Louisiana Health Service & Indemnity Co. v. Rapides Healthcare System

213 F. Supp. 2d 650, 27 Employee Benefits Cas. (BNA) 2522, 2002 U.S. Dist. LEXIS 7244, 2002 WL 1303028
CourtDistrict Court, M.D. Louisiana
DecidedApril 15, 2002
DocketCiv.A.00-694-D
StatusPublished
Cited by2 cases

This text of 213 F. Supp. 2d 650 (Louisiana Health Service & Indemnity Co. v. Rapides Healthcare System) is published on Counsel Stack Legal Research, covering District Court, M.D. Louisiana primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Louisiana Health Service & Indemnity Co. v. Rapides Healthcare System, 213 F. Supp. 2d 650, 27 Employee Benefits Cas. (BNA) 2522, 2002 U.S. Dist. LEXIS 7244, 2002 WL 1303028 (M.D. La. 2002).

Opinion

*651 RULING ON MOTION FOR SUMMARY JUDGMENT

BRADY, District Judge.

This matter is before the court on a motion for summary judgment (doc. 50) filed by the plaintiff, Louisiana Health Service & Indemnity Company d/b/a Blue Cross and Blue Shield of Louisiana (“Blue Cross”). The motion is opposed, and ami-cus curiae briefs have been filed on behalf of the defendants by the Louisiana Department of Insurance and the Louisiana Hospital Association. Subject matter jurisdiction is based on federal question pursuant to 28 U.S.C. § 1381 because the interpretation of the Employee Retirement Income Security Act, 29 U.S.C. § 1101, et seq. (“ERISA”) is necessary for resolution of the dispute.

Blue Cross filed this lawsuit seeking a declaration that ERISA preempts the provisions of La. R.S. 40:2010 (the “Louisiana Assignment Statute”) as applied to employee benefit plans governed by ERISA and insured or administered by Blue Cross. The lawsuit was filed because the Louisiana Department of Insurance, acting upon complaints submitted by defendant Rapides Healthcare System (“Rapides”), had issued findings that health insurance policies issued or administered by Blue Cross violated various state laws, including the Louisiana Assignment Statute. Blue Cross seeks a declaratory judgment based on ERISA’s broad preemption provision in order to prevent actions being brought against it for violation of the- Louisiana statute.

FACTUAL BACKGROUND

Blue Cross underwrites, provides, and administers various forms of health care service plans for individual and group members who become subscribers. A portion of the health benefit plans that Blue Cross insures and administers are employee welfare benefit plans governed by ERISA. ERISA defines an “employee welfare benefit plan” as one “established or maintained by an employer or by an employee organization” for the purpose of providing employees with “medical, surgical, or hospital care or benefits, or benefits in the event of sickness, accident, disability, [or] death,” whether these benefits are provided “through the purchase of insurance or otherwise.” See 29 U.S.C. § 1002(1).

As part of its plan administration, Blue Cross enters into individual and group contracts to provide health benefits to subscribers and also enters into contracts with various health care providers for the provision of health care services to its subscribers. When Blue Cross has a contract with a health care provider that includes a provision allowing for direct payment to the provider, then Blue Cross will make payment directly to that provider. However, Blue Cross’ insurance contracts all provide that, in the absence of such an agreement with the provider for direct payment, Blue Cross will pay benefits only to the subscriber (the patient), and it will not recognize the patient’s attempted assignment of benefits to the provider. Therefore, Blue Cross will pay a hospital or provider directly only if such hospital or provider has an agreement with Blue Cross for direct payment. Otherwise, Blue Cross will only pay benefits to the patient, and then it is the patient’s responsibility to make sure that the provider is paid.

Blue Cross’ refusal to recognize certain assignments of benefits by patients is included as a provision in its contracts for health benefit plans, including its ERISA plans. Although ERISA establishes uniform procedural standards concerning reporting, disclosure, and fiduciary responsibility of plan administrators, it does not regulate the substantive content and terms of employee benefit plans. See Metropoli *652 tan Life Ins. Co. v. Massachusetts, 471 U.S. 724, 105 S.Ct. 2380, 85 L.Ed.2d 728 (1985). ERISA requires that an employee benefit plan be administered “in accordance with the documents and instruments governing the plan.” See 29 U.S.C. § 1104(a)(1)(D). Therefore, Blue Cross argues that, in order to comply with ERISA, it must act in accordance with its ERISA plan provisions and refuse to hon- or assignments of benefits to providers that do not have a contract with Blue Cross.

However, Blue Cross’ refusal to honor assignments is in direct conflict with the Louisiana Assignment Statute, La. R.S. 40:2010, which requires Blue Cross and other insurers to honor all patients’ assignments of benefits, even if the benefits are assigned to a provider that does not have a contract with Blue Cross providing for direct payment. Section 2010, entitled “Itemized statement of billed services by hospitals,” appears within Title 40 of the Louisiana Revised Statutes, “Public Health and Safety,” Chapter 11, “State Department of Hospitals,” Part I, “Organization and Powers,” and provides in its entirety:

Not later than ten business days after the date of discharge, each hospital in the state which is licensed by the Department of Health and Hospitals shall have available an itemized statement of billed services for individuals who have received the services from the hospital. The availability of the statement shall be made known to each individual who receives service from the hospital before the individual is discharged from the hospital, and a duplicate copy of the billed services statement shall be presented to each patient within the specified ten day period. No insurance company, employee benefit trust, self-insurance plan, or other entity which is obligated to reimburse the individual or to pay for him or on his behalf the charges for the services rendered by the hospital shall pay those benefits to the individual when the itemized statement submitted to such entity clearly indicates that the individual’s rights to those benefits have been assigned to the hospital. When any insurance company, employee benefit trust, self-insurance plan, or other entity has notice of such assignment prior to such payment, any payment to the insured shall not release said entity from liability to the hospital to which the benefits have been assigned, nor shall such payment be a defense to any action by the hospital against that entity to collect the assigned benefits. However, an interim statement shall be provided when requested by the patient or his authorized agent, (emphasis added).

The italicized language is the focus of this lawsuit. Blue Cross argues that it cannot comply with both ERISA and La. R.S. 40:2010, and therefore, it asks this court to find that ERISA preempts the provisions of La. R.S. 40:2010 with respect to ERISA plans insured or administered by Blue Cross.

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Bluebook (online)
213 F. Supp. 2d 650, 27 Employee Benefits Cas. (BNA) 2522, 2002 U.S. Dist. LEXIS 7244, 2002 WL 1303028, Counsel Stack Legal Research, https://law.counselstack.com/opinion/louisiana-health-service-indemnity-co-v-rapides-healthcare-system-lamd-2002.