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UNIT ED STA TES C OURT OF

APPEALS FO R T HE TH IRD CIR CU IT

__________ No. 03-4196

__________ PASCACK VALLEY H OSPITAL,

IN C.; COMMUNITY MEDICAL CENTER, (LAWRENCE TAYLOR, DEBRA

SAVERINO)

v.

LOCAL 464 A UFCW WELFARE REI MBURSEMENT PLAN

Pas cac k V alley H osp ital, In c., Appellant

On Appeal From The United State s

District Cou rt For The Distr ict Of New Jersey (D.C. Civi l Nos. 02- cv-05974 & 03-cv-02813)

Distric t Judg e: Th e H ono rable D ennis

M. Cavanaugh

__________ Argued June 16, 2004

__________ Before: ALITO, SMITH, and W AL LA CE , Circuit

Judges *
(Fil ed: November 1, 2004)

Shea H. Lukacsko Keith R. McMurdy (Argued) Grotta, Glassman & Hoffman 75 Livingst on Avenue Roseland, NJ 07068
John Sydl ar Maloof, Lebowitz, Connahan & O leske 127 Main Street Chatham, NJ 07928
Counsel for

Appellant

John M . Ag nello Ke rrie R. H eslin Carell a, Byr

ne, Bain, Gilfil lan, Cec chi, Ste wa rt & O lstein 5 Becker Farm Road Roseland, NJ 07068
Michael T. Anderson ( Argued) Dav is , C owe ll& Bowe 17 01 K St

r ee t , N. W. Suite 210 Washington, DC 20006
Counsel for

Appellee

* The Honorable J. Cliffor d Wallace, Senior Cir cuit J

udge for the United States C ourt o f A ppea ls for th e N inth Circuit , si tting by des ignati on.1 OPI NION

SM ITH , Circuit

Judge.
This case pres ents a ques tion of jurisd ic tionunder the c ivilenforcement provisi on of the Employ ee Retir ement In come S e curit

y Act ( “ERISA”), 29 U.S .C. § 1132(a). Pas cac k Valley Hospital (the “Hospital ”) sued t

he United Food and Commercial Workers Int ernati onal Union Local 464A, AFL- CIO Grou p ReimbursementWelfare Plan(the “Pl an”) in s tate c our t for bre ach of c ont ract. Th e Plan removed the cas e to feder al dis tri ct court and moved f

o r sum mary jud gm ent. The Hospitalmoved to remand . Th e D i stri ctCou rt held that the H ospital’s breach of cont

ract c laims aga inst

the Plan
were comp le te ly

pr e- emp te d byERISA and theref

ore rai sed a federa l quest ion supporting removal und er 2 8 U .S.C . § 1441(a ). We hold that, und er the w ellpleadedcomplaint rule, t he Hosp it al’s
com pla in t does not pr esent a f ederal questi on that w ould support r em ov al

. We further hold that the Hospital ’s st ate l aw breach of contract claims a re not
com pletely pr e- em pt ed by E RI SA ’s civil enf or ceme nt provisi on b ecau se th e Hospitalcould not h ave b roug ht its cl ai ms underERISA. We w illtheref or e v acate the judgment of t

he Distr ict Court

and remand to that

court wit

h instructi ons that it, in turn, r emand these proc eedin gs to the state cou rt w hen ce th ey cam e. I.
The Plan i s an “em ployee welfa re bene fit plan” as de fined by ERISA. 29 U.S .C. § 1002(1)

. 1 Th e Plan is a reimburs ement plan only ; it reimburs es particip ants a nd benefici aries for out- ofp ocketmedical expenses but does n o t itself pro vid e m edic al ca re. M agN et, Inc. i s an independe nt consult an t. MagN et has organized a
ne twork of h ospitals that ha ve ag reed to acceptdiscount ed payment for medical servi ces provided t o benefici aries of group health plans i n retur

n for the plans’ promise to encoura ge ben eficiari es to use netwo rk hospit als. Network hospit als do
no t contrac t dir ectl y wit h the plan s

. Inste ad, Mag Net enters into se par ate contra cts with indivi dual plans, and sep arate contrac ts wit h indivi dua l hos pital s. Around 1995, the Plan ente red into

1 An ERISA Plan is a legalentit y t hat
can sue and be s ued . 29 U .S.C . § 1132(d )(1). Accord ingly, the term “Plan ” refe rs not o nly to the d efen dant in the underlyi ng lawsuit

and the appel lee before this Court , but a lso t o the underlying “[r] ules gover ning coll ecti on of premiums, definition of benefits, submissi on of clai ms, and res oluti on of disag reem ents o ver en titlemen t to servi ces” that make up an employ ee
we lfar e pla n. Pegram v. Herdrich , 530 U.S. 21 1, 223 (20 00).2

a “Subs cr iber A greem ent” w ith M agN et. In 199 6, the H ospital e nte red into a “Networ k Ho spital A greem ent” w ith M agN et. Secti on 2. 1 of the Subscriber A gr eement gov ern s “H osp ital p ayme nt,” and prov ides tha t the disco unted rate offeredby t

he Hospi tal w illbe forfei ted unless c laims are timely pai d:
Subscribe r

. . . shallpay Ne tw ork Ho spita ls fo r Covered S ervice s furni shed to Eligible Persons.
Pu rsuant to a val i d assignment from Eligib le Person, S ubscriber . . . shall dir ectly p ay Networ k Ho spitals for Cover e d Serv ic es provided t o Eligib le Persons withi n thirty (3 0) da ys after

date of recei pt of submitt ed Clean Cla ims

. . . . For other n on-c le a n claims, payment shall b e made with in thir

ty (30) day s of
re c eipt of allrecords and other informat ion necessary for prop er cla i m s adjudic ation.

