at 2; Dkt. #43, Opp. at 14; Dkt. # 43-8, Ex. V (Aff. of Hal Halo) at ¶ 3]. Once Halo submitted formal post-service claims for these visits, YHP complied with the ERISA notification requirements. YHP received Halo’s claim on July 8, 2008, see [Dkt. # 38-6 at Ex. D], and issued an initial written denial on July 30, 2008. [Dkt. # 38-7 at Ex. E]. YHP’s initial written denial of Halo’s claims came within ERISA’s 30-day requirement for post-service claims. See 29 C.F.R. § 2560.503-l(f)(2)(iii)(B). While Halo adamantly maintains that she and her family communicated to YHP that her condition was an emergency or was otherwise urgent, [Dkt. # 43, Opp. at 14], and YHP does not expressly dispute this contention, simply stating that a condition or procedure is an “emergency” does not convert a claim for benefits into an “urgent care claim” under ERISA. Urgent care claims are limited to claims in which the application of the time periods for making non-urgent care determinations “Mould seriously jeopardize the life or health of the claimant or the ability of the claimant to regain maximum function,” 29 C.F.R. § 2560.503-l(m)(l)(i)(A) or where, “[i]n the opinion of a physician with knowledge of the claimant’s medical condition, would subject to the claimant to severe pain that cannot be adequately managed without the care or treatment that is the subject of the claim.” 29 C.F.R. § 2560.503-l(m)(l)(i)(B). In addition, ERISA provides that, unless a physician with knowledge of the claimant’s medical condition determines that a claim is urgent, the decision of whether a particular claim is urgent is to be made “by an individual acting on behalf of the plan applying the judgment of a prudent layperson who possesses an average knowledge of health and medicine.” 29 C.F.R. § 2560.503-l(m)(l)(ii). Halo does not state—and there is no evidence in the record to suggest—that, at the time of either her treatment or the submission of her claim, any physician with knowledge of her medical condition had determined that any of her out-of-network procedures constituted urgent claims under ERISA, a. Sufficiency and Timing of Benefit Determinations Although YHP’s initial written denial met the timing requirements under ERISA, the Court finds that the notification itself falls short of ERISA’s requirements. Under ERISA, a notification of any adverse benefit determination must communicate, “in a manner calculated to be understood by the claimant ... [t]he specific reason or reasons for the adverse determination.” 29 C.F.R. § 2560.503-1(g)(1)—(g)(l)(i). The notification must also make “[r]eference to the specific plan provisions on which the determination is based,” 29 C.F.R. § 2560.503-l(g)(l)(ii), and it must describe “the plan’s review procedures and the time limits applicable to such procedures, including a statement of the claimant’s right to bring a civil action under section 502(a) of the Act following an adverse benefit determination on review.” 29 C.F.R. § 2560.503-l(g)(l)(iv). The “Explanation of Benefits” form YHP sent Halo provides only the following explanation for YHP’s denial of her June 17 and June 18 claims: “REJ—SERVICE NOT AUTHORIZED.” [Dkt. # 38-7, Ex. E]. Without more, this explanation does not sufficiently communicate the “specific reason or reasons” for YHP’s denial. 29 C.F.R. § 2560.503-l(g)(l)(i). The form also failed to reference specific plan provisions and to state the plan’s review procedures. See 29 C.F.R. § 2560.503-l(g)(l)(ii)-(iv). However, YHP’s second letter, denying Halo’s August 7, 2008 “first level claim appeal,” [Dkt. # 38-8, Ex. F at 1], cured some of these defects, by explaining the basis for YHP’s denial and notifying Halo of her right to appeal, and it also put Halo on notice about subsequent claims for out-of-network treatment in connection with her eye condition. See [Dkt. #38-12 at Ex. J]. First, YHP explained the basis for its denial of the claims, stating that Halo “elected to leave the New Haven area and requested coverage for a second opinion with a[n] [out-of-network] physician,” that “Moverage for non-emergency out of network care is not part of [Halo’s] health care benefit with Yale Health Plan,” that while Halo’s request for a second opinion had been approved, “[t]he services provided by Dr. D’Amico went beyond consultation, resulting in charges that were not covered by the original request.” [Id. at 1]. The letter then referenced the recent conversation YHP had with Halo on August 11, 2008, in which Dr. Forster advised Halo to stay in network in order for the plan to cover her medical expenses, [Dkt. #38-10 at Ex. H], stated that “further visits and follow-up surgery with Dr. D’Amico would be denied, based on the terms of [Halo’s] coverage,” and reminded Halo “of the availability of in-network retinal specialists to provide [her] needed follow up care.” [Dkt. # 38-12, Ex. J at 2], The letter further advised Halo to “contact Dr. Forster regarding [her] options for follow up care.” [Id.]. Finally, it informed Halo that she was “entitled to further review [her] appeal with the Claims Review Committee as described in [YHP’s] member handbook,” and stated that in the event Halo wished to pursue an appeal, she should “contact Vicki Eisler ... for information and assistance.” [Id.]. Accordingly, the August 15 letter satisfied the “fundamental purpose of these procedural requirements [which] is to insure that when a claimant appeals a denial to the plan administrator, he will be able to address the determinative issues and have a fair chance to present his case.” Alternative Case Sys. v. Metropolitan Life Ins. Co., No. 92 Civ. 7208(RPP), 1996 WL 67737, at *2-3 (S.D.N.Y. Feb. 16, 1996); see also Testa v. Hartford Life Ins. Co., 483 Fed.Appx. 595, 597 (2d Cir.2012) (“Substantial compliance with the regulations is all that is needed to constitute ‘adequate notice’ under ERISA.”); Schnur v. CTC Communications Corp. Group Disability Plan, 413 Fed.Appx. 377, 380 (2d Cir.2011) (finding that plan’s notice complied 29 C.F.R. § 2560.530-l(g) because the “notice of denial—a thorough, four- and-a-half-page document—amply laid out the basis for the denial, and, by implication, a description of those materials necessary to perfect the claim. Specifically, that notice informed [plaintiff] that ‘we do not see any evidence in the current medical records to establish that your condition imposes a physical or psychological impairment that would preclude you from engaging in the substantial and material duties of your regular occupation on a sustained basis.’ ”). On September 8, 2008, Halo sought a second and final appeal of these two claims, see [Dkt. #38-13 at Ex. K], and ten days later, on September 18, 2008, YHP sent Halo a written notice informing her that YHP voted to approve the payment, [Dkt. # 38-14 at Ex. L], well within the 30-day ERISA notification period. See 29 C.F.R. § 2560.503-l(i)(2)(iii)(A). Halo alleges that YHP was “51 days delinquent” in issuing its “denial of benefits for (June 17, 18).” [Dkt. # 43, Opp. at 19]. Halo appears to have arrived at this figure by calculating the number of days between the date she first orally requested an out-of-network referral, June 16, 2008, and August 6, 2008, the day Halo alleges she received YHP’s notice denying her claims for the out-of-network treatment. This calculation is incorrect for at least three reasons. First, there is no dispute that the only pre-service approval Halo requested on June 16 was for a second opinion, see [id. at 13], and YHP approved this request the next day. Second, even under Halo’s calculation, YHP would have had to provide written notice of its denial by July 17, at the earliest, for a post-service claim. Thus, at most, YHP’s denial letter was 20 days late. Third, and most importantly, this allegation hinges on the conclusion that an oral request for authorization, which did not comply with YHP’s claim procedures, constituted a claim for benefits under ERISA. This is not correct. YHP required claimants (or their treating doctors) to submit itemized billing statements as part of a claim for benefits. See [Dkt. # 38-3, Ex. A at 39]. Halo complied with these requirements and YHP received these billing statements on July 8, 2008. See [Dkt. # 38-6 