FMS Nephrology Partners North Central Indiana Dialysis Centers, LLC, Appellant-Plaintiff,
v.
Meritain Health, Inc., Beacon Health System, Inc., Beacon Health System Group Benefit Plan, Beacon Health System Group Benefit Plan - Union Plan, University of Notre Dame Du Lac, University of Notre Dame CHA HMO Plan (Medical), University of Notre Dame Select HMO Plan (Medical), and University of Notre Dame PPO Plan (Medical), Appellees-Defendants.
Appeal
from the St. Joseph Superior Court Trial Court Cause No.
71D07-1605-PL-194 The Honorable Steven L. Hostetler, Judge.
Attorneys for Appellant Stephanie L. Nemeth Anderson Agostino
& Keller, P.C. South Bend, Indiana Caroline Turner
English Brian D. Schneider Emily Baver Slavin Arent Fox LLP
Washington, DC
Attorneys for Appellees Beacon Health System, Inc., Beacon
Health System Group Plan, and Beacon Health System Group Plan
- Union Plan Joseph L. Amaral R. William Jonas Hammerschmidt,
Amaral & Jonas South Bend, Indiana Richard B. Urda, Jr.
Urda Professional Corporation South Bend, Indiana
Attorneys for Appellees University of Notre Dame du Lac,
University of Notre Dame CHA HMO Plan (Medical), University
of Notre Dame Select HMO Plan (Medical), and University of
Notre Dame PPO Plan (Medical) Brian E. Casey Kelly J.
Hartzler Alice J. Springer Barnes & Thornburg LLP South
Bend, Indiana
Bradford, Judge.
Case
Summary
[¶1]
FMS Nephrology Partners North Central Indiana Dialysis
Centers, LLC ("FMS") provides dialysis to patients
suffering from end-stage renal disease. FMS filed suit
against Meritain Health, Inc.; Beacon Health System, Inc.;
Beacon Health System Group Benefit Plan; Beacon Health System
Group Benefit Plan-Union Plan (collectively, "the Beacon
Appellees"); University of Notre Dame du Lac; University
of Notre Dame CHA HMO Plan (Medical); University of Notre
Dame Select HMO Plan (Medical); and University of Notre Dame
PPO Plan (Medical) (collectively, "the Notre Dame
Appellees") (collectively all together, "the
Appellees") claiming that Appellees failed to provide
proper payment for services rendered by FMS. The Beacon and
Notre Dame Appellees sought summary judgment, arguing that
FMS's claims against them were preempted by the Employee
Retirement Income Security Act ("ERISA"). The trial
court agreed and granted summary judgment in favor of the
Beacon and Notre Dame Appellees. FMS challenges the award of
summary judgment on appeal. Because the record demonstrates
that resolution of each of the claims at issue requires
interpretation of the provisions of an ERISA-governed health
plan, we are firmly convinced that FMS's claims against
the Beacon and Notre Dame Appellees are preempted by ERISA.
We therefore affirm.
Facts
and Procedural History[1]
I. The
Parties
[¶2]
FMS provides dialysis for patients suffering from end-stage
renal disease. The Beacon Health System Group Benefit Plan
and the Beacon Health System Group Benefit Plan-Union Plan
(collectively, "the Beacon Plans") are welfare
plans offering healthcare and medical benefits to eligible
employees of Beacon Health System, Inc., and their
dependents. Beacon Health System is the sponsor, plan
administrator, and named fiduciary of the Beacon Plans. The
Notre Dame CHA HMO Plan (Medical), University of Notre Dame
Select HMO Plan (Medical), and University of Notre Dame PPO
Plan (Medical) (collectively, the Notre Dame Plans") are
health plans offering medical benefits to eligible employees
of the University of Notre Dame du Lac and their dependents.
The University of Notre Dame du Lac is the sponsor, plan
administrator, and named fiduciary of the Notre Dame Plans.
Meritain serves as the third-party claims administrator for
the Beacon and Notre Dame Plans. As the third-party claims
administrator, Meritain is responsible for overseeing network
contracts and adjudicating claims and appeals for
reimbursement from the Beacon and Notre Dame Plans in
accordance with network and other agreements.
II.
Services Rendered to Patients/Disputes Relating to Payment
A. The
Beacon Appellees
[¶3]
The Beacon Plans provided participants and their
beneficiaries with certain medical benefits as detailed by
the Plans. The Beacon Plans also set forth the exclusive
procedure for a participant or beneficiary to appeal the
denial of a claim. The claims procedures, as adopted,
complied with the requirements of ERISA and the regulations
promulgated by the United States Department of Labor. Each
procedure required an appeal be filed by a participant or
beneficiary or the claimant's legal representative within
180 days after notice of the initial denial of the claim.
[¶4]
In its lawsuit, FMS alleged insufficient payment relating to
two Beacon patients, who were participants in the Beacon
Plans. The first received dialysis services from FMS from
July of 2012 through March of 2015. The second received
dialysis services from FMS from June of 2013 through May of
2015. Some, but not all, of the charges relating to the
services provided by FMS were paid by the Beacon Plans after
approval by Meritain.
B. The
Notre Dame Appellees
[¶5]
The Notre Dame Plans provided participants and beneficiaries
with certain medical benefits as detailed by the Plans and
defined the medical expenses eligible for coverage. The Notre
Dame Plans also set forth the procedure for filing an appeal
following denial of a claim. The claims procedures, as
adopted, complied with the requirements of ERISA and the
regulations promulgated by the United States Department of
Labor.
[¶6]
In its lawsuit, FMS alleged insufficient payment relating to
five Notre Dame patients, who were participants in the Notre
Dame Plans and received dialysis services from FMS for the
following periods:
Patient 1-March of 2011 through November of 2013,
Patient 2-August of 2013 through November of 2014,
Patient 3-December of 2013 through January of 2015,
Patient 4-January of 2013 through June of 2013, and
Patient 5-April of 2012 through March of 2014.
Some,
but not all, of the charges for services provided by FMS to
the patients were paid by the Notre Dame Plans after approval
by Meritain. For instance, some of the charges specifically
relating to one of the patients were not paid after the
services at issue were found to not qualify as "covered
...