. . . Wh ere obl iga ted, i f Su bs criber

fail s to pay with in the appropriate t i me fr ame , the Sub scri be r acknowledges that it w ill lose the b enefit

of the M a gNet disco unte d reimburs ement rate and that Netw ork Hospitalis t hen entitledto bil l and col lect f rom Sub scrib er an d Eligib l e Person it s customa ryrate f

or servi ces rendered. If

Sub scribe r fails to make the payment, t he Networ k Hosp it al ma y p ursue an y remed ie s availa ble against

Subscribe r and Eligible Pers on. In 199 9, the H ospital p rovided medical servi ces to Kimberly Rovetto and Betty Psara s. Bo th Psa ras an d R ovetto
were “E ligi bl e Persons” unde r the S ubs criber

Agreement, and t

he medical servi ces prov ided to Psara s and Ro vetto
were “Covered Servi ces” under t he Subscribe r Agre eme nt . The Hospit al alle ges that the Pla n fail ed to pay the Hospitalfor the servic es ren dered to Psaras and Rovetto acc ording t o the te rms of the S u bscri ber Agreement. The Hospitalcontends t

hat cl ai ms for those servi ces were properl y submi tted on A pril 15, 199 9, and October 5, 1999. The Hospitalfurthe r con tends that it re ceived payment on these cl aims at t

he discount ed rate on June 8, 1999, and November 22 , 1999, respectivel y. According to t he Hosp ital’s in t erpret ation of § 2.1 of the Su bsc riber

Agree ment, the P lan’s failure to pay these claim s wit h in thirty days of recei pt effected a

forfeit ure of the discount ed rate provided in t he Netw ork HospitalAg reem ent. T he Hospital th er efore seek s to rec over the alleg edly for feite d di sco unt fro m th e Pl an.3

On Oc tob er 2 3, 2002 , the Hospital file d suit in the Superior Court of New Jers ey. The Complaint al leges t hatthe Ho spital is

a third-party beneficiary to the Subscr iber Agreement between MagNet and the Plan, underwhich the Plan “be came obliga ted to pay [the Hospit al] for eligible medical servi ces pro v ided by

[the Hospit al], ” and “was requir ed to comply with certain te r m s and conditi ons of [the Hospit al’s ] contr act with Ma gN et [ i.e

. , the Network Hospital Agree ment], requiring payment inth e t ime periodspec ified in said co ntr ac t.” The two-countcomplaint

alle ges that

the Plan breachedt h is con tract by im prop erly takinga discount

on the ser

vices pr ovided to Psaras and Rov etto despite the Plan ’s failure to make ti mely payment u nder the Sub scribe r Ag reem ent. 2
The Plan removed t

he c a se to t

he Distri ctCourt. Ther eafter , the Plan moved forsummary j udgment and the Hospi tal
cross- mo ved to rem and th e case to state
cour t. The parti es’ motions focus ed on whe ther, under the doc tri ne of “co mp lete pre -em ptio n,” the Hospit al’s stat e law breach of cont ract clai ms raise d a federal qu est ion. The Distri ct Court he ard oral argumenton th e partie s’ mo tio ns o n September25, 2003. The next da y, o n September26, 2003, t he Dist rict Court issued an Opinion and Order gr anting t he Plan’s motion for

su mm ary judgm ent, denying the H ospital’s cross- mo tion to remand, and di sm issing the complaint withoutprejudice. Th e District Cou rt’s two-page Opinion a nd Ord er states in releva nt part: Defendant belie ving that Plaintiff’s stat e l a w cl ai ms are c ompletel y preemptedby [ER ISA ] in th at Plaintiff no w sta nds in the shoes of the P lan ’s benefici aries as assi gnee, and theref

ore Defendant belie ves the facts sh ow i t is
e nti tled to judgment as a matter of law; and
P laintiff belie ving th e acti on is not pr eempted by ERISA since Pl ainti ff is not

a pa rticipant or beneficiary underER IS A an d therefore there is no fede ra l l aw cl ai m, and there fore the matter should be re manded to the s tate court; and
This Co urt bein g in agreementwith a nd ad opts the reasoni ng of counsel for Defe nda nt as stated on the
reco rd , and f

urther rejects t he arguments put

forth by counsel for

Plaintiff; and 2 The Plan incor

rectly states t

hat “[t ]h e Hos pi ta l’ s c ompl ai ntonl ycl ai ms unjust enrichment .” Appell ee’s Br. at 2, 21-22. Alt

hough the Complaint

does allege that the Plan “has been unju stly enriche d to the de tri ment of [the Ho spital],” th e Co mp laint ex plicitly allege s that the Plan “brea ched ” its contra ctual o bligatio ns to th e H ospital.4 This Court agree s with and adop ts the an alysis and holding as set for

th i n Charter Fairmount

Insti tute , Inc. v. Alta H ealt h Strategies , 835 F. Supp. 233; and
This Court being sati sfiedthat [ the doctr ine of
com plete preem pti o n ] ha v ing been met in this case; and
As this case f

al ls with in the “complet e preempti on” except i on to the we ll p l eaded complai nt doctrine, removalto feder al
c ourt was proper, an d remand to state court wo uld be in app rop riate

. . . .

