[DO NOT PUBLISH]

IN THE UNITED STATES COURT OF APPEALS

FOR THE ELEVENTH CIRCUIT

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No. 18-10046

Non-Argument Calendar

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D.C. Docket No. 1:15-cv-04439-AT

W. A. GRIFFIN,

 Plaintiff - Appellant,

versus

GENERAL ELECTRIC COMPANY,

BLUE CROSS AND BLUE SHIELD OF ALABAMA, INC., 

 Defendants-Appellees.

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Appeal from the United States District Court

for the Northern District of Georgia

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(January 28, 2019)

Before JORDAN, BRANCH, GRANT, Circuit Judges.

PER CURIUM:

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Dr. W.A. Griffin, proceeding pro se, appeals the district court’s dismissal of 

her complaint alleging gender and racial discrimination under Section 1557 of the 

Affordable Care Act, 42 U.S.C. § 18116. The district court granted the 

defendants’ motions to dismiss, concluding that Dr. Griffin’s complaint was 

devoid of sufficient factual support to allow her claims to proceed. After careful 

consideration, we affirm.

I

Dr. Griffin is a female, African-American medical provider who practices in 

Fulton County, Georgia. According to Dr. Griffin, on June 14, 2013, she treated 

V.H., a patient insured by General Electric’s (GE) employer-based health plan. 

Blue Cross Blue Shield of Alabama (Blue Cross) was the plan’s third-party claims 

administrator. Dr. Griffin requested that V.H. sign an assignment of benefits

authorizing GE’s healthcare plan to pay benefits directly to Dr. Griffin. Dr. Griffin 

submitted claims to GE seeking payment for her services as an out-of-network 

provider, but she did not receive payment at the benefit level she says was 

promised to her as an out-of-network provider. 

Dr. Griffin then sued GE and Blue Cross under the Employee Retirement 

Income Security Act of 1974, 29 U.S.C. § 1132(a). Both defendants raised an antiassignment provision in the health plan at issue as a bar to Dr. Griffin’s claims. 

GE and Blue Cross moved to dismiss, and the district court granted dismissal on 

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the grounds that Dr. Griffin had not sufficiently pled a valid assignment of V.H’s 

assignment of benefits. She therefore did not have a cause of action under ERISA. 

See Griffin v. Blue Cross and Blue Shield of Alabama, et al., 157 F. Supp. 3d 1328

(N.D. Ga. 2015).

On December 22, 2015, Dr. Griffin brought this separate action against GE 

and Blue Cross, asserting two different claims: (1) discrimination under Section 

1557 of the Affordable Care Act, 42 U.S.C. § 18116; and (2) promissory estoppel. 

Dr. Griffin alleges that GE discriminated against her by raising the antiassignment defense selectively. She claims that GE raised this defense against her 

because of her race and gender, when it did not raise the defense against white 

male plaintiffs. Dr. Griffin pointed to four cases she believed were analogous to 

hers in which GE treated the plaintiffs differently regarding enforcement of the 

health plan’s provisions pertaining to assignment of claims. According to Dr. 

Griffin, these cases show that GE and Blue Cross treated her differently than other 

white, male doctors by “applying more restrictive assignment of benefit criteria to 

her as compared to other providers who have sued GE under ERISA.” D.E. 40 at 

25. In addition to alleging discrimination, Dr. Griffin asserted a promissory 

estoppel claim based on GE’s and Blue Cross’ promises to pay her a certain benefit 

level, on which she relied on to her detriment. 

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The defendants separately moved to dismiss Dr. Griffin’s complaint. The 

district court granted both of the motions, concluding that Dr. Griffin’s fourth 

amended complaint failed to sufficiently plead viable claims. 

The district court noted that the cases Dr. Griffin relied on did not involve 

Blue Cross, and she had therefore failed to “plausibly allege[ ] any facts that Blue 

Cross discriminated against her.” D.E. 50 at 8. After carefully reviewing the listed 

cases, the court also concluded that “GE’s litigation conduct . . . does not suggest 

that GE discriminated against Plaintiff in the present case.” Id. at 12. And even if 

the cases were sufficient, “[n]othing in Section 1557 or the relevant regulations 

suggests that it applies to a covered entity’s litigation conduct.” Id.

