Court Opinion

ID: 9916753
Source: CourtListenerOpinion
Date Created: 2024-01-10 17:00:48.711621+00
Date Added: 2024-06-11T13:25:59.450193
License: Public Domain

FOR PUBLICATION

  UNITED STATES COURT OF APPEALS
       FOR THE NINTH CIRCUIT

SOUTH COAST SPECIALTY                       No. 22-55717
SURGERY CENTER, INC.,
                                             D.C. No.
             Plaintiff-Appellant,         8:21-cv-01944-
                                             TJH-KES
 v.

BLUE CROSS OF CALIFORNIA,                    OPINION
DBA Anthem Blue Cross,

             Defendant-Appellee.

      Appeal from the United States District Court
          for the Central District of California
      Terry J. Hatter, Jr., District Judge, Presiding

        Argued and Submitted October 3, 2023
                Pasadena, California

                 Filed January 10, 2024

  Before: Susan P. Graber, Salvador Mendoza, Jr., and
           Roopali H. Desai, Circuit Judges.

               Opinion by Judge Mendoza
2 SOUTH COAST SPECIALTY SURGERY CTR. V. BLUE CROSS OF CAL.

                          SUMMARY*

                              ERISA

   The panel reversed the district court’s dismissal of an
ERISA action brought by South Coast Specialty Surgery
Center, Inc., and remanded.
    South Coast, a healthcare provider, sought
reimbursement from Blue Cross of California, d/b/a Anthem
Blue Cross, an insurer and claims administrator, for the costs
of medical services provided to South Coast’s patients.
South Coast, neither a plan participant nor a beneficiary,
could not bring a direct enforcement action under ERISA,
but it argued that it could enforce ERISA’s protections
directly because its patients assigned it the right to sue for
the non-payment of plan benefits via an “Assignment of
Benefits” form.
    The panel held that, under longstanding precedent, a
healthcare provider has derivative authority to enforce
ERISA’s protections if it has received a valid assignment of
rights. Construing South Coast’s “Assignment of Benefits”
form, the panel held that South Coast’s patients effectuated
a valid assignment. Accordingly, South Coast had the right
to seek payment of benefits and to sue for non-payment.

*
 This summary constitutes no part of the opinion of the court. It has
been prepared by court staff for the convenience of the reader.
  SOUTH COAST SPECIALTY SURGERY CTR. V. BLUE CROSS OF CAL. 3

                       COUNSEL

Mina Hakakian (argued), Williams Wollitz Hakakian PC,
Los Angeles, California; Steven M. Goldberg, David S.
Markun, and Kevan T. Hunt, Markun Zusman & Compton
LLP, Encino, California; for Plaintiff-Appellant.
David J. de Jesus (argued), Reed Smith LLP, San Francisco,
California; Amir Shlesinger and Avraham E. Aizenman,
Reed Smith LLP, Los Angeles, California; for Defendant-
Appellee.

                        OPINION

MENDOZA, Circuit Judge:

    Plaintiff-appellant South Coast Specialty Surgery
Center, Inc. (“South Coast”) filed suit against defendant-
appellee Blue Cross of California, d/b/a Anthem Blue Cross
(“Anthem”) under section 502(a) of the Employee
Retirement Income Security Act of 1974 (“ERISA”) for
Anthem’s alleged failure to fully reimburse the costs of
medical services provided to South Coast’s patients. Unlike
its patients, South Coast cannot bring a direct enforcement
action under ERISA; it is neither a plan participant nor a
beneficiary within the meaning of that statute’s civil
enforcement provision. But South Coast argues that it may
enforce ERISA’s protections derivatively because its
patients validly assigned it the right to sue for the non-
payment of plan benefits via an “Assignment of Benefits”
form. The district court disagreed, concluding that South
Coast lacked authority to bring an ERISA claim and
4 SOUTH COAST SPECIALTY SURGERY CTR. V. BLUE CROSS OF CAL.

dismissing the healthcare provider’s suit. South Coast’s
appeal thus raises two questions. First, does a healthcare
provider have derivative authority to enforce ERISA’s
protections if it has received a valid assignment of rights?
And second, did South Coast’s patients effectuate such an
assignment, permitting the medical provider to sue Anthem
under ERISA? Longstanding precedent answers “yes” to the
first question.     And after construing South Coast’s
“Assignment of Benefits” form, we answer “yes” to the
second. So we conclude that South Coast has authority to
enforce ERISA’s protections in federal court, reverse, and
remand.
        I. Procedural and Factual Background
    South Coast operates an ambulatory surgery center,
where it provides medical services to patients, some of
whom are insured under ERISA-governed health benefits
plans. As a condition of treatment, South Coast requires its
patients to sign an “Assignment of Benefits” form. That
form states:

                  Assignment of Benefits
       I hereby authorize my Insurance Company to
       pay by check made payable and mailed
       directly to: [South Coast] for the medical and
       surgical benefits allowable, and otherwise
       payable to me under my current insurance
       policy, as payment toward the total charges
       for the services rendered. I understand that
       as a courtesy to me, the South Coast Specialty
       Surgery Center will file a claim with my
       insurance company on my behalf. However,
       I am financially responsible for, and hereby
    SOUTH COAST SPECIALTY SURGERY CTR. V. BLUE CROSS OF CAL. 5

         do agree to pay, in a current manner, any
         charges not covered by the insurance
         payment. If it is necessary to file a formal
         collection action, I agree to pay all costs,
         including reasonable attorney’s fees incurred
         by the outpatient medical center in the
         collection of the outstanding fees.
         Actual Plan Benefits cannot be determined
         until the claim is received by your insurance
         company and is based upon their
         determination of medical necessity. The
         information received from the above stated is
         not a guarantee of payment.1

Per the terms of that assignment, South Coast submits claims
to its patients’ insurance companies and claim
administrators, seeking payment of insurance benefits to
cover the costs of its medical services.
    According to South Coast, Blue Cross of California,
d/b/a Anthem Blue Cross2 is just such an insurer and claims
administrator. Anthem, through a wide network of entities
and affiliates, serves approximately 41 million medical
member-insureds through its affiliated health plans.
Relevant here, Anthem provides coverage under ERISA-
governed insurance plans to many South Coast patients.
Through its Blue Card Program, Anthem also administers

1
  South Coast uses a substantially identical “Assignment of Benefits”
form with respect to anesthesia services. But it is unclear whether South
Coast also seeks reimbursement from Anthem under that assignment.
2
  This entity is one of the many entities apparently associated with parent
company, Anthem, Inc., and which we call “Anthem” for purposes of
this appeal.
6 SOUTH COAST SPECIALTY SURGERY CTR. V. BLUE CROSS OF CAL.

plans and oversees and adjusts claims for South Coast’s
patients under ERISA-governed health plans. Since 2012,
South Coast has submitted hundreds of claims on behalf of
its patients to Anthem.
    Until relatively recently, Anthem processed and paid
those claims without dispute. But in 2019, Anthem formally
instituted a “pre-payment review” process, which
significantly curtailed its coverage for the costs of South
Coast’s procedures. According to South Coast, Anthem
(1) ignored ERISA-governed insurance plan documents and
benefits coverage requirements, implementing its own
“Local Plan Pricing” to determine appropriate medical costs;
(2) began requiring “full medical records” to evaluate the
“appropriateness,” “accuracy,” and “correctness” of
submitted claims; and (3) started rejecting South Coast’s
submitted claims without proper reference to the terms and
conditions of the controlling ERISA plan. In sum, South
Coast maintains that Anthem failed to follow ERISA plan
requirements and failed to provide appropriate benefits for
approximately 150 medical claims, resulting in a potential
shortfall exceeding $5.4 million.
    So South Coast sued Anthem under section 502(a) of
ERISA, 29 U.S.C. § 1132(a)(1)(B), alleging that Anthem
“failed to follow [p]lan terms and conditions with respect to
the processing and payment of [submitted] claims.”
Recognizing that healthcare providers generally lack direct
authority to sue under ERISA, South Coast asserts that its
“Assignment of Benefits” form, signed by its patients, gives
South Coast both the right to seek payment of these benefits
and to sue for non-payment. The district court disagreed.
Granting with prejudice Anthem’s motion to dismiss under
Federal Rules of Civil Procedure 12(b)(1) and 12(b)(6), the
district court reasoned that (1) South Coast’s “Assignment
  SOUTH COAST SPECIALTY SURGERY CTR. V. BLUE CROSS OF CAL. 7