(Foo tnote omit

te d). Th e H ospit al fi led a timely notice of appeal on October 22, 200 3.
II.
Befo re turning to the Distr ict Cou rt’s removal jurisdict ion, we must first address our own appellate jurisdi c tion. Although the Dist

rict Court pu r ported to gr ant summary j udgment in favor of the Plan, the Dist

rict Court act

ually dismis sed the Ho spit al’s complai nt withou t prejudi ce. That dispos iti on allowed the Ho spital, which emp hatica llydisavows an E RISA clai m for benefit s, t o replea d i t s complaint u nder ER ISA’s civi l enforcementpr ovi si on. The Ho spi tal decli ned to do so an d instea d filed this app eal.
28 U. S.C . § 129 1 pro vides this Cou rtwith jurisdi ction ove r a fi nal order dismis sing a compl ai nt as co mp letely pre-empte d. DiFelice v . Aetna U.S. Healthcare , 346 F .3d 442, 44 5 (3d C ir. 2003). “G ener ally , an order which dismis ses a com plaint w ithout p rejudic e is neithe r final nor a ppealabl e because t he defici encymay be co rrec ted by the plaintiff without af

fecti ng the cau se of actio n.” Borelli

v. Cit y of Reading , 532 F.2d 950, 951 (3d Cir. 1976) (per curiam). 3 If the pla inti ff elect s to st and on th e dismis sed com plaint, how ever, t he order of dismis sal is fina l and app eala ble. Id. at 951-52. At oral argument, couns el for t he Hospitaldeclar ed the Hospit al’s intention to fo re go an y E RIS A claim it may have and to stand on its co mp laint. Co unse l’ s declar ationis sufficient to re n der the Distri ctCourt’s order fina l and appeal able. Remick v. Manfredy , 238 F.3d 248, 254 (3d Cir. 2001) . This Court exerci ses plenary review o ver a district court’s exercise of juris dictio n a nd order of dism issal. DiF eli ce , 346 F.3d at 445;

3 That the Dis tri ct Court a lso deni ed the Hospit al’s motion t o remand does not

ma ke th e co urt’s ord er ap pea lable

. Ca terpillar Inc. v. L ewis , 519 U.S. 61, 74 (199 6) (“A n ord er den ying a m otion to
rema nd, ‘stan ding alone ,’ is ‘[o]b viou sly
. . . n ot fin al a nd [im m ed iat ely] appealabl e’ as of right. ” (quoting Chicago, R.I

. & P.R. Co. v. Stude , 346 U.S . 574 , 578 (19 54) ).5

Pryzbowskiv. U.S. Hea lthc are, I nc. , 245 F.3d 26 6, 268 (3d Cir. 2001 ).

III.
A civi l action filed in a state cou rt may be r emoved to federa l court if the claim is one “arisin g u nde r” fe de ra l l aw. 28 U.S.C. §§ 1331, 1441(a). Und er th e “well-pl eaded com plain t” rule, the pla intif f is ordin arily entitled to rema in in sta te court so long as it s complaint does not, on its face, af

firmat ively

alle ge a federal cl ai m. BeneficialNat’l Bank v. Anderson , 539 U.S. 1, 6 (2 003) . To supp ort rem oval, “‘[a] right or i m munity creat ed by t

he Constit utionor laws of the U nited St ates must be an element , and an es sen tialone, of the plaintiff’s cause of action.’” Franchise Tax Bd. of Cal. v. Constr. Laborers Vacat ion Trus t for S. C al. , 463 U.S. 1, 10-11 ( 1983) (quot ing Gully v. Fir st Nat’l Bank in Meridian , 299 U. S. 109, 112 (19 36) ). Fed eral pre -emp tion is ordin arily a defense to a pla intiff’s s uit and, as such, does not appear on the face of a well-pl eaded com plain t. Anderson , 539 U.S. at

6; Franchise Tax Bd. , 463 U.S. at 12.
On its fa ce , the Hosp ital’s
co mp laint

does not pr esent a f ederal ques ti o n. Rath er, the c om plaint a sserts state c ommon law claims for br each of contra ct. The complaint does not expr essly refer to ERISA and the ri ghts or immuniti es creat ed under ERISA are not elements, let a lone ess entia l ele ments, of the plaintiff’s clai ms. The possibi lit y—or
even likel ihood—that ERISA’s preemptionpro visio n, 29 U.S .C. § 1144(a ), may pre-empt t he Hospital ’s st ate l a w cl ai ms is not

a sufficien t basis for rem oval. Franchise Tax Bd. , 463 U.S. at 12. 4
The Plan argu es that the H ospital’s cl ai ms aris e under “the fe de ral common law” of E RIS A. On se ve ra l o cc as io ns , w e have predica

tedjurisdiction on a plaintiff’s invocat ion of the feder al common law o f ERI SA. Bollman Hat Co. v. Roo t , 112

