Lee Memorial Health System v. Blue Cross & Blue Shield of Florida, Inc.

248 F. Supp. 3d 1304, 2017 WL 1174231, 2017 U.S. Dist. LEXIS 47273
District Court, M.D. Florida·Decided March 30, 2017·No. Case No: 2:16-cv-901-FtM-38MRM·Published·Cited by 8 cases

Opinion

OPINION AND ORDER1

SHERI POLSTER CHAPPELL, UNITED STATES'DISTRICT JUDGE

This matter comes before the Court on United States Magistrate Judge Mac R. McCoy’s Report .and. Recommendation (Doc, 33) dated February 22, 2017. Judge McCoy recommends denying Plaintiff Lee Memorial Health' System’s (“Lee Memorial”) Motion for Remand (Doc. 13), granting Defendants Blue Cross and Blue Shield'of Florida,, Inc. (“BCBSF”), and Horizon Healthcare Services, Inc. d/b/a Blue Cross Blue Shield of New Jersey, Horizon Blue Cross and Blue Shield - of New Jersey (“BCBSNJ”) and Horizon BCBSNJ’s Motion to Dismiss (Doc. 9), and allowing Lee Memorial leave to. fíje an amended complaint. (Doc. 33 at 37). The parties have filed timely objections to the Report and Recommendation. (Doc, 37; Doc. 38). Defendants BCBSF and BCBSNJ have responded to Lee Memorial’s objections.2 (Doc. 40). Thus, the. Report and Recommendation is ripe for review.

BACKGROUND

The Report and Recommendation extensively covers the background of this case. For the sake of brevity, the. Court will only recount the necessary facts. This case is premised upon insurance coverage. Lee Memorial operates a healthcare system that includes a hospital providing medical services and treatments to admitted patients. Defendants BCBSF and BCBSNJ are underwriters and administrators of [1308] healthcare plans that provide policyholders with healthcare benefits and coverage.

In 1985, Lee Memorial and BCBSF entered into a Preferred Patient Care Hospital Agreement (“Agreement”) in which Lee Memorial agreed to provide healthcare services in exchange for payment by BCBSF. There are two relevant amendments to the Agreement that bear mentioning. The first is the Tenth Amendment, which provides in pertinent part, “that no person, entity, or organization other than BLUE CROSS AND BLUE SHIELD shall be held accountable or liable to HOSPITAL for any of BLUE CROSS AND BLUE SHIELD’S obligations to HOSPITAL created under this Agreement.” (Doc. 2 at ¶ 10). The second relevant amendment is the Twentieth Amendment, which provides, in pertinent part:

It is further agreed that BLUE CROSS AND BLUE SHIELD is entitled to treat individuals covered through sister Blue Cross and/or Blue Shield Plans (i.e. each Plan an independent corporation operating under a license or sub-license with the Blue Cross and Blue Shield Association) as Policyholders under this Agreement. Such individuals being treated as being covered under a PREFERRED PATIENT CARE Benefit Agreement or other benefit agreement which provides access to participating providers in either the PREFERRED PATIENT CARE network or Network-Blue network ... whichever is applicable .... Payment for covered services provided to such Policyholders shall be in accordance with Exhibit D PREFERRED PATIENT CARE if the Policyholder is entitled to access the PREFERRED PATIENT CARE network or in accordance with Exhibit D NETWORK BLUE if the Policyholder is entitled to access the NetworkBlue network.

(Doc. 2 at ¶ 10).

Relevant to this case is Heather Picardi and her son, N.P., who was born at Lee Memorial. Picardi is a policyholder of BCBSNJ and sought treatment at Lee Memorial for complications relating to her pregnancy. There, Picardi prematurely gave birth to N.P., a covered dependent under Picardi’s BCBSNJ plan. Later, BCBSNJ argued that N.P. was covered under a separate group policy agreement held by N.P.’s father. Per the Agreement’s Twentieth Amendment, Lee Memorial submitted claims to BCBSF for treatment provided to Picardi and N.P. BCBSF denied and delayed payment of the claims.

Consequently, Lee Memorial filed this suit in state court. It alleges the following seven claims:

• Count I, Declaratory Relief Under Florida Statutes, Chapter 86;
• Count II, Breach of Contract;
• Count III, Promissory/Equitable Es-toppel;
• Count IV, Negligent Misrepresentation;
• Count V, Breach of Fiduciary Duty;
• Count VI, Unjust Enrichment; and
• Count VII, Breach of Implied Covenants of Good Faith and Fair Dealing Against BCBSF.

(Doc. 2). Subsequent to Lee Memorial’s filing, Defendants removed this case to federal court on grounds that Lee Memorial’s state law claims are preempted by the Employee Retirement Income Security Act of 1974 (“ERISA”). (Doc. 1). The Motions before the Court are Lee Memorial’s Motion for Remand and Defendants’ Motion to Dismiss. (Doc. 9; Doc. 13). The undersigned referred both Motions to Judge McCoy for a Report and Recom[1309] mendation. As stated, Judge McCoy recommends denying Lee Memorial’s Motion for Remand, granting Defendants’ Motion-to Dismiss, but allowing Lee Memorial leave to amend. (Doc. 33). The parties object to the recommendations. (Doc. 37; Doc. 38; Doc. 40).

LEGAL STANDARD

After conducting a- careful and complete review of the findings and recommendations, a district judge may accept, reject, or modify the magistrate judge’s report and recommendation. See 28 U.S.C. § 636(b)(1); see also Williams v. Wainmight, 681 F.2d 732 (11th Cir. 1982). In the absence of specific objections, there is no requirement that a district judge review factual findings de novo, Garvey v. Vaughn, 993 F.2d 776, 779 n.9 (11th Cir. 1993), and the court may accept, reject, or modify, in whole or in part, the findings and recommendations, 28 U.S.C. § 636(b)(1)(C). The district judge reviews legal conclusions de novo, even in the absence of an objection. See Cooper-Houston v. Southern Ry. Co., 37 F.3d 603, 604 (11th Cir. 1994).

DISCUSSION

A. Motion for Remand

Lee Memorial moves to remand this case to state court, arguing its state law claims are not preempted by ERISA, and that this Court lacks federal question jurisdiction. (Doc. 13). And, Lee Memorial raises several objections to the Report and Recommendation’s finding to deny its Motion. (Doc. 37). First, it avers it lacks standing to assert an ERISA claim. (Doc. 37 at 12). In support, Lee Memorial insists that it is a third party healthcare provider and not as an assignee of a health plan beneficiary. (Doc. 37 at 12). Next, Lee Memorial asserts its claims are independent of any ERISA healthcare plan. (Doc. 37 at 19-20). As a final measure, Lee Memorial argues lack of jurisdiction and renews its request for remand. (Doc. 37 at 24).

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Lee Memorial Health System v. Blue Cross & Blue Shield of Florida, Inc., 248 F. Supp. 3d 1304, 2017 WL 1174231, 2017 U.S. Dist. LEXIS 47273 (M.D. Fla. 2017).

248 F. Supp. 3d 1304 (Lee Memorial Health System v. Blue Cross & Blue Shield of Florida, Inc.) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

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