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Reiter v. Anthem Blue Cross Blue Shield

United States District Court, D. New Jersey

July 18, 2018

MITCHELL F. REITER, on assignment of John W., Plaintiff,
v.
ANTHEM BLUE CROSS BLUE SHIELD, Defendant.

          OPINION

          KEVIN MCNULTY UNITED STATES DISTRICT JUDGE

         The plaintiff, Mitchell F. Reiter, M.D., PC (for convenience, "Dr. Reiter"), brings this ERISA action "on assignment of John W, ," his patient. The Complaint alleges that John W.'s insurer, Anthem Blue Cross Blue Shield ("Anthem"), [1] did not provide appropriate reimbursement for medical services. Now before the court is Anthem's motion to dismiss the complaint. Because I find that Dr. Reiter lacks standing to sue as assignee, the Complaint will be dismissed.

         I. BACKGROUND

         The plaintiff, Dr. Reiter, is a physician. His patient, John W., a member of Moody's Corporation health benefits plan, is insured by Anthem.

         On May 2, 2016, Dr. Reiter furnished certain medical services to John W. Reiter billed John W. for those services in the amount of $56, 805.00. Anthem, John W.'s insurer, paid $4, 365.66 on the claim.

         Dr. Reiter is an out-of-network provider with respect to the plan. He sues strictly in the capacity of John W.'s assignee.

         On March 8, 2016, some two months before providing the services in question, Dr. Reiter obtained an assignment of benefits from John W. That assignment, a copy of which is attached to the Complaint, states in part as follows:

I hereby convey to the above named doctor and clinic to the full extent permissible under the law and under the any applicable insurance policies and/or employee health care plan any claim, chose in action, or other right I may have to such insurance and/or employee health care benefits coverage under any applicable insurance policies and/or employee health care plan with respect to medical expenses incurred as a result of the medical services I received from the above named doctor and clinic and to the extent permissible under the law to claim such medical benefits, insurance reimbursement and any applicable remedies.

(Cplt. Ex. B)

         Also attached to the Complaint is a copy of the Moody health benefits plan. (Cplt. Ex. A) The Plan provides that it is the responsibility of the patient, not Anthem, to reimburse an out-of-network provider for amounts not covered by the Plan. (Cplt. Ex. A at 52) The Plan also contains an anti-assignment provision:

You cannot assign your right to receive payment to anyone else, except as required by a "Qualified Medical Child Support order" as defined by ERISA or any applicable Federal law... The coverage and any benefits under the Plan are not assignable by any Member without the written consent of the Plan, except as provided above.

(Cplt. Ex. A at 52)

         On November 15, 2017, Dr. Reiter filed this federal-court action against Anthem, seeking payment of the balance billed but not paid, calculated to be $52, 439.34.

         Count One seeks payment for services rendered to the patient pursuant to ERISA § 502(a)(1)(B), 29 U.S.C. § 1132(a)(1)(B) Count Two asserts a claim of breach of fiduciary duly under ERISA.

         II. LEGAL STANDARDS

         Anthem moves to dismiss the complaint for lack of standing under Rule 12(b)(1), or in the alternative for failure to state a claim under rule 12(b)(6). In this case, the distinction is not significant. Either way, the argument is that the Complaint on its face reveals that an ...


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