4 Pre-empti on under § 514(a) of ERISA, 29 U.S.C. § 1144(a) , must be di st in gui she d fr om complete pre-empti on und er § 502 (a) o f E RIS A, 2 9 U .S.C . § 1132(a). Only t

he latter per

mits r emoval of what would other

wise be a st ate l aw clai m under the well -pleade d complaint rule. Under § 514(a), ERISA supersedes state law s tha t “rel ate to ” an ER ISA plan

. 29 U.S.C. § 1144(a ). Unli ke the scope of § 502(a), which is j urisdi ctiona l and creat es a basi s for re moval to federal court, § 514(a) merely gover ns the l aw that will apply

to state l aw claims, regardl ess of whether

the case is brought in sta te or fed eral c our t. Lazorko v. Pa. Hosp. , 237 F.3 d 24 2, 24 8 (3 d C ir. 20 00)

. Section 514( a), t

herefore, does not perm it remo val of

an oth erw ise w ellplead ed co mp laint asse rting on ly state law claim s. Pryzbowski , 245 F.3d at 275 (“[W ]hen the do ctrine o f com plete preempti on does not apply, but the plaintiff ’s state cla im is arg uably preempted under

§ 514(a), the dis tri ct court, being without

removal j urisdi ction, cannot re solve t

he disput e regarding preempti on.” (internalquotati on omitted)).6

F.3d 113, 115 (3d Cir. 199 7); Airco Indus. Gases, Inc. Div. of the BOC Group, Inc. v. Teamsters Health & Welf are Pension Fund , 850 F .2d 1028 , 1033-34 (3d Cir. 1988); N. E. Dep ’t

IL GW U He alth & Welfare Fund v. Te a msters Local Union No. 229 Welfare Fund , 764 F.2d147, 154- 55 (3d Cir. 19 85) (Becker, J., writi ng for himself). Th ese cas es, h owe ver, do not support the Pl an ’s argument that removal is proper because “sui ts bet ween plans and third par ties imp licatin g ben efit s administ rati on ‘arise under’ E R ISA’s fe d eral common law.” Appellee’ s Br. at 5 4. Inste ad, the plai ntiff s in these cas e s d elibera tely invoked feder al ERIS A juri sdict ion. See Bollman Hat , 112 F.3d at 115 ( l awsu it seeking to enf orc e subrogat ion provi si on in ER ISA p lan); Airco , 850 F.2d at 103 1 (amended
c omp laint

asserting cause of

acti on for unjus t enrich men t und er ER ISA ); IL GWU, 764 F.2d at 150, 154-55 (l awsuit se eking declaratory reli ef regarding the meaning of te rms in an ER ISA pla n). A s such , their well-pl eaded com plaints nece ssarily arose underfederallaw. Here, the Hospi tal’s
c omplaint

assert s a state law claim for breach of c ont ract, a nd the feder al
common law of ERISA does not provide

an element—essenti al or ot herwise—of such a clai m. The Plan maybe correc t that, in interp reting th e Su bscrib e r Ag reem ent, the fed era l common law of ERISA di sp la ce s s tate law. Nevertheless, potenti al defens es, evenwhen anticipated in the co mp laint, are not r elevant under the well-pl eaded com plain t rule

. Fr an chise Tax Bd. , 463 U.S. at 10-12. IV. Althoug h the we ll-p leade d complaint

ru le wo uld ordinarily bar the removal of an ac tion to federal co urt whe re federaljuri sdict ion is not present ed on the face of the pl ainti ff’s compla int, the act ion may be removed i f it fall s withi n the
narrow class of cases to which the doctrine of “co mp lete p re-e mp tion ” ap plies

. Aetna He alth Inc. v. Da vila , 542 U.S. __, No. 02- 1845, slip op . at 5 (Jun e 21, 2 004 ); Metro. Life Ins. Co. v. Taylor , 481 U.S. 58, 63- 64 (1987). As a “co rolla ryof the
we ll- pleadedcom plaint ru le,” com plete pre- e mption recognizes “that Congress may so complete ly

pre-empt a

parti cular
areathat an y ci vil com plaint ra ising th is select group of cl a ims is n ecess arily federal i n charact er.” Taylor , 481 U.S. at 63-64; accord A nde rson , 539 U .S. at 8 (“When the fe deral s tatute co mp letely pre-em pts the state -la w c aus e of actio n, a claim which comes withi n the s cope of that cause of

action , even if plea ded in te rms of state law, is in re al ity based on fed eral l aw .”).
ER ISA’s civil enforc emen t mech ani sm, § 502(a), “is one o f those provisi on s with such ‘extraord inary pre-emptive pow er’ that it ‘c onverts an ordinary stat e common law c om plaint in to
one stat ing a federalclai m for purposes of the well-pl eade d complaint rule. ’” Da vila , slip op. at

7 (quoti ng Taylor , 481 U.S. at 65-66). A s a resul t, s tate law causes of
ac tionthat a re “w ithin the s cop e of . . . § 50 2(a)” are complet ely pre-empte d a n d therefore remo vable to fed eral co urt. Taylor , 481 U.S. at 66; DiFelice , 346 F.3d7

at446. The Su pr eme Co urt has recen tly clarifi ed the inquiry

in such cases:
Itfo ll ows that i f an indi vidual brings s ui t complaini ng of a den ial of coverage for medicalcare, whe re the ind ividua l is entitledto such coverage only bec aus e of

th e t erms of

a n ER ISA-r e g ulate d employe e benefit

plan, and whe re no legalduty

(state or feder al) in depe nden t o f ER ISA or the p lan term s is violated, then th e suit fa lls with in the scope of

ERI SA § 502(a)(1)(B ). In other words, i f

an indivi dual, at
som e poi nt in time , c ould have b r oug ht his cla im under ERI SA § 502(a)( 1 )(B), and w here there is no o the r independent

legalduty

that i s i mplicat e d by a defend ant’s action s, th en th e indivi dual ’s cause of act ion is com pletely pre-empte d by ER ISA § 502(a)(1)(B ).