at Ex. D]. Since the ERISA notification requirements are triggered upon an administrator’s “receipt of [a] claim,” 29 C.F.R. § 2560.503—1(f)(2)(iii)(B) (emphasis added), and ERISA defines a claim as “a request for a plan benefit or benefits made by a claimant in accordance with a plan’s reasonable procedure for filing benefit claims,” 29 C.F.R. § 2560.503-l(e), the timing requirements under ERISA did not begin until July 8, 2008. See, e.g., Baackes v. Kaiser Foundation Health Plan, Inc., 990 F.Supp.2d 228, 239 (N.D.N.Y.2014) (declining to apply de novo review and holding that ERISA 90-day timing requirement was not triggered because the document upon which the claimant relied was not “an actual formal claim”). Accordingly, YHP had until August 8, 2008 to notify Halo of its denial of her claims— which Halo admits YHP did. See [Dkt. #43, Opp. at 18 (“The June 17[and] 18 claims were processed by Yale on July 30, 2008, and the denial was received by [Halo] via mail on August 6, 2008.”) ]. Halo’s assertion that YHP was “86 days delinquent” when it notified her in September 2008 that her claims had been approved, [id. at 19-20], similarly misses the mark. This figure is based on the approximate numbers of days in between the date of Halo’s first procedure (June 17) and the date on which YHP’s review committee met for Halo’s second appeal (September 9). Turning now to Halo’s next two procedures, June 20 and June 26, 2008, Halo maintains that YHP did not render a benefits decision on her claims until November 11, 2008. [Dkt. # 43, Opp. at 19]. However, the Court is unable to assess whether or not YHP violated the procedures because there is no evidence in the record as to when Halo submitted these claims. The Court does, however, note that the denial notice YHP issued in connection with both of these claims suffers from the same deficiencies as the initial notice Halo received regarding her June 17 and 18 claims. Compare [Dkt. #38-7 at Ex. E] with [Dkt. # 38-19 at Ex. Q]. Halo next complains that YHP did not provide timely notice of its denial of her claim for surgery on August 13, 2008. Indeed, Halo alleges that YHP was “116 days delinquent” in denying her claim for this procedure. [Dkt. #43, Opp. at 20]. Halo also maintains, as she did with regard to her previous procedures, that YHP was required to comply with the accelerated notification requirements ERISA prescribes for urgent care claims. [Id.] However, as noted, Halo’s and her parents’ characterizations of this procedure as an emergency or urgent are not sufficient to trigger YHP’s duty to comply with the ERISA urgent care timing requirements, see supra at 257, and after considering the other evidence in the record, the Court finds that YHP’s decision not to treat Halo’s August 13 claim as a claim involving urgent care was not unreasonable. In addition, YHP complied with the non-urgent timing requirements. Halo first informed YHP of her upcoming August 13 surgery in her letter of August 7, which appealed the initial denial of her June 17 and 18 procedures. See [Dkt. # 38-8, Ex. F at 2]. Within eight days, YHP had provided both an oral notification informing Halo of ‘YHP[’s] denial of coverage” for the surgery, [Dkt. #38-10, Ex. H; Dkt. #43, Opp. at 17], and a follow-up letter, which both parties understood conveyed a denial of coverage for Halo’s August 13 surgery. See [Dkt. # 38, Mot. for J., at 12; Dkt. # 38-12 at Ex. J; Dkt. # 43, Opp. at 19]. Accordingly, YHP satisfied its timing of notification requirements, regardless of whether Halo’s claim was construed as a pre-service or post-service claim. See 29 C.F.R. § 2560.503—l(f)(2)(iii)(A)—(B). The August 15 letter served as an adequate, though imperfect, denial letter, which reiterated Dr. Forster’s oral explanation for the denial of Halo’s claim for surgery on August 13 and provided her with information concerning her right and ability to appeal the denial. See [Dkt. # 38-12, Ex. J at 2]. YHP also dealt with each of Halo’s appeals of this claim in a timely manner under the ERISA provisions. See [Dkt. # 38-13-15 at Exs. KM], Finally, YHP timely handled Halo’s