of Benefits” form conveyed only “the right to receive direct
payment from Anthem,” and not the right to sue for non-
payment of plan benefits; and (2) under our precedent, South
Coast lacked authority to sue under ERISA. This timely
appeal followed.
                  II. Standard of Review
    Some ERISA cases raise Article III standing issues, and
we examine whether the plaintiff has suffered a cognizable
injury, redressable by a court. See, e.g., Spinedex Physical
Therapy USA Inc. v. United Healthcare of Ariz., Inc., 770
F.3d 1282, 1289 (9th Cir. 2014) (addressing whether
plaintiff suffered “‘injury in fact’ necessary for Article III
standing” to assert ERISA claims). When a plaintiff has
Article III standing, a defendant may challenge the authority
of the plaintiff to sue under ERISA, and we examine
“whether Congress has granted a private right of action to a
particular plaintiff[.]” DB Healthcare, LLC v. Blue Cross
Blue Shield of Ariz., Inc., 852 F.3d 868, 873 (9th Cir. 2017).
Notably, we formerly characterized whether a plaintiff may
sue under ERISA as a “standing” inquiry. See, e.g., Harris
v. Amgen, Inc., 573 F.3d 728, 732 (9th Cir. 2009) (examining
whether a plaintiff had “standing under ERISA”);
Davidowitz v. Delta Dental Plan of Cal., Inc., 946 F.2d
1476, 1477 (9th Cir. 1991) (“Under ERISA, a beneficiary
has standing to bring a civil action for non-payment.”). But
that label is a “misnomer” when considering whether
Congress has authorized a plaintiff to bring suit. Lexmark
Int’l, Inc. v. Static Control Components, Inc., 572 U.S. 118,
125–27 (2014) (quoting Ass’n of Battery Recyclers, Inc. v.
EPA, 716 F.3d 667, 675–76 (D.C. Cir. 2013) (Silberman, J.,
concurring)). “For clarity on this point, we avoid in this
opinion references to [South Coast’s] ‘standing.’” DB
Healthcare, 852 F.3d at 873.
8 SOUTH COAST SPECIALTY SURGERY CTR. V. BLUE CROSS OF CAL.

    The district court here ruled that South Coast lacked
authority under ERISA to file suit seeking to recover
payments due for services rendered. We see no Article III
concerns in South Coast’s suit, and none are raised by the
parties, so we cabin our analysis to South Coast’s authority
to sue under ERISA. Whether the district court dismissed
South Coast’s complaint under Rule 12(b)(1) or Rule
12(b)(6), we have jurisdiction under 28 U.S.C. § 1291, and
we review the district court’s dismissal order de novo.
Vaughn v. Bay Env’t Mgmt., Inc., 567 F.3d 1021, 1024 (9th
Cir. 2009).
                       III. Discussion
                              A.
     The Employee Retirement Income Security Act of 1974
sets minimum standards for most voluntarily established
retirement and health plans in private industry to provide
protection for plan members. See Aetna Health Inc. v.
Davila, 542 U.S. 200, 208 (2004) (citing 29 U.S.C.
§ 1001(b)). Significantly, ERISA gives plan participants the
right to sue insurers and claim administrators for plan
benefits and breaches of fiduciary duty. 29 U.S.C.
§ 1132(a)(1), (3); see also Pilot Life Ins. Co. v. Dedeaux, 481
U.S. 41, 54 (1987). By enacting ERISA, Congress “intended
that a body of [f]ederal substantive law will be developed by
the courts to deal with issues involving rights and obligations
under private welfare and pension plans.” Amato v. Bernard,
618 F.2d 559, 567 (9th Cir. 1980) (quoting 120 Cong. Rec.
29942 (1974) (remarks of Senator Javits)). ERISA thus
effectuates “a careful balancing of the need for prompt and
fair claims settlement procedures against the public interest
in encouraging the formation of employee benefit plans.”
Pilot Life, 481 U.S. at 54. And it establishes a federal cause
    SOUTH COAST SPECIALTY SURGERY CTR. V. BLUE CROSS OF CAL. 9

of action to remedy failures to follow plan terms and
conditions and to ensure the payment of benefits to insureds.
See Davila, 542 U.S. at 210.
    To effectuate its purpose, ERISA § 502(a) contains
broad civil enforcement mechanisms, which state in relevant
part:

         A civil action may be brought—(1) by a
         participant or beneficiary . . . (B) to recover
         benefits due to him under the terms of his
         plan, to enforce his rights under the terms of
         the plan, or to clarify his rights to future
         benefits under the terms of the plan; . . . (3)
         by a participant, beneficiary, or fiduciary (A)
         to enjoin any act or practice which violates
         any provision of this subchapter or the terms
         of the plan, or (B) to obtain other equitable
         relief (i) to redress such violations or (ii) to
         enforce any provisions of this subchapter or
         the terms of the plan[.]