Da vila , slip op. at

8 (int ernal quotation and citatio n om itted ).
A cc or di ng ly, this case is remo vable only if (1) the Hospit al coul d have brought its breach of

contrac t cla im under§ 502(a ), and (2) no other legal duty supports t h e Hosp ital’s claim

. Id. “[A] feder al cou rt may lookbeyond t

he face of the complaint to determi ne whether a pl ainti ff has

ar tf ully pleaded hi s suit

so as to c ouch a federalclai m in terms of s tate law .” Pryzbowski , 24 5 F.3d at 274 ( inter nal quo tatio n om itted ).
A.
We con c lude that the Hospi tal
co uld not have brought its clai ms under § 502(a) because the Hospitaldoes not have standi ng to sue und er th at sta tute. Section 502(a) of ERISA allows “a parti cipant or be ne fic iar y” to bri ng a civi l act ion , int er alia , “to rec over bene fits du e to him under the te rms of

his pl an, to enforce h is rights underthe te rms of th e pla n, o r to clari fy his rights to future bene fits underth e t erms of the plan.” 29 U.S. C. § 1132(a) ( 1)(B). 5 Byits terms, standing un der t h e statute is limi ted to parti cipant s and
beneficiaries. 6 Fra n chise Tax Bd. , 463

5 Section 502( a) provi des other causes of acti on not rel evant on this appeal . The Plan makes no argument that t he Hospitalcould have br ought thi s acti on under an y other provision of § 502(a ).

6 A participant is defined as
any empl oyee or

former employee o f an em ployer, or any member or former member of an employ ee organization, who is or may be com e eligib le to recei ve a benefit

of any ty pe from an employ ee benefit plan w hich cov ers8

U.S. at27 ( “ER ISA careful ly enumerates the parti es entit led to seek relief u nder § 502

. . . .”). The parti es agree t hat the Hospitalis nether a participant n or a be ne fic iar y, and that

the Hospitaldoes not have standing under ERISA to su e in i ts
ow n rig ht.
The parti es dispu te whether, unde r the law of t his Circuit , the Hospitalcan obtain standi ng under § 502(a) byvirt ue of

an as si gnme n t o f a c la im f ro m a parti cipant

or be ne fic iar y. 7 We need not resol ve this dispute, however, because there is not

hing in t he record indicat ing

employe es of such employe r or members of such organization, or whose benefici aries may be eligible to recei ve any s uch bene fit.
29 U.S.C. § 1002(7) . A benefici ary is “a person desi gnated by

a parti cipant , or by the te rms of an employ ee benefit plan, who is or maybecome entitled to a benefit thereunde r.” Id. § 10 02( 8).

7 In part icular, t

he parti es disa gree
over wh ether th is Co urt’s op inion in IL GWU forecl oses derivative standi ng under § 502(a) . Though the IL GWU Court denie d the cl aimant’ s plan fede ral questi on juri sdict ion to s ue to rec oup paid medicalbenefit s from a second plan, 764 F .2d at 153, pa rt of the Co urt’s rationa le wa s that the claim ant ha d no t, in fa ct, as sign ed h er cla im to her plan

. Id . at 154 n.6. Ther efore, while the IL GWU Co urt exp ressed “serio us do ubts whether [the clai mant] coul d assign along with he r subst antive right s her right to sue i n federalcourt, ” id. , the Court could not

so hold. Distri ct court s in this Cir cuit have disagr eed over the scope of IL GWU

. Compare Allergy Diagnostics Lab. v. The Equ itable , 785 F. Supp. 523, 526-27 & n.3 (W.D. Pa. 1991) ( citing Footnote 6 of IL GWU

for the proposit ion that assigne es of benefi ciari es do not have stan din g to sue und er § 502 (a)), and Health Scan, Ltd. v. Traveler s Ins. Co. , 725 F. Supp. 268, 269-70 (E.D. Pa. 198 9) (s am e), with Commonwealth of Pa. Dep’t of

Public Welf

are v. Quaker Med. Care & Survivor

s Plan , 836 F. Supp. 314, 317 ( W.D. Pa. 1993) (observing that given the fact s of IL GWU, Foo tnote 6 is non -bind ing d icta in cases invo lving an ac tual assignm ent), and Ch arter F airm oun t Inst., Inc. v. A lta Health Str

ategies , 835 F. Supp. 233, 238 (E.D . Pa. 1 993 ) (sam e). Almost every

circuit to have
cons idered the qu estion h as he ld that a health care p rovid er can assert a claim under § 502(a) where a benefici ary or parti cipant

has assi gned to the provider that individual ’s ri ght to bene fits under the p lan, see e.. g., Tango Trans port v. He alth car e F in. Servs. , 322 F.3d 888, 891 (5th. C ir. 2003) (collecting cas es), but as the issue is not squarely before us,
we expr ess no opin ion o n it.9

