Opinion ID: 75441
Heading Depth: 3
Heading Rank: 4

Heading: The Sixth Circuit Decisions

Text: In accepting Humana’s argument in this regard, the district court relied on two Sixth Circuit cases directly on point. In Baptist Memorial Hosp. v. Pan American Life Ins. Co., 45 F.3d 992 (6th Cir. 1995), Horace Thomas, a retired postal worker, was simultaneously covered for hospitalization by three separate entities. Blue Cross/Blue Shield provided coverage in connection with Thomas’s former federal employment. Thomas was also covered by Pan-American as a dependent of his wife by virtue of her current employment. Id. at 993. Finally, Thomas was enrolled in Medicare. Id. After an automobile accident, Thomas was hospitalized for several months, incurring a hospital bill of almost $600,000. Blue Cross/Blue Shield refused to pay 10 the bill, claiming that Pan-American’s dependent coverage was primary. PanAmerican likewise refused to pay the bill, claiming that Blue Cross/Blue Shield was the primary payer as Thomas’s former employer. The hospital brought suit against both Blue Cross/Blue Shield and PanAmerican, seeking a determination as to which insurer was primary. Id. Medicare was not joined as a party and the hospital apparently never demanded payment from Medicare. Id. Although the coordination of benefits provisions of both plans demonstrated that the Blue Cross/Blue Shield coverage was primary to the PanAmerican coverage, the district court entered summary judgment against PanAmerican. The district court found that Pan-American became primary to Blue Cross/Blue Shield by virtue of the MSP statute. While Pan-American was not permitted to make Medicare primary to its coverage for Thomas because his coverage was based upon his wife’s current employment status, Blue Cross/Blue Shield was permitted to do so and had done so. Based upon this priority under the MSP statute, the district court found Pan-American primarily responsible for Thomas’s hospital bill. On appeal, the Sixth Circuit reversed, finding that the MSP statute had no impact on the priority as between solely private insurers and did not trump the plan language adopted by the private insurers as to priority: 11 What difference does the MSP statute make as far as priority of payment obligations between Blue Cross and Pan-Am is concerned? None at all, in our view, on the facts presented here. In precluding Pan-Am from making its coverage secondary to the coverage provided by Medicare, Congress did not purport to preclude either Pan-Am or Blue Cross from making the Pan-Am coverage secondary to the coverage provided by Blue Cross.