On Wednesday a case was filed in the Southern District of Florida by Sovereign Health of California et al against Blue Cross Blue Shield of Florida. The case is regarding the validity of assignments of benefits for members of ERISA-funded health plans; it parallels litigation filed earlier this week. Although the suits were filed by different counsel, and feature a slightly different set of plaintiffs, the claims largely track each other.
The plaintiffs are out of network medical providers in the states of California, Arizona, Florida, and other locations that have provided services to ERISA plan insured members of the defendant. As mental health services providers, the plaintiffs explained that they routinely obtain assignments of benefits from the patients in order to pursue appeals rights with insurance companies without requiring the assistance of the patients, which can be difficult especially for mental health patients.
Like the suit against BCBS of Tennessee, the plaintiffs are suing the Florida entity for allegedly attempting to prevent payment to out of network medical providers by misleading the out of network plaintiffs about the ability to assign claims, then paying the plaintiffs directly, as well as refusing to honor assignments, even if the patient’s ERISA plan specifically permits them. As in the other lawsuit, the plaintiffs argue that this leads to extra expense as they must recover from the patients, who already suffer mentally and may not be capable of ensuring full payment from the defendant, as well as appealing as necessary.
Plaintiffs are suing for recovery of benefits under ERISA and breach of contract regarding the contract between the patients and the insurance plans. Plaintiffs are represented by Dabdoub Law Firm, PA.