that Psara s and Ro vetto d id, in fa ct, assign any claim s to the H ospital.
As th e party

seeking r emoval, t

he Plan bore the bu rden of p rovin g th at the Hosp ital’s cl ai m is an ER ISA c la im. DiF eli ce , 34 6 F .3d at 4 52 . A cc or di ng ly, the Plan bore the b urden of est ablis hing the exi s tenc e of

an a ssig nm ent. Hobbs v. Blue Cross Blue Shi eld of Al a. , 276 F.3d 1236, 1242 (11th Cir . 2001). The Plan concedes that t

he r ecord cont ains no evidence of an ex pre ss assign men t, whetheroral or written, from eithe r Psaras
or Rovetto t o the Hospit al. Inste ad, the Pla n argues t

hat “[t ]he MagNet contrac t itself establ ishes t

he Hospital ’s cl aim as an assignment from the part icipa nt

. ” App ellee’s Br. at

25. Essentially, the Plan argues that ( 1) under t he Subscriber Ag reem ent, “[the Ho spital’s] o nly right to demand money from the Plan comes fr om the particip ant’s a ssignm ent of her rig ht to reim bur sem ent,” Appellee’ s Br. at 16, 24; (2) t her efore, the Hospit al must be s uing
on an assi gn ment from Psaras and Rovetto.

Th e Plan’s argument is a n o n
se quitur

. Whether the S ubscri ber Agreement requir es the Hospi tal to obtain

an assignment

in order to demand payment from the Plan say s nothi ng aboutwhether

an assignment

was in fact

made. Because neithe r Psara s nor R ovetto are pa rties to the Subscribe r Agreement, that doc umen t cannot , in and of it self, establ ish an assignment of thei r claims. At best , the Plan’s inter

pretation of the Sub scr iber Agreem ent provides a n affirm ativ e defense to the Hospi tal’ s breach of contr ac t claim s, i.e

. , that the Pl an has no
co ntract ual liabi lity absent a valid assign men t. The Plan’ s argument may therefore entitle it

to judgment

on the Hosp ital’s breach of cont ract c laims in a court of co mp etent ju ris dic tion. It does not, however, conver

t thos e breach of contrac t claim s i nto deri vative clai ms for benefits un der § 50 2(a). 8
Nor can we find an actual assignment

based on any othe r doc um ents in the record.
Section 5 of the Sum mary P la n Descript ion, entitled “ Ho w B enefit s W ill Be Paid, ” provides : “If you qualif y for hospi tal care a nd are ent itl ed t o reimb ursem ent, and the hospi tal has sent in an assignment e

xecuted byyou , we w ill

8 The parties v igoro usly dispu te whether the Subscribe r Agreement requir es the Hospi tal to obtain an assignment

before the Plan is obligated to make payment. We express no opi nio n on the m erits o f this disp ute. Nor do we express any

opinion on ot

her disput es regar ding the interpr etat ion of the Subscr iber Agreement . For exampl e, the Plan argues that the re is no direct contra ctual re lationsh ip betw een itse lf and the Hospit al. The questi on on appeal is whether

the Hospit al coul d have brou ght its cla im un der § 502 (a). If it could no t, then remov al was im proper, and the Plan’s arguments on the merits, including its argument that no contract exist s, can only be adj udicat ed in st ate, not fed eral, c our t.10

pay the h osp ital d irect ly . . . .” Th us, th e Plan its elf contemplates an independent act byw hi ch a participan t or beneficiary assig ns his or he r claim to the H ospital. The record conta ins no evi dence that Psara s or R ovetto und ertook such an ac t. The Plan offers the certifi cati on of KathyPridmore, the Pla n’s Direc tor of Medical Benefits , to s upport a finding of

an assignm ent. Pridmo re broa dly declar es that, in her expe rience , the Plan has “con sistently followed the clai ms an d claim review procedures” contai ned in the Sum mary Plan De scrip ti on. The Plan argu es that Pridmo re’s declara tio n
cons titute s e vidence of “routine practi ce” thatsupports an infer enc e of a n assign men t. See Fed . R. E vid . 4 0 6. We disagr ee. Pridmore d oes not decl are that the Plan routine ly receives assign men ts prior to pa ym ent. In her r ecit ation of the Plan’s “standard p rocedure forprocessing cl aims, ” she does not

even mention t

he executi on of assi gnmen ts by Pla n particip ants or benefi ciari es. As suc h , Pridmo re’s certi ficat ion cannot establ ish a routi ne practi ce rel evantto this ap peal, let alone sati sfythe Plan’ s bur den of establ ishi ng fe deral s ubjec t- matte r juri sdict ion by a pr epon d erance of t he evid enc e. Because the Plan ha s fail ed t o demonstrat e that

the Hospit al obta ined an assignment

from Psaras and Rov ett o, we do not reac h the “st anding-by -assi gnment of claim” issue. T herefore , the Plan cannotdem onstra te that the Ho spital h a s standi ng to sue under

§ 502(a ). As a result, the Hos pi ta l’ s s tate law cl ai ms could not have been br ought under t he scope of § 502 (a) and are no t com pletely pre-empte d by ER ISA

