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Emerus Hosp. Parnters, LLC v. Health Care Serv. Corp.

United States District Court, N.D. Illinois, Eastern Division

April 29, 2014

EMERUS HOSPITAL PARNTERS, LLC and EMERUS HOSPITAL, f/k/a 24 Hours Emergency Hospital, Plaintiffs,
v.
HEALTH CARE SERVICE CORPORATION, a Mutual Legal Reserve Company, and BLUE CROSS AND BLUE SHIELD OF TEXAS, a division of Health Care Service Corporation, a Mutual Legal Reserve Company, Defendants

For Emerus Hospital Partners, L.L.C., Emerus Hospital, formerly known as, Plaintiffs: Alexander B Klein, III, The Klein Law Firm, Houston, TX; Carlton E. Odim, Odim Law Offices, Chicago, IL.

For Health Care Service Corporation, a Mutual Legal Reserve Company, Defendant: Martin J. Bishop, Rebecca R. Hanson, LEAD ATTORNEYS, Foley & Lardner, Chicago, IL.

Page 696

MEMORANDUM OPINION AND ORDER

Robert W. Gettleman, United States District Judge.

Plaintiffs Emerus Hospital Partners, LLC, and Emerus Hospital f/k/a 24 Hours

Page 697

Emergency Hospital (" Emerus" ) sued defendants Health Care Service Corporation, a Mutual Legal Reserve Company, and Blue Cross Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company (collectively, " HCSC" ), in the Circuit Court of Cook County, Illinois, seeking damages Emerus incurred as a result of HCSC's alleged breach of statutory obligations. In its complaint, Emerus alleges that HCSC violated the Texas Prompt Pay Act (" TPPA" ), Tex. Ins. Code. Ann. § § 1301.101-1301.109, by failing to comply with the statutory provisions of the TPPA. HCSC timely removed the action to this court, pursuant to 28 U.S.C.A. § 1331, and the Employee Retirement Income Security Act (" ERISA" ), 29 U.S.C.A. § 1001 et seq., alleging that ERISA preempts any state law claims. Emerus has moved to remand the action to state court. For the reasons discussed below, the motion to remand is denied.

BACKROUND

Emerus is a group of health care providers and physicians who provide emergency care services for emergency medical conditions to patients in Texas. HCSC is an insurer as defined under the TPPA.[1]

From November 1, 2009, to the present, Emerus provided emergency care to some patients insured by HCSC. A number of these patients were insured under an employee welfare benefit plan. At all times relevant to the allegations, Emerus was an out-of-network, or nonpreferred, provider with HCSC. During this time, Emerus submitted " clean" claims [2] for payment to HCSC, pursuant to the provisions of the TPPA, Tex. Ins. Code Ann. § § 1301.102, 1301.131, for the emergency care provided to patients insured by HCSC. HCSC denied coverage for the claims submitted by Emerus on behalf of individuals covered by an ERISA regulated employee welfare benefit plan after HCSC determined that certain benefits were not available under the relevant ERISA plan.

HCSC argues that because some of the patients treated by Emerus were beneficiaries of a federally regulated employee benefit plan, the claims are preempted by ERISA, and that consequently this court has subject matter jurisdiction over Emerus' claims. Just prior to the commencement of this lawsuit, however, in June of 2013, Emerus executed written, irrevocable waivers of assignment, expressly waiving any and all assignment benefits and/or claims from all patients who received emergency care provided by Emerus. Consequently, Emerus claims that this court lacks subject matter jurisdiction because any standing under ERISA, derivative or otherwise, has been waived. Accordingly, Emerus brought suit in state court under the TPPA, which provides a statutory claim for an out of network emergency care provider to receive payment, Tex. Ins. Code Ann. § 1301.069, " at the usual or customary rate or at a rate agreed to by the issuer and the nonpreferred provider" for the provision of emergency care services. Id. § 1301.0053.

DISCUSSION

The " [p]urpose of ERISA is to provide a uniform regulatory ...


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