The district court also dismissed Dr. Griffin’s promissory estoppel claims for 

failing “to plead a promise with sufficient particularity to state a claim for 

promissory estoppel.” Id. at 14. Dr. Griffin did not allege that she had spoken

with a Blue Cross representative who promised that the services she provided to 

V.H. would be reimbursed at a particular level. Id. Instead, she alleged that a 

representative told her that V.H. had benefits for out-of-network care that would be 

based upon the usual, reasonable rate. Id. Because this statement did not amount 

to a promise to pay a particular rate for a particular treatment, Dr. Griffin failed to 

sufficiently plead her promissory estoppel claim. Id. at 15. 

Dr. Griffin appealed. 

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II

We review de novo a district court’s ruling on a Rule 12(b)(6) motion to 

dismiss for failure to state a claim. See Ironworkers Local Union 68 v. 

AstraZeneca Pharm., LP, 634 F.3d 1352, 1359 (11th Cir. 2011). A complaint fails 

to state a claim if it does not contain “factual content that allows the court to draw 

the reasonable inference that the defendant is liable for the misconduct alleged.” 

Ashcroft v. Iqbal, 556 U.S. 662, 679 (2009). In considering a Rule 12(b)(6) 

motion, we construe the complaint in the light most favorable to the non-moving 

party and accept the allegations of facts therein as true. See Duke v. Cleland, 5 

F.3d 1399, 1402 (11th Cir. 1993). To survive dismissal for failure to state a claim, 

“a plaintiff’s obligation to provide the ‘grounds’ of his ‘entitlement to relief’ 

require more than labels and conclusions, and a formulaic recitation of the 

elements of a cause of action will not do.” Bell Atl. Corp. v. Twombly, 550 U.S. 

544, 555 (2007). A pro se litigant who does not address an issue in her brief 

abandons the issue on appeal. See Timson v. Sampson, 518 F.3d 870, 874 (11th 

Cir. 2008).

Dr. Griffin does not present any argument or claim against Blue Cross in her 

brief and she expressly abandoned her promissory estoppel claims. So the only 

issue on appeal is whether the district court properly dismissed Dr. Griffin’s 

discrimination claim against GE under Section 1557 of the ACA.

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Section 1557 of the ACA provides that:

[A]n individual shall not . . . be excluded from participation in, be 

denied the benefits of, or be subjected to discrimination under, any 

health program or activity, any part of which is receiving Federal 

financial assistance, . . . or under any program or activity that is 

administered by an Executive Agency or any entity established under 

this title.

42 U.S.C. § 18116(a). To state a claim under this provision, a plaintiff is required 

to show that he or she (1) was a member of a protected class, (2) qualified for the 

benefit or program at issue, (3) suffered an adverse action, and (4) the adverse 

action gave rise to an inference of discrimination. See 42 U.S.C. § 2000d; 20 

U.S.C. § 1681.

Dr. Griffin based her discrimination claim on actions that GE took in 

litigation with four other plaintiffs (who were white male doctors) in comparison to 

GE’s actions in litigation against her. As the district court explained, however, 

nothing in the four comparator cases cited by Dr. Griffin suggests that GE has a 

different process for handling claims brought by minority or women providers 

compared to claims brought by white males. In all of the cited cases, GE brought 

the same or similar challenges to the plaintiff’s claims. See Almont Ambulatory 

Surgery Ctr., LLC v. UnitedHealth Grp., 2:14-cv-02139-MWF-VBK (C.D. Cal.)

(arguing that the plaintiff lacked standing due to the anti-assignment provision in

the plan); Eden Surgical Ctr. v. General Electric Co., No. 2:09-cv-04301 (C.D. 

Cal.) (challenging the surgical center’s standing under ERISA); Neurological 

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Surgery, P.C. et. al. v. General Electric Co., No. 2:15-cv-07076- JMA-SIL

(E.D.N.Y.) (challenging the plaintiffs’ standing to bring the complaint); Murdoch 

v. United Healthcare, 2:03-cv-00178-EAK (M.D. Fla.) (arguing that the court 

lacked jurisdiction because the plaintiff failed to overcome the plan’s limitations 

on suits, including the anti-assignment clause). 

Thus, the district court did not err when it dismissed Dr. Griffin’s

discrimination claim against GE.

III

The district court’s judgment is AFFIRMED.

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