. E.g. , Hobbs , 276 F.3d at 124 3; Wa rd v. A lte r native He alth Delivery Sys
., Inc. , 261 F.3d 624, 627 (6th Cir. 200 1); Ha rri s v. Provident Lif e & Accident Ins. Co. , 26 F.3d 9 30, 933-34 (9th Cir. 1994 ).
B.
We further

conclude t

hat the Hosp ital’s state law claims are predicated
on a legalduty

that i s independent

of ERI SA. See D avila , slip o p. at 8

. Th e Hosp ital’s clai ms, to be s ur e , are de rived from an E RIS A p lan, an d exis t “only because” of th at pla n. Id. at11. The crux of t he parti es’ di spute i s the meani ng of Section2.1 of

the S ubsc riber A greem ent, which governs pay

men t for “Covered Services fur nish ed to Elig ible P erso ns.” We re cove rage a nd elig ibil ity disputed in this case, interpr etat ion of the Plan mi ght form an “ essential part” of the Hosp ital’s claim s. Id. Coverage and eligibility, however,
are not in d ispute

. Inste ad, the resolution of this lawsuit

requir es int erpret ation of the Sub scribe r Ag reem ent, no t t he Plan. Th e Hos pital’s righ t to reco very, if it exists, depends entirely

on the operati on of third-p arty contrac ts execut ed by t he Plan that are inde pendentof the Pla n itse lf. Cf. Caterpillar

In c. v. Williams , 482 U.S. 386 (1987) (sui t for breach of indivi dual employment

contrac t, e ven if

defend ant’s acti on also co nsti tuteda breach of an entirely separat e coll ecti ve bargai ning agree men t, not pre- empted by§ 301 of the11

Labo r Ma nagem ent Relations A ct).
We find ins truc ti ve the Nin th Circuit’s opinion in Blu e Cr oss of Ca lifornia v. Anest

hesia Care Ass ociates MedicalGroup, Inc. , 187 F .3d 10 45 (9 th Cir. 1999). I n that c ase, t he court he ld that cl ai ms asserte d by health care pro viders againsta healt

h care pl an for breac h of their prov i der agree ments were not
com pletely pre-empte d underERI SA. Id. at1051-52. The cour t r each ed this conclusi on notwiths tanding “th e fact t hat these medical pr ovider s obtai ne d assign men ts of benefit s from benefi ciari es of ER ISA -cov ered h ealth care plans. ” Id. at 10 47, 1 052

. The litigatio n in Anesthesia Care
arose from a fee disp ute between four health care pro vid ers a nd B lue C ross

. I d. at1048. Blue C ross h ad en tered in to “provider

agreements ” with phy si cians in which Blue Cross agr eed t o identi fy t he providers in the in form ation it dist ribut ed to ben ef iciaries of the pl an and to di rect benefici aries to those providers. In ret urn, the providers agreed t o acceptpayment for servi ces rend ered to ben eficiari e s
ac cor ding to specified fee schedules. When Blue Cross attem pted to change the fee schedules , the providers filed a clas s acti on in st ate court all eging a bre ach of the p rov ider agr eem ents

. Id. at 10 49.
The Nin th Circ uit held th at “the Providers’ clai ms, which a rise from the te rms of thei r provi der agree men ts a nd could n ot be as serted by their pa tientassignors, are not c laims for benefit s under th e terms of ERISA plans, and hence d o no t fallwithin § 502( a)(1) (B).” Id. at 1050. The court

explai ned: [T] he Providers a r e assert ing c o n tract u a l bre ac hes . . . that their patient-assi

gnors could not

a ssert: th e p at ie nt

s s imp l y
a re not parties to t h e p r ovider agreement s between the Provi ders and Blue C ros s . The dispu te here is not

over the right

to payme nt, whi ch might be said to depe nd on the patients’ assi g nments to t he Providers, but the amount , or level, of

payment , which de pend s on the te rms of the pro vid er ag reem ents

.

Id. at 1051 (first emphasis a d ded). Because t he P rovider s asser ted “st ate l aw cl ai ms aris ing out o f sep arate a greem ents for the provi sion o f

goo ds a nd s erv ices ,” the court found “no basis to conclude that the mere fact of a ssignment converts the Pr ov iders’ clai ms into cl aims to r ecover bene fits under the t erms of an ER IS A plan. ” Id. at 1052. 9

9 The reasoni ng in Anesthesia Care was followed in Orthopaedic Surgery Associates of San Antonio, P.A. v. Prudential

Health Care Plan, Inc. , 147 F. Supp. 2d 595 ( W.D. Tex. 2001). The facts in Orthopaedic Surgery are ne arly identi cal t o this case. In Orth opa edic Surgery , heal th care provider s enter ed12

The facts o f this case a re sim ilar to Ane sthesia Care in important respect s: (1) the Hosp ital’s claims in this case ari s e from the te rms of a co nt ract—the Subscribe r Ag reem ent— that is allege dly independentof the P la n; (2) th e particip ants a nd benefici aries of the Plan do not appear

to be pa rt ies t o the Subscribe r Ag reem ent; an d (3) “[t ]he dispu te here is n ot over t he right to p aymen t, which might be sa id to depe n d
on the pat ients ’ assi gnments to t he [Ho spital], but the amount , or le vel, o f pa y men t, which depends on the terms of the [Subscri ber Agreement] .” Id. at 1051.

