United States District Court, D. New Jersey
MITCHELL F. REITER, on assignment of John W., Plaintiff,
ANTHEM BLUE CROSS BLUE SHIELD, Defendant.
MCNULTY UNITED STATES DISTRICT JUDGE
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"),  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.
plaintiff, Dr. Reiter, is a physician. His patient, John W.,
a member of Moody's Corporation health benefits plan, is
insured by Anthem.
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.
Reiter is an out-of-network provider with respect to the
plan. He sues strictly in the capacity of John W.'s
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)
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
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)
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.
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.
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 ...