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Surgery Center of Viera, LLC v. United Launch Alliance LLC

United States District Court, M.D. Florida, Orlando Division

January 31, 2018

SURGERY CENTER OF VIERA, LLC, Plaintiff,
v.
UNITED LAUNCH ALLIANCE LLC, THE UNITED LAUNCH ALLIANCE HEALTH & WELFARE BENEFITS PLAN FOR ACTIVE EMPLOYEES, ULA ADMINISTRATIVE COMMITTEE and ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICES, INC., Defendants.

          REPORT AND RECOMMENDATION

          DANIEL C. IRICK UNITES STATES MAGISTRATE JUDGE

         This cause comes before the Court for consideration following oral argument on the following motions:

         MOTION: DEFENDANT ROCKY MOUNTAIN HOSPITAL AND

         MEDICAL SERVICES, INC. d/b/a ANTHEM BLUE CROSS AND BLUE SHIELD'S MOTION TO DISMISS SECOND AMENDED COMPLAINT (Doc. 41)

         FILED: November 27, 2017 THEREON it is RECOMMENDED that the motion be GRANTED.

         MOTION: MOTION TO DISMISS SECOND AMENDED COMPLAINT (Doc. 45)

         FILED: December 11, 2017 THEREON it is RECOMMENDED that the motion be GRANTED.

         I. Introduction

         This matter is before the undersigned to consider two motions to dismiss the Second Amended Complaint for a failure to state a claim pursuant to Federal Rule of Civil Procedure 12(b)(6). Docs. 41; 45. For the reasons set forth in this Report, the undersigned respectfully recommends that the Second Amended Complaint be dismissed with prejudice because Plaintiff's ability to bring this Employee Retirement Income Security Act of 1974 (ERISA) action is precluded by a valid anti-assignment provision contained within the plan documents.

         II. Procedural Background

         On April 26, 2017, Plaintiff, the operator of a surgical center in Melbourne, Florida, filed a Complaint alleging three claims against Defendants pursuant to ERISA, all related to the treatment of a patient (Patient BG) by Plaintiff. Doc. 1. Plaintiff filed an Amended Complaint (Doc. 13) on August 29, 2017, and a Second Amended Complaint (Doc. 33) on November 10, 2017, which remains the operative pleading. On November 27, 2017, Defendant Rocky Mountain Hospital and Medical Services, Inc., d/b/a Anthem Blue Cross and Blue Shield (Anthem) filed a motion to dismiss the Second Amended Complaint that included, amongst other attachments, the ERISA plan at issue. Docs. 41; 41-1. On December 11, 2017, Defendants, United Launch Alliance, LLC (ULA), the United Launch Alliance Health & Welfare Benefits Plan for Active Employees (the Plan), and ULA Administrative Committee (the Plan Administrator) (collectively the ULA Defendants) filed a motion to dismiss the Second Amended Complaint. Doc. 45. Those two motions to dismiss are the subject of this Report.

         III. Allegations in the Second Amended Complaint

         According to the allegations in the Second Amended Complaint, which the Court takes as true for purposes of this Report, ULA provided healthcare insurance to its employees (including Patient BG) through a self-insured welfare benefit plans. The Plan Administrator was a committee of ULA employees appointed as Plan Administrator for the Plan. Anthem was a healthcare insurance company that provided administrative services to ULA for the Plan. The Plan was the self-insured employee welfare benefit plan sponsored by ULA and administered by Anthem and the Plan Administrator.[1]

         On December 12, 2014, Patient BG received medical services from Plaintiff. Patient BG was covered under the terms of the Plan. Plaintiff was an out of network provider in relation to the Plan. In exchange for medical services, Patient BG gave Plaintiff an assignment of benefits owed to Patient BG under the Plan. See Doc. 33-1. In relation to the assertion of any ERISA claim, Patient BG agreed in the assignment to “promptly furnish information to, and otherwise cooperate reasonably with Provider, in its assertion of any such claim.” Id. at 1. After providing medical services to Patient BG, Plaintiff submitted a bill to Anthem for the amounts charged to Patient BG, i.e. $295, 210.00.

         On February 2, 2015, Anthem notified Plaintiff that Anthem would only pay Plaintiff $26, 125.77 for the medical services provided to Patient BG. See Doc. 33-3. On February 27, 2015, Plaintiff filed an initial appeal of the claim denial. See Doc. 33-4. On May 6, 2015, Plaintiff filed a second appeal with Anthem and a request for documents. See Doc. 33-5. On December 22, 2015, Plaintiff filed a third and final appeal and request for documents. See Doc. 33-6. Plaintiff alleged that in response to Plaintiff's appeals, Defendants have not issued payment for the unpaid amounts and have not provided Plaintiff with the Plan documents. Thus, Plaintiff alleged that “Plaintiff has exhausted all of its administrative requirements under ERISA to the best of its ability, despite lack of meaningful access to Plan documents.”

         In the Second Amended Complaint, Plaintiff alleged three claims pursuant to ERISA. In Count I, Plaintiff brought a claim pursuant to ERISA § 502(a)(1)(b) and 29 U.S.C. § 1132(a)(1)(B), alleging that it is entitled to enforce the rights, terms, and conditions of the Plan as an assignee of Patient BG and, as such, Plaintiff is entitled to recover benefits due to Patient BG under the Plan. In the alternative, Plaintiff asserted that it is entitled to assert the rights of Patient BG under the Plan because Plaintiff is an authorized representative of Patient BG. Plaintiff further alleged that Defendants breached the terms of the Plan by, amongst other things, failing to make payments and failing to provide a full and fair review of the claim at issue. As a result, Plaintiff seeks damages in the amount of $269, 084.23 against Defendants. In Count II, Plaintiff brought a claim for breach of fiduciary duty pursuant to ERISA § 502(a)(3) and 29 U.S.C. § 1132(a)(3) against all Defendants. Again, Plaintiff sought relief both as an assignee and, alternatively, as a personal representative of Patient BG. In Count II, Plaintiff seeks “appropriate equitable relief and all other damages and costs the Court deems appropriate.” In Count III, Plaintiff brought a claim seeking civil penalties against ULA, the Plan, and the Plan Administrator (the ULA Defendants) pursuant to ERISA § 502(c) and 29 U.S.C. § 1132(c)(1)(B) in relation to those Defendants alleged failure to provide requested documents, including the “master governing plan document.”

         IV. The ...


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