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Blue Cross Blue Shield Wins Appeal Over ERISA Standing

A federal Appeals Court says health-care providers may not pursue lawsuits against health insurers over reimbursement disputes under ERISA, the Employee Retirement Income Security Act.

The ruling, issued Wednesday, says lawsuits against Blue Cross Blue Shield of Arizona and a unit of Anthem were in line with at least four other federal appeals courts that have ruled on the issue.

Medical providers that sued Blue Cross-connected health insurers over more than $500,000 in reimbursements lost their appeal when a federal court found they weren’t authorized to bring suit.

The U.S. Court of Appeals for the 9th Circuit offered a narrow view of standing under ERISA, saying medical providers aren’t ERISA plan beneficiaries and can therefore bring ERISA lawsuits only in a derivative capacity.

The providers in this case also lacked derivative standing, the 9th Circuit said, because the assignment forms they received from ERISA plan beneficiaries weren’t legally valid.

Every federal appeals court to have considered this issue has ruled that medical providers don’t qualify as ERISA plan beneficiaries, the 9th Circuit said. The court noted that its decision was in line with earlier rulings of the 3rd, 6th, 7th and 11th circuits.

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Heather van Blokland was a host at KJZZ from 2016 to 2021.