Eleventh Circuit Affirms Dismissal of Health Provider’s ERISA Claims Due to Valid Anti-Assignment Provisions

In Griffin, MD v. Blue Cross Blue Shield Healthcare Plan of Georgia, Inc., et. al, No. 22-14187, 2024 WL 889560 (11th Cir. Mar. 1, 2024), the Eleventh Circuit considered the appeal of Dr. W. A. Griffin, proceeding pro se, seeking reversal of the district court’s dismissal of her ERISA claims against various health care providers for non-payment of medical services she provided to her patients. The court determined that Dr. Griffin’s patients were part of ERISA plans that contained valid anti-assignment provisions. These provisions were enforceable regardless of any state laws to the contrary. Lastly, Dr. Griffin lacked standing to bring her lawsuit because she was not a beneficiary under her patients’ plan.

First, the court explained that to maintain a cause of action under ERISA, a plaintiff must be a plan participant, plan beneficiary, plan fiduciary, or the Secretary of Labor. Healthcare providers are generally not participants or beneficiaries under ERISA, though an assignee may obtain derivative standing for payment of medical benefits through a written assignment obtained from a participant or beneficiary. The court has previously held that unambiguous anti-assignment provisions in an ERISA-governed welfare plan are valid and enforceable against healthcare providers. The court has also previously held that state laws limiting anti-assignment provisions are preempted by ERISA since they “relate to” an employee benefit plan. The court noted that it has rejected Dr. Griffin’s arguments repeatedly in past published and unpublished opinions. See Physicians Multispecialty Grp. v. Health Care Plan of Horton Homes, Inc., 371 F.3d 1291 (11th Cir. 2004); Griffin v. Coca-Cola Refreshments USA, Inc., 989 F.3d 923 (11th Cir. 2021). These decisions have not been overruled or abrogated by the Supreme Court or by this court sitting en banc. With respect to the plans at issue in the present case, the court found that there are valid unambiguous anti-assignment provisions in each plan document. As such, Dr. Griffin’s patients are barred from assigning their entitlement to plan benefits to her.

Dr. Griffin argued that the dismissal of her claims was at odds with two Supreme Court cases—Metropolitan Life Insurance Co. v. Massachusetts, 471 U.S. 724 (1985), and Kentucky Association of Health Plans, Inc. v. Miller, 538 U.S. 329 (2003). The court found that these decisions did not support Dr. Griffin’s position since they addressed whether a state law regulation might be excepted from ERISA preemption under ERISA’s “saving clause.” The issue here is whether unambiguous anti-assignment provisions in ERISA-governed welfare benefit plans are valid and enforceable against healthcare providers and ERISA preempts state laws that purport to limit anti-assignment provisions in this respect. Judgment affirmed.