United States District Court, E.D. Missouri, Eastern Division
DANA R. HERN, on behalf of herself and and all others similarly situated, Plaintiff,
ST. ANTHONY'S MEDICAL CENTER, Defendants.
MEMORANDUM AND ORDER
A. ROSS UNITED STATES DISTRICT JUDGE.
matter is before the Court on Plaintiff's Motion to
Remand. (Doc. No. 17) The motion is fully briefed and ready
for disposition. For the following reasons, the motion will
9, 2013, Plaintiff Dana Hern received emergency medical
treatment at Defendant St. Anthony's Medical Center
(“St. Anthony's”) for injuries she sustained
in an accident. At the time of treatment, she had health
insurance coverage through a plan administered by Anthem Blue
Cross Blue Shield (“Anthem”). Plaintiff alleges
that pursuant to its provider contract with Anthem, St.
Anthony's was required to submit its medical bills for
Plaintiff's treatment directly to Anthem, accept
reimbursement at reduced rates as payment in full for
“covered benefits” provided to her, and refrain
from seeking payment for “covered benefits” from
any other source. (Petition (“Pet.”), Doc. No. 7
at ¶¶ 23-27) Plaintiff further alleges that instead
of submitting her medical bills to Anthem, St. Anthony's
placed a lien on her tort recovery in the amount of $16,
974.42. (Id. at ¶ 26) On or about September 3,
2014, the insurer of the tortfeasor responsible for
Plaintiff's injuries, American Family Insurance Group,
paid St. Anthony's $16, 974.42 from Plaintiff's tort
settlement to satisfy the outstanding lien. (Id.)
16, 2016, Plaintiff filed a class action petition for damages
against St. Anthony's in St. Louis County Circuit
Court. (Petition (“Pet.”), Doc. No.
7) The Petition alleges three state-law claims: violation of
the Missouri Merchandising Practices Act (“MMPA”)
(Count I); tortious interference with a contract or business
relationship (Count II); and unjust enrichment (Count III).
On August 9, 2016, St. Anthony's removed the action to
this Court based on complete federal preemption under the
Employee Retirement Income Security Act of 1974, 29 U.S.C.
§§ 1001, et seq. (“ERISA”). (Doc. No.
1) Plaintiff moves to remand the case because her claims
against St. Anthony's are based solely on state law and
she is not seeking benefits under an ERISA
defendant may remove a state law claim to federal court only
if the action originally could have been filed there.”
In re Prempro Products Liability Litigation, 591
F.3d 613, 619 (8th Cir. 2010) (citing Phipps v.
FDIC, 417 F.3d 1006, 1010 (8th Cir. 2005)). The removing
defendant bears the burden of establishing federal
jurisdiction by a preponderance of the evidence, Altimore
v. Mount Mercy College, 420 F.3d 763, 768 (8th Cir.
2005), and “[a]ll doubts about federal jurisdiction
should be resolved in favor of remand to state court.”
In re Prempro, 591 F.3d at 620 (citing Wilkinson
v. Shackelford, 478 F.3d 957, 963 (8th Cir. 2007)).
28 U.S.C. § 1331, federal courts have jurisdiction over
“all civil actions arising under the Constitution,
laws, or treaties of the United States.” Under the
“well-pleaded complaint rule, ” a suit
“arises under” federal law “only when the
plaintiff's statement of his own cause of action shows
that it is based upon [federal law].” Vaden v.
Discover Bank, 556 U.S. 49, 60 (2009); see
also, Baker v. Martin Marietta Materials, Inc.,
745 F.3d 919, 923 (8th Cir. 2014); M. Nahas & Co. v.
First National Bank of Hot Springs, 930 F.2d 608, 611
(8th Cir. 1991). Removal of a complaint setting forth state
law claims is proper under the well-pleaded complaint rule
where (1) federal law completely preempts a plaintiff's
state-law claim, or (2) an issue of federal law is a
necessary and central element of plaintiff's state law
claims. Mabe v. Golden Living Ctr.-Bransom, No.
07-03268-CV-S-FJG, 2007 WL 3326857, at *3 (W.D. Mo. Nov. 6,
2007) (citing Gaming Corp. of Am. v. Dorsey &
Whitney, 88 F.3d 536, 542 (8th Cir. 1996), and
Bellido-Sullivan v. American Int'l Group, Inc.,
123 F.Supp.2d 161, 164 (S.D.N.Y. 2000)).
preemption under ERISA can only occur when a plaintiff's
state law claims are “displaced” by ERISA §
502, the statute's civil enforcement provision.
Metropolitan Life Ins. Co. v. Taylor, 481 U.S. 58,
64 (1987). Section 502(a) provides that “a civil action
may be brought by a participant or beneficiary to recover
benefits due to him under the terms of his plan, to enforce
his rights under the terms of the plan, or to clarify his
rights to future benefits under the terms of the plan.”
