ERISA

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Civil

7^th Circuit Court of Appeals

Officials: EASTERBROOK, KANNE, and WILLIAMS, Circuit Judges.

ERISA

No. 15-1274 ;14-3174; 14-2322 Pennsylvania Chiropractic Association v. Independence Hospital

Service provider not a “beneficiary” under ERISA & Insurer not required to utilize fee-for-service system in paying providers.

“The Second Circuit recently held that a network contract between a medical provider and an insurer does not make that provider a “beneficiary” under ERISA. See Rojas v. CIGNA Health & Life Insurance Co., 793 F.3d 253 (2d Cir. 2015). Plaintiffs insist that Rojas contradicts this circuit’s approach, established in Kennedy, but we have explained why Kennedy and similar opinions do not support plaintiffs’ position. Rojas concludes that every circuit that has addressed the subject has distinguished between providers’ status as assignees of particular claims to benefits and providers’ status as voluntary members of a network established by an insurer. See 793 F.3d at 258, discussing Spinedex Physical Therapy USA Inc. v. United Healthcare of Arizona, Inc., 770 F.3d 1282, 1289 (9th Cir. 2014); Hobbs v. Blue Cross Blue Shield of Alabama, 276 F.3d 1236, 1241 (11th Cir. 2001); and Ward v. Alternative Health Delivery Systems, Inc., 261 F.3d 624, 627 (6th Cir. 2001). The language of those other decisions is not as clean as the Second Circuit’s—and the Second Circuit’s use of “standing” as a synonym for statutory coverage itself leaves something to be desired—but our review of the decisions in other circuits leads us to agree with Rojas that the distinction between assignment of particular claims and status as an in network provider is supported by the case law. And, more to the point, it is supported by the language of ERISA. Nos. 14-2322 et al.”

Reversed

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