claim for surgery she underwent on September 17, 2008. YHP received her post-service claim on October 3, 2008, see [Dkt. #38-18 at Ex. P], and issued a written denial on November 7, see [Dkt. #38-19 at Ex. Q], within the 30-day time period mandated by ERISA. See 29 C.F.R. § 2560.503—1(f) (2)(iii) (B). However, once again, YHP provided Halo with a facially deficient denial notice. See [Dkt. # 38-19 at Ex. Q]. Although the Court is troubled by some of the sparse denial notices YHP issued in response to some of Halo’s claims, YHP’s overall course of conduct, which included pre- and post-service telephone conversations with Halo, a detailed denial letter setting forth the reasons for YHP’s denials of Halo’s June 17 and 18 and August 13 claims and providing Halo with the information necessary for her to pursue her administrative appeals, YHP’s timely handling of Halo’s appeals, and the uncertainty of if and when Halo submitted claims that complied with YHP’s claims procedures, lead to the conclusion that, while YHP did not behave perfectly, “the instant case is not Nichols.” Wedge v. Shawmut Design & Constr. Grp. Long Term Disability Ins. Plan, No. 12 Civ. 5645(KPF), 2013 WL 4860157, at *9 (S.D.N.Y. Sept. 10, 2013) (applying arbitrary and capricious standard even when plan administrator issued a final appeal decision after plaintiff had filed his suit in court where the administrator “exchanged substantial communications with [p]laintiff” and demonstrated efforts to efficiently resolve plaintiffs administrative appeal). Taking into consideration all of the circumstances, by providing Halo sufficient and timely information of its benefit determinations and the reasons therefore, YHP complied sufficiently with the notification requirements such that its decisions are entitled to arbitrary and capricious review. 3. Arbitrary and Capricious Standard of Review A decision that is arbitrary and capricious will not be upheld and is defined as “without reason, not supported by substantial evidence or erroneous as a matter of law.” Kinstler, 181 F.3d at 249 (citing Pagan v. NYNEX Pension Plan, 52 F.3d 438 (2d Cir.1995)). “Substantial evidence is ‘such evidence that a reasonable mind might accept as adequate to support the conclusion reached by the [administrator and] ... requires more than a scintilla but less than a preponderance.’ ” Celardo v. GNY Auto. Dealers Health & Welfare Trust, 318 F.3d 142, 146 (2d Cir.2003) (quoting Miller v. United Welfare Fund, 72 F.3d 1066, 1072 (2d Cir.1995)). “This scope of review is narrow and the Court is not permitted to substitute its own judgment for that of the decision maker.” Burgio v. Prudential Ins. Co. of America, No. 06-CV-6793, 2011 WL 4532482, at *4 (E.D.N.Y. Sept. 26, 2011) (citing Pagan v. NYNEX Pension Plan, 52 F.3d 438, 442 (2d Cir.1995) and Jordan v. Ret. Comm. of Rensselaer Polytechnic Inst., 46 F.3d 1264, 1271 (2d Cir.1995)). In addition, courts have held that where a plan administrator both evaluates and pays benefits claims out of its own pocket, the administrator has a conflict of interest that must be taken into account in a court’s review under an arbitrary and capricious standard. The conflict of interest analysis was articulated by the Supreme Court in Glenn. Metropolitan Life Ins. Co. v. Glenn., 554 U.S. 105, 128 S.Ct. 2343, 2349, 171 L.Ed.2d 299 (2008) (ERISA “permits a person denied benefits under an employee benefit plan to challenge that denial in federal court ... Often the entity that administers the plan, such as an employer or an insurance company, both determines whether an employee is eligible for benefits and pays benefits out of its own pocket. We here decide that this dual role creates a conflict of interest; that a reviewing court should consider that conflict as a factor in determining whether the plan administrator has abused its discretion in denying benefits; and that the significance of the factor will depend upon the circumstances of the particular case.”) (citations omitted). A plaintiff’s showing that the administrator’s conflict of interest affected the choice of a reasonable interpretatio