29 U.S.C. § 1132(a). In Aetna Health Inc. v.
Davila, 542 U.S. 200 (2004), the Supreme Court set out a
two-part test to determine whether complete ERISA preemption
is applicable: “[I]f an individual, at some point in
time, could have brought his claim under ERISA §
502(a)(1)(B), and where there is no other independent legal
duty that is implicated by a defendant's actions, then
the individual's cause of action is completely pre-empted
by ERISA § 502(a)(1)(B).” Id. at 210. The
Supreme Court has reasoned that Congress intended ERISA
§ 502 to be the exclusive means for a plan participant
to recover benefits from an ERISA-governed plan. See
Davila, 542 U.S. at 208; Taylor, 481 U.S. at
63. Thus, any claim filed by a plan participant for the same
relief provided under ERISA § 502, even a claim
purportedly raising only a state-law cause of action, arises
under federal law and is removable to federal court.
Prudential Ins. Co. of Am. v. Nat'l Park Med. Ctr.,
Inc., 413 F.3d 897, 907 (8th Cir. 2005) (citing
Neumann v. AT & T Communications, Inc., 376 F.3d
773, 779-80 (8th Cir. 2004)). See also Fink v.
Dakotacare, 324 F.3d 685, 688-89 (8th Cir. 2003).
argues there is no complete preemption under ERISA because
this is a tort action brought under state law to challenge
St. Anthony's billing practices and not a claim for
benefits under ERISA § 502. She relies on a Facility
Agreement between St. Anthony's and Anthem that requires
St. Anthony's to submit claims to Anthem within 180 days
of the date of service or discharge and prohibits it from
pursuing payment in any other form. (Doc. No. 11-1 at Secs.
Anthony's responds that “billing practices”
cannot be analyzed separately from insurance coverage, as
Plaintiff suggests. The Court agrees. The alleged billing
limitation in the Facility Agreement, by its terms, only
applies if Plaintiff's treatment was covered by her Plan:
“Facility agrees that in no event … shall
facility … seek compensation from … a Covered
Individual … for Covered Services …”
(Doc. No. 11-1 at sec. 2.7.2). Under the Facility Agreement,
a “Covered Individual” is a person eligible
“to receive Covered Services under a Health Benefit
Plan.” (Id. at 2) “Covered
Services” are medically-necessary health services
“determined by Plan and described in the applicable
Health Benefit Plan, for which Covered Individual is
eligible.” (Id.) Where a claim based on a
provider agreement implicates coverage under an ERISA plan,
the claim is completely preempted. See Montefiore Med.
Ctr. v. Teamsters Local 272, 642 F.3d 321, 331 (2nd Cir.
crux of Plaintiff's complaint is that St. Anthony's
deprived her of “benefits” under her health
insurance plan by refusing to submit its charges for the
allegedly “covered services” to her plan and
instead seeking payment from a third-party liability insurer.
Plaintiff can only prevail on her claims if she was entitled
to benefits under her health insurance plan in the first
instance. As St. Anthony's points out, without coverage,
any failure to submit its charges to Anthem could not have
been misleading (Count I), tortious (Count II) or inequitable
(Count III). (Doc. No. 19 at 4, 9-10) Because coverage has
not yet been determined, the Court will have to make that
determination based on the terms of Plaintiff's plan. For
these reasons, the Court finds Plaintiff's claims fall
within the scope of § 502(a) and are completely
preempted. Davila, 542 U.S. at 212-14.
contends her case is factually similar to Pruitt v.
United Healthcare Services, Inc., No. 07-3307-CV-S-WAK,
2007 WL 4244998 (W.D. Mo. Nov. 29, 2007). In Pruitt,
plaintiff incurred substantial medical bills following an
accident. Her health insurance plan paid a portion of her
bills. The tortfeasor's liability insurer offered to
settle with plaintiff, but before the funds were released,
plaintiff's health insurer placed a lien on the
settlement proceeds. As a result, the liability insurer
refused to consummate the settlement with plaintiff.
Plaintiff brought a state law claim against her health
insurer for tortiously interfering with her expectancy of a
personal injury settlement. The insurer removed the case to
federal court, arguing that the propriety of its lien under
the plan and ERISA was dispositive. Id. at *1-2. The
district court remanded the case, holding that plaintiff was
not seeking to recover benefits under her plan since her
medical bills had been paid in accordance with the plan
provisions. The court also held that “the mere fact
that interpretation of the plan may come up in
plaintiff's case to show lack of justification [for the
lien] does not convert the claim into one for benefits under
the plan.” Id. at *3. ...