C.
We have not over looked th e apparentc onve rgen ce be twee n th e Hosp ital’s breach of cont ract c laim and a claim for benefi ts under § 502(a). Because the Plan is a reimburs ement pl an, t he payme nts m ade t o the H ospital are the b enefits receiv ed by P saras a nd R ovett o underthe Plan. A s a re sult, it wo uld appea r th at any claim s the H ospital c ould have obtaine d by as signment from Ps aras and Ro vetto w ould be for the s ame amount
as the brea ch of con tra ct claims that are the subject

of this appeal. Moreover, had the Hospitalsuccessf

ully sued Psaras and Ro vetto for the payme nts du e, it wo uld appearthat any cl aims for re imbursement that Psaras and Rovetto would have againstthe Plan would be clai ms for bene fits under § 502(a). Indeed, one of the principal reaso ns w hy cour ts have allowed particip ants and b enef icia r ies t o assign their clai ms under § 50 2(a) is to avoid the
nece ssity of prov iders suing patien ts in the first insta nce

. See C agle , 11 2 F .3d at 151 5. Nevertheless, the absenc e of an assignment

is di spositive of the com pl ete pre-empti on questi on. Although t he Hospital“ma y not d efe at removalby
om ittin g t o plead neces sary federal questi ons in a complaint ,” Franchise Tax Bd. , 463 U.S. at 22, it i s clear that t he Hospitalis ass erting a claim that co uld not be assert ed under the civilenforcement into cont racts with a heal thcare plan, Prudential. Under the contracts , Prudenti al agre ed to pay the provi ders for servi ces render ed to benefi ciari es of the plan. When Prudentialalle gedly paid the provider s less than the agreed upon amount, t

he provider s sued for br each of the p hysicia n ag reem ents

. Orth opa edic Surgery , 147 F. Supp. 2d at 597. The Distri ct Court in Orthopaedic Surgery
rema nded the ca se to sta te cou rt, concludi ng that § 502( a) did not completely pre- empt the providers’ clai ms. Citing Anesthesia Care , the
court chara ct er iz ed t

he p ro vi der s’ cl ai ms as “cla im[s] for

the amount or

levelof payment and not the right

to payment.” Id. at 601. The court r eject ed Prudenti al’s argument that, since t he med ical serv ices tha t wer e alleg edly unpaid were provi ded to participants or benefici aries of ERISA plans, the prov iders’ c laims s oug ht ben efits pa yable under the terms of those plans.13

provisi on of E RIS A. I t mayvery well be that the H ospital’s breac h of contra ct claim againstth e Plan wil l f

ai l unde r s tate law,
or that t he Hosp ital’s state law claims are pre-empte d under § 514(a). These matters, how ever, go to the merits of the H ospital’s breach of co ntract c laim, w hich c an on ly be a dju dica ted in state cou rt.

IV.
Under the well -pleade d complaint rule, the H ospital’ s complaint does not present a federalquesti on that w ould sup por t rem ova l. The complaint does not expr essly ref

e r to ERISA or the fe deral
common law of ERISA, and the r ight s or immuni t ies creat ed under ERISA are not elements, let a lone ess entia l ele ments, of the plaintiff’s claims. M oreover, t he Hosp ital’s stat e law breach of cont ract
c la ims are not c ompletely pr e-empted by ER ISA’s civilenforcement provisi on, because the Hospit al co uld not have brough t i ts cl aims under t hat provi sion. Ac cord in gl y, removal i n this case was imprope r, and the or der of the Distri ct Cou rtden yi ng remand willbe vacated. We w ill remand this case to the Distri c t Cou rtwith ins tructions that the Distri ct Co urt, in turn, reman d to the Su peri o r Co urt o f N ew Jers ey. PascackValley Hospi ta l, I nc. v. Local 464A
No. 03-4196
ALI TO, Circu it Judge , concurring in t he judg men t.
I concu r i n the judgment based on the decisi o n in N. E. De pt ’ t I LGWU He alth & W elfare Fun d v. Team sters Local Union No. 229 Welfare Fund , 764 F.2d 147 (3d Cir. 198 5). A lthoug h there is
now substantial co ntrary au th or it y , w e are bound b y prior

panel deci sions of our Co urt u ntil th ey are ove rrule d.
The Co urt avo id s the question whetheran as sig n ee ca n asse rt a claim underSection 502( a)(1) (B) of ERISA, 29 U.S .C. § 1132(a)( 1)(B), by hol ding that there is i nsuffici ent evi denc e to supp ort a finding that the re w ere ass ignm ents in th is
case. I di sa gr ee

. Wh i le the summ ary judgmentrecord does not conta in any express as si gnme nt s of

th e cl ai ms at is sue, there is ample e vidence t o sup p ort a finding that the claim s we re assig ned to the Hospital . What happened here is very
common. Parti cipa nts of a hea lth care plan recei ved treatment fr om a provider; the part ic ipants did not pay for those servi ces but ins tead gave t he provider

the informat ion needed to bi ll t heir pl an; the provider then bill ed the plan purs uant to a contrac t obligating the plan to pay t he provider on the ass igned cl aims of partic ipa nts; and th e plan paid, a lbeit at a discount ed rate. These facts are more than suffici entto prov e tha t the claims w ere implic itlyassigne d to the provider. In holding that the summ ary judgmentrecord14

is insuffi cient

to prove as sign men ts, the Cou rtignores the obvious real it y of t he sit uation.