29 U.S.C. § 1132(a)(1)(B), (3).               Section 502(a)
“demonstrates Congress’[s] care in delineating the universe
of plaintiffs who may bring certain civil actions.” Harris Tr.
& Sav. Bank v. Salomon Smith Barney, Inc., 530 U.S. 238,
247 (2000). And, by its plain terms, ERISA identifies
“[plan] participants, beneficiaries, [and] fiduciaries” as
among those empowered to bring a civil action under
ERISA.3 Misic v. Bldg. Serv. Emps. Health & Welfare Tr.,

3
 ERISA also permits the Secretary of Labor, States, and employers to
bring civil actions in certain circumstances that are not relevant here. See
29 U.S.C. § 1132(a); see also Bristol SL Holdings, Inc. v. Cigna Health
& Life Ins. Co., 22 F.4th 1086, 1089 n.3 (9th Cir. 2022).
10 SOUTH COAST SPECIALTY SURGERY CTR. V. BLUE CROSS OF CAL.

789 F.2d 1374, 1378 (9th Cir. 1986) (per curiam); see also
Davila, 542 U.S. at 210 (“If a participant or beneficiary
believes that benefits promised to him under the terms of the
plan are not provided, he can bring suit seeking provision of
those benefits.”).
    Healthcare providers like South Coast are neither
“participants” nor “fiduciaries” under ERISA. See 29 U.S.C.
§ 1002(7) (“The term ‘participant’ means any employee or
former employee of an employer, or any member or former
member of an employee organization, who is or may become
eligible to receive a benefit of any type from an employee
benefit plan . . . .”); 1002(14)(A) (defining “fiduciary” to
include “administrator, officer, trustee, or custodian” of an
“employee benefit plan”). And we have long held that
“health care providers are not ‘beneficiaries’ within the
meaning of ERISA’s enforcement provisions.”                DB
Healthcare, 852 F.3d at 874; see also Spinedex, 770 F.3d at
1289 (“[A] non-participant health care provider . . . cannot
bring claims for benefits on its own behalf.”); Bristol SL
Holdings, Inc. v. Cigna Health & Life Ins. Co., 22 F.4th
1086, 1089 (9th Cir. 2022) (“Circuit case law has made clear
that healthcare providers are not ‘beneficiaries’ within the
meaning of ERISA.”). Thus, under ERISA’s clear terms,
South Coast lacks direct authority to enforce its protections.
    ERISA, however, permits the assignment of health and
welfare benefits to a healthcare provider, and it allows such
a provider to bring derivative claims on behalf of its patients.
We held as much in Misic, where we stated that “ERISA
does not forbid assignment by a beneficiary of his right to
reimbursement under a health care plan to the health care
provider.” 789 F.2d at 1377. Indeed, a plaintiff, “as assignee
of beneficiaries pursuant to assignments valid under ERISA,
has [authority] to assert the claims of his assignors.” Id. at
  SOUTH COAST SPECIALTY SURGERY CTR. V. BLUE CROSS OF CAL. 11

1379. We said the same in Spinedex, noting that patients
may assign their right to benefits under ERISA and the
assignees may bring derivative actions. Spinedex, 770 F.3d
at 1289, 1292; see DB Healthcare, 852 F.3d at 876 (“[A]
health care provider in appropriate circumstances can assert
the claims of an ERISA participant or beneficiary.”); see
also Bristol SL Holdings, Inc., 22 F.4th at 1089–90
(reasoning similarly).
    Neither Anthem nor South Coast challenges this
precedent, agreeing that South Coast cannot bring claims for
benefits directly as an ERISA beneficiary. But South Coast
asks us to conclude that it can enforce ERISA’s protections
derivatively, relying on its patients’ assignments of their
plan benefits to South Coast. Turning to the text of South
Coast’s “Assignment of Benefits” form, we agree that it can.
                              B.
    South Coast’s “Assignment of Benefits” form validly
assigns it the right to sue for non-payment of benefits under
ERISA. Assignments are “interpreted ‘in the same way as
any other contract.’” Knott v. McDonald’s Corp., 147 F.3d
1065, 1067 (9th Cir. 1998) (quoting Lowrance v. Hacker,
888 F.3d 49, 51 (7th Cir. 1989)). “The question of what
rights and remedies pass with a given assignment depends
upon the intent of the parties.” Pac. Coast Agric. Exp. Ass’n
v. Sunkist Growers, Inc., 526 F.2d 1196, 1208 (9th Cir.
1975). “To make that determination [of intent], ‘we look at
the language and context of the authorization[].’” DaVita
Inc. v. Amy’s Kitchen, Inc., 981 F.3d 664, 679 (9th Cir. 2020)
(quoting DB Healthcare, 852 F.3d at 877); see also Knott,
147 F.3d at 1067 (“If a contract is clear and unambiguous,
[the court] must determine the intention of the parties ‘solely
from the plain language of the contract[.]’” (quoting MJ &
12 SOUTH COAST SPECIALTY SURGERY CTR. V. BLUE CROSS OF CAL.

