United States District Court, N.D. Illinois, Eastern Division
LB SURGERY CENTER, LLC d/b/a GREATER LONG BEACH SURGERY CENTER, Plaintiff,
THE BOEING COMPANY, HEALTH CARE SERVICE CORPORATION d/b/a BLUE CROSS BLUE SHIELD OF ILLINOIS, and THE BOEING COMPANY EMPLOYEE BENEFIT PLANS COMMITTEE, Defendants.
OPINION AND ORDER
L. ELLIS, UNITED STATES DISTRICT JUDGE.
provided medical services to beneficiaries of Defendant The
Boeing Company's (“Boeing”) welfare benefit
plan and not received payment for the full amount due,
Plaintiff LB Surgery Center, LLC d/b/a Greater Long Beach
Surgery Center (“LB Surgery) filed suit against
Defendants Boeing, The Boeing Company Employee Benefit Plans
Committee (the “Plan Administrator”), and Health
Care Service Corporation d/b/a Blue Cross and Blue Shield of
Illinois (“BCBSIL”). LB Surgery alleges that
Defendants violated the Employee Retirement Income Security
Act of 1974 (“ERISA”), 29 U.S.C. § 1001
et seq., by failing to provide benefits in violation
of ERISA § 502(a)(1)(B) (Count I), breaching their
fiduciary duties of loyalty and care in violation of §
502(a)(3) (Count II), failing to provide a full and fair
review of claims in violation of § 503 (Count III), and
failing to provide LB Surgery with requested Plan-related
documents in violation of § 502(c)(1)(B) (Count IV).
Defendants have moved to dismiss the claims against them.
Because the Court finds that the anti-assignment provision in
the Boeing welfare benefit plan bars LB Surgery from bringing
an action under ERISA, the Court dismisses the first amended
complaint with prejudice.
provides healthcare insurance to its employees through a
self-insured welfare benefit plan, The Boeing Company Master
Welfare Plan (the “Plan”). ERISA governs the
Plan. The Plan Administrator, a committee of Boeing
employees, serves as the administrator of the Plan. BCBSIL, a
commercial healthcare insurance company, provides
administrative services to Boeing for the Plan. Under the
Plan, employees have access to BCBSIL's network of
providers. These providers are considered in-network
providers, meaning they agree to accept negotiated lower
amounts for their services. Out-of-network providers, in
contrast, are not bound by the negotiated lower amounts, with
payment instead based on the usual, customary, and reasonable
rate for the service in the same geographic area.
Plan includes an anti-assignment provision:
Health care benefits payable under the applicable Component
Benefit Programs shall not be subject in any manner to
anticipation, alienation, sale, transfer, assignment, pledge,
encumbrance or charge by any person, institution, or
otherwise. The Plan or any Component Benefit Program may, at
the sole and absolute discretion of the Plan Administrator,
pay benefits directly to an institution in which the
Participant or Dependent has been admitted as inpatient or to
any provider of health care services or supplies in
consideration for medical or hospital or dental services or
supplies rendered or to be rendered regardless of the
presence or absence of an assignment of benefits or other
form of benefit directive. The Plan or any Component Benefit
Program may also, at the sole and absolute discretion of the
Plan Administrator, pay benefit claims directly to a
Participant or Dependent regardless of any purported benefit
assignment. . . .
No Participant or Dependent may assign to any person,
institution, or otherwise his or her right to file a claim
and/or an appeal under the Plan's claims and appeal
procedures (as described in Section 4.4) or to initiate any
action or proceeding (legal, equitable, or otherwise) against
the Plan (including the Component Benefit Programs
thereunder), Plan Administrator, Company, EBPC, or trustee,
including, without limitation, a suit for statutory penalties
under ERISA for an alleged failure to provide plan or
claim-related documents, with the sole exception of an
assignment of the right to appeal an urgent care claim as
specifically provided in applicable Department of Labor
Doc. 32-1 at 19.
Surgery operates a surgical center in Long Beach, California
that provides gastroenterology, gynecology, ophthalmology,
orthopedic, otolaryngology, plastic surgery, podiatry, and
urology services. LB Surgery is an out-of-network provider
for Boeing beneficiaries. Certain beneficiaries of the Plan,
JR, CP, KN, MC, SW, and LF, received medical services from LB
Surgery. In exchange for receiving medical services, these
beneficiaries executed an assignment of their benefits under
the Plan to LB Surgery. The assignment provides, as relevant
I hereby assign my right to assert any and all causes of
action for judicial review to Greater Long Beach Surgery
Center. This assignment is wholly personal to this entity. My
assignee may “stand in my shoes”, as that phrase
is understood under assignment law. I intend for my personal
standing under ERISA's disclosure and civil enforcement
procedures under 29 U.S.C. §§ 1024 and 1132 to be
hereby transferred to my assignee, so that it may seek
judicial review of denied claims and/or disclosure under 29
U.S.C. § 1132(a)(1)(B), 29 U.S.C. § 1132(a)(1)(A),
and/or 29 C.F.R. 2560.503-1. This assignment specifically
includes an assignment of my rights to seek relief as a
claimant under 29 U.S.C. § 1132(c), and my rights to
seek attorney fees under 29 U.S.C. § 1132(g).
Doc. 1-1 at 1.
the beneficiaries received medical services from LB Surgery,
LB Surgery billed the beneficiaries and provided BCBSIL with
the bills as well. In each case, BCBSIL covered only a
portion of the amounts LB Surgery charged, determining that
LB Surgery's charges exceeded the allowed amounts payable
to a non-participating provider or the priced amount for the
services rendered. LB Surgery then filed appeals on behalf of
the beneficiaries with respect to the claim denials and also
requested the beneficiaries' summary plan descriptions.
Defendants have not issued payment for the unpaid charged
amounts or provided LB Surgery with the requested summary
motion to dismiss under Rule 12(b)(6) challenges the
sufficiency of the complaint, not its merits. Fed.R.Civ.P.
12(b)(6); Gibson v. City of Chicago, 910 F.2d 1510,
1520 (7th Cir. 1990). In considering a Rule 12(b)(6) motion
to dismiss, the Court accepts as true all well-pleaded facts
in the plaintiff's complaint and draws all reasonable
inferences from those facts in the plaintiff's favor.
Anchor Bank, FSB v. Hofer, 649 F.3d 610, 614 (7th
Cir. 2011). To survive a Rule 12(b)(6) motion, the complaint
must not only provide the defendant with fair notice of a
claim's basis but must also be facially plausible.
Ashcroft v. Iqbal, 556 U.S. 662, 678, 129 S.Ct.
1937, 173 L.Ed.2d 868 (2009); see also Bell Atl. Corp. v.
Twombly, 550 U.S. 544, 555, 127 S.Ct. 1955, 167 L.Ed.2d
929 (2007). “A ...