Ninth Circuit Holds ERISA Preempts Provider’s State-Law Misrepresentation Claims Against Insurer

In Healthcare Ally Management of California, LLC v. United Healthcare Services, Inc., No. 24-5178, 2025 WL 3485391 (9th Cir. Dec. 4, 2025), the Ninth Circuit affirmed the dismissal of a medical provider’s negligent-misrepresentation and promissory-estoppel claims, holding that ERISA expressly preempted those state-law causes of action. The panel relied heavily on its 2024 decision in Bristol SL Holdings, Inc. v. Cigna Health & Life Insurance Co., 103 F.4th 597 (9th Cir. 2024), which addressed when provider-asserted misrepresentation claims “relate to” ERISA plans.

Background

Healthcare Ally Management of California (“HAMOC”), an out-of-network provider, alleged that United made telephone representations promising reimbursement at the “usual, customary, and reasonable” (UCR) rate rather than the lower Medicare rate. When United paid at Medicare levels, HAMOC sued under state law. The district court dismissed the complaint with prejudice, finding ERISA preemption.

Holding

The Ninth Circuit affirmed, concluding that ERISA preempted HAMOC’s claims because they both referenced and impermissibly connected with an ERISA plan.

1. “Reference to” an ERISA Plan

A claim is preempted when it is “premised on the existence of an ERISA plan or if the existence of the plan is essential to the claim’s survival.” Here, the services at issue were undisputedly covered by an ERISA plan, and HAMOC sought to secure plan benefits by recasting them as state-law promises made during a verification call. As in Bristol, the provider attempted to recover plan-based payments “through alternative means,” triggering § 514 preemption.

2. “Connection with” an ERISA Plan

The court further held that enforcing alleged phone-call representations would interfere with nationally uniform plan administration:

• It would intrude upon a central matter of plan administration, forcing administrators to choose between enforcing written plan terms and honoring statements made during verification calls.
• It would undermine uniformity by allowing benefits to turn on “innumerable phone calls and their variable treatment under state law,” rather than on ERISA and plan documents.

The panel emphasized that Bristol’s reasoning squarely controlled, and mandating UCR-based payments based on a call recording would distort the ERISA framework.

The Ninth Circuit found no abuse of discretion in the district court’s dismissal with prejudice. Although the court granted HAMOC an opportunity to amend, HAMOC elected not to do so and instead requested entry of judgment. Under those circumstances, dismissal was proper.

Takeaway

This decision reinforces the Ninth Circuit’s now-settled view post-Bristol: state-law misrepresentation and estoppel theories aimed at securing ERISA plan benefits are preempted, particularly when based on preauthorization or verification calls. Providers seeking payment disputes must proceed, if at all, under ERISA’s civil-enforcement framework—not state-law theories of reliance or oral promises.