CHCA BAYSHORE, L.P. D/B/A HCA HOUSTON HEALTHCARE SOUTHEAST, et al. v. LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY D/B/A BLUE CROSS/BLUE SHIELD OF LOUISIANA

District Court, N.D. Texas·Decided August 21, 2026·No. 3:25-cv-02895·Unknown

Opinion

UNITED STATES DISTRICT COURT NORTHERN DISTRICT OF TEXAS DALLAS DIVISION

CHCA BAYSHORE, L.P. D/B/A HCA § HOUSTON HEALTHCARE § S OUTHEAST, et al., § § Plaintiffs, § § v. § CIVIL ACTION NO. 3:25-CV-2895-B § LOUISIANA HEALTH SERVICE & § INDEMNITY COMPANY D/B/A BLUE § CROSS/BLUE SHIELD OF § LOUISIANA, § § Defendant. §

MEMORANDUM OPINION AND ORDER Plaintiffs CHCA Bayshore, L.P. d/b/a HCA Houston Healthcare Southeast; Orthopedic Hospital, Ltd. d/b/a Texas Orthopedic Hospital; Houston–PPH, LLC d/b/a HCA Houston Healthcare Medical Center; St. David’s Healthcare Partnership, L.P., LLP d/b/a St. David’s Round Rock Medical Center and d/b/a St. David’s Medical Center; and CHCA Clear Lake, L.P. d/b/a HCA Houston Healthcare Clear Lake (collectively, the “Hospitals”) filed their Complaint (Doc. 1) in October 2025 against Louisiana Health Service & Indemnity Company d/b/a Blue Cross/Blue Shield of Louisiana (“BCBSLA”). In February 2026, BCBSLA filed a Motion to Dismiss the Complaint (Doc. 14). For the reasons described below, the Court GRANTS in part the Motion. I. BACKGROUND This case involves an insurance reimbursement dispute between the Hospitals and BCBSLA. “BCBS LA is a licensee of the Blue Cross and Blue Shield Association . . . and is licensed to offer Blue Cross and Blue Shield . . . branded health plans in the State of Louisiana.” Doc. 1, Compl. ¶ 6. The Hospitals are “acute care hospitals in Texas.” Id. ¶ 10. Relevant to this dispute, the Hospitals

provided treatment to 15 patients who reside in Texas and have insurance issued and/or administered by BCBSLA. See id. ¶¶ 7, 33-200. For varying reasons, BCBSLA either denied the claims or did not fully reimburse the claims. Id. ¶ 258. The Hospitals entered into two Hospital Service Agreements (“HSAs”) with non-party Blue Cross Blue Shield of Texas (“BCBSTX”). Id. ¶ 11. The HSAs set the terms by which the Hospitals will treat patients with BCBSTX plans. Id. ¶ 12. The discounted rates set in the HSAs apply not only

to BCBSTX subscribers, but also to patients who have any Blue Cross Blue Shield plan pursuant to the “Blue Card Program.” Id. ¶ 13. “BlueCard is a national program that enables members of one Blue Cross and Blue Shield . . . Plan to obtain in-network healthcare services while traveling or living in another [Blue Cross Blue Shield] Plan service area.” Doc. 1-6, Compl., Ex. 4, 117.1 Under the Blue Card Program, an individual with any Blue Cross Blue Shield plan can obtain treatment at the Hospitals under the rates agreed upon in the HSAs even though he or she

is not insured by BCBSTX—the in-state plan. See Doc. 1, Compl. ¶ 13. In this context, the Blue Card Program works as follows: After treating a patient with a BCBSLA health plan, the Hospitals submit a claim to BCBSTX (the “Host Plan”), which reviews the claim and prices it according to the HSAs. See id. BCBSTX then sends the claim to BCBSLA (the “Home Plan”), which applies the patient’s benefits to the claim and processes the claim. See Doc. 1-6, Compl., Ex. 4, 117. BCBSLA then

1 The Court cites to the page number generated by the ECF system for the combined Document 1 with all attachments. provides BCBSTX its coverage determination and BCBSTX pays the claim to the Hospital. Id. The Blue Card Program overview states that the Host Plan is the “sole contact for all [Blue Cross Blue Shield] claim submissions, payments, adjustments, services and inquiries.” Id.

Some of the patients who received treatment by the Hospitals have an “employer-sponsored health insurance policy that . . . ERISA governs.” Id. ¶ 239. The ERISA plans include anti-assignment provisions. See, e.g., Doc. 14-1, Ex. 4-15, Health Plans, at Appx_94. Despite those provisions, upon admission to the Hospitals, each patient signs a Conditions of Admission Form that includes “an assignment of the patient’s health insurance benefits” to the Hospitals: [P]atient assigns all his/her rights and benefits under existing polices of insurance providing coverage and payment for any and all expenses incurred as a result of services and treatment rendered by the Provider . . . I hereby irrevocably appoint the Provider as my authorized representative to pursue any claims . . . and/or legal remedies. Doc. 1, Compl. ¶ 32. According to the Hospitals, this Form authorizes them to assert the patients’ claims. Id. Moreover, the Hospitals allege that each claim submitted to BCBSLA indicated that it was submitted through the patient’s assignment of benefits to the Hospital. Id. The Hospitals allege that BCBSLA did not inform them that it was denying any claims because of anti-assignment provisions in the patients’ health plans. Id. For some of the claims, the Hospitals “received correspondence or communications directly from BCBSLA.” Id. ¶ 30. Based on BCBSLA’s denial or partial payment of the claims, the Hospitals seek no less than $673,030.79 in unpaid reimbursement from BCBSLA and assert six counts: (1) Petition to Compel Arbitration Pursuant to 9 U.S.C. § 4 (“Count I”); (2) Breach of Contract (HSAs) (“Count II”); (3) Breach of Implied-In-Fact Contract (“Count III”); (4) Failure to Comply with Health Benefit Plan In Violation of ERISA (“Count IV”); (5) Breach of Contract (For Plans Not Subject to ERISA) (“Count V”); and (6) Promissory Estoppel (“Count VI”). For the contract counts, the Hospitals contend that BCBSLA expressly or impliedly assumed the terms of the HSAs in three ways: “(a) by reason of its status as an ‘Affiliate’ of [Blue Cross and Blue Shield Association]; (b) as a ‘Payer’ under

the [ HSAs]; and (c) by its participation in the BlueCard Program.” Id. ¶ 13; Doc. 21, Resp., 5-13. Because BCBSLA benefited from the discounted rates set in the HSAs, the Hospitals believe that BCBSLA is therefore bound by some of the HSAs’ obligations.2 See Doc. 1, Compl. ¶ 14. BCBSLA moves to dismiss each Count. Specifically, BCBSLA moves to dismiss Count IV (the ERISA Count) for lack of standing under Rule 12(b)(1). BCBSLA moves to dismiss Counts II, III, V, and VI (the contract Counts) for lack of personal jurisdiction under Rule 12(b)(2).3 BCBSLA

also moves to dismiss Counts I, II, III, and VI under Rule 12(b)(6) for failure to state a claim. Lastly, BCBSLA argues that Counts IV and V are time-barred. See Doc. 14, Mot., 2. The Hospitals have filed a response (Doc. 21), and BCBSLA has filed a reply (Doc. 22). The Court evaluates the Motion below. II.

LEGAL STANDARD A. Rule 12(b)(1) “Federal courts are courts of limited jurisdiction . . . .” Stockman v. Fed. Election Comm’n, 138

2 Although the Court takes as true all well-pleaded facts, the same consideration is not given for legal conclusions. See Machete Prods., LLC v. Page, 809 F.3d 281, 287 (5th Cir. 2015) (“For the purposes of a motion to dismiss, we must take all of the factual allegations in the complaint as true, but we are not ‘bound to accept as true a legal conclusion couched as a factual allegation.’” (quoting Ashcroft v. Iqbal, 556 U.S. 662, 678 (2009)). 3 Although BCBSLA does not explicitly cite to Rule 12(b)(2) in its motion to dismiss, it does clearly argue that the Court lacks personal jurisdiction over BCBSLA for the state law claims. See Doc. 14, Mot., 9. Therefore, the Court finds that BCBSLA sufficiently raised a challenge under Rule 12(b)(2) in its Motion to Dismiss. F.3d 144, 151 (5th Cir. 1998) (citation omitted). For that reason, they can adjudicate claims only when subject matter jurisdiction “is expressly conferred by the Constitution and federal statute.” Armstrong v. Tygart, 886 F. Supp. 2d 572, 584 (W.D. Tex. 2012) (citation omitted). “Federal Rule of

Free access — add to your briefcase to read the full text and ask questions with AI

CHCA BAYSHORE, L.P. D/B/A HCA HOUSTON HEALTHCARE SOUTHEAST, et al. v. LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY D/B/A BLUE CROSS/BLUE SHIELD OF LOUISIANA, (N.D. Tex. 2026).

CHCA BAYSHORE, L.P. D/B/A HCA HOUSTON HEALTHCARE SOUTHEAST, et al. v. LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY D/B/A BLUE CROSS/BLUE SHIELD OF LOUISIANA (CHCA BAYSHORE, L.P. D/B/A HCA HOUSTON HEALTHCARE SOUTHEAST, et al. v. LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY D/B/A BLUE CROSS/BLUE SHIELD OF LOUISIANA) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

Related

Jacobsen v. Osborne
133 F.3d 315 (Fifth Circuit, 1998)
Kelly v. Syria Shell Petroleum Development B.V.
213 F.3d 841 (Fifth Circuit, 2000)
Schiller v. Physicians Resource Group Inc.
342 F.3d 563 (Fifth Circuit, 2003)
Mello v. Sara Lee Corp.
431 F.3d 440 (Fifth Circuit, 2005)
International Shoe Co. v. Washington
326 U.S. 310 (Supreme Court, 1945)
Burger King Corp. v. Rudzewicz
471 U.S. 462 (Supreme Court, 1985)
Ashcroft v. Iqbal
556 U.S. 662 (Supreme Court, 2009)
Odie v. Evans v. Lester Tubbe
657 F.2d 661 (Fifth Circuit, 1981)
Pitts v. American Security Life Insurance Company
931 F.2d 351 (Fifth Circuit, 1991)
Hermann Hospital v. Meba Medical and Benefits Plan
959 F.2d 569 (Fifth Circuit, 1992)
Pervasive Software, Inc. v. Lexware GMBH & Co. KG
688 F.3d 214 (Fifth Circuit, 2012)
Mary Ainsworth v. Cargotec USA, Incorporated
716 F.3d 174 (Fifth Circuit, 2013)