Searching over 5,500,000 cases.


searching
Buy This Entire Record For $7.95

Download the entire decision to receive the complete text, official citation,
docket number, dissents and concurrences, and footnotes for this case.

Learn more about what you receive with purchase of this case.

Beverly Oaks Physicians Surgical Center, LLC v. Blue Cross Blue Shield of Illinois

United States District Court, C.D. California

June 20, 2019

BEVERLY OAKS PHYSICIANS SURGICAL CENTER, LLC, A California Limited Liability Company Plaintiff,
v.
BLUE CROSS BLUE SHIELD OF ILLINOIS; and Does 1 through 100; Defendants.

          ORDER RE: DEFENDANT'S MOTION TO DISMISS PLAINTIFF'S SAC [31]

          HONORABLE RONALD S.W. LEW, SENIOR U.S. DISTRICT JUDGE.

         Currently before the Court is Defendant Blue Cross Blue Shield of Illinois' (“Defendant”) Motion to Dismiss Plaintiff's Second Amended Complaint [31] (“Motion”). Having reviewed all papers submitted pertaining to this Motion, the Court NOW FINDS AND RULES AS FOLLOWS: the Court GRANTS Defendant's Motion WITHOUT LEAVE TO AMEND.

         I. BACKGROUND

         A. Factual Background

         Plaintiff Beverly Oaks Physicians Surgical Center, LLC, (“Plaintiff”) brings this Action against Defendant for recovery of benefits under the Employee Retirement Income Security Act of 1974 (“ERISA”). Plaintiff is an ambulatory surgery center located in Sherman Oaks, California. Second Am. Compl. (“SAC”) ¶ 3, ECF No. 30. Defendant is a managed care company that, among other things, insures and/or administers employer health plans typically governed by ERISA. Id. ¶ 6. Defendant carries out its health insurance business activities in each state where covered employees and their dependents are located. Id. ¶ 8. Plaintiff brings this Action as the purported assignee of patients seeking recovery of ERISA benefits they allege Defendant owes them. Id. ¶¶ 14-16.

         Plaintiff provided surgery center facility services to eleven patients[1] enrolled in the Teamsters Western Region & Local 177 Health Care Plan (“Teamsters Plan”), a health plan governed by ERISA.[2] Id. ¶¶ 10, 11. Plaintiff alleges that all of these patients assigned their health plan benefits to Plaintiff and that Plaintiff submitted seventeen claims for medical services provided to these patients. Id. ¶¶ 21, 46; see id., Ex. A, ECF No. 30-1. Plaintiff alleges that Defendant failed to pay Plaintiff's full billed charges, and that as an assignee of these benefits, it is entitled to recover additional payments from Defendant. Id. ¶¶ 38, 39.

         Defendant has provided the Teamster's Summary Plan Description document (“Teamsters SPD”). Id. ¶ 17. The Teamsters SPD contains the following clause in a section titled “General Provisions”: “Participants are generally responsible for notifying the Fund of changes in family circumstances. Benefits are not assignable, although the Fund will honor qualified medical child support orders.” Id. The parties dispute whether this clause is a valid anti-assignment provision (“AAP”). The Teamsters SPD is not by itself the Teamsters Plan document, but it expressly references Article X of the Teamsters Plan Rules and Regulations. Id. ¶ 18. Article X of the Teamster Plan Rules and Regulations, Section B provides:

Benefits payable hereunder shall not be subject in any manner to anticipation, alienation, sale, transfer, assignment, pledge, encumbrance, or charge by any person; however, any Eligible The Court granted Defendant's Motion to Dismiss Plaintiff's FAC without leave to amend as to these three patients, and as such, these claims are no longer before the Court. Employee may direct that benefits due him/her, except benefits payable under Article III, be paid to an institution in which he/she or his/her Dependent is hospitalized, or to any provider of medical, dental or vision care services or supplies in consideration for Hospital, medical, dental or vision care services rendered or to be rendered.
Notwithstanding the foregoing, the Fund will honor any “qualified medical child support order” as defined by ERISA Section 609, received with respect to the Fund, and will make any payment required by ERISA Section 609 to a State which has acquired rights under that Section.

Id. ¶ 20; see id., Ex. D at 59.

         B. Procedural Background

         Plaintiff filed its Complaint [1] on May 9, 2018 for recovery of benefits under ERISA. Defendant filed a Motion to Dismiss [13] on August 6, 2018. This Court granted Defendant's Motion to Dismiss with leave to amend [17] on November 8, 2018.[3] On November 29, 2018, Plaintiff filed its First Amended Complaint (“FAC”) [18]. On December 13, 2018, Defendant filed a Motion to Dismiss Plaintiff's FAC [19], which the Court granted on February 27, 2019 [29]. Specifically, the Court dismissed without leave to amend Plaintiff's claims under the Woodward & Williams Lea Plans, and Plaintiff's claim brought on behalf of Patient E. The Court granted leave to amend solely as to Plaintiff's claims under the Teamsters Plan.

         On March 20, 2019, Plaintiff filed its SAC [30]. On April 3, 2019, Defendant filed the instant Motion to Dismiss Plaintiff's SAC [31]. Plaintiff timely opposed [33], and Defendant timely replied [34].

         II. ...


Buy This Entire Record For $7.95

Download the entire decision to receive the complete text, official citation,
docket number, dissents and concurrences, and footnotes for this case.

Learn more about what you receive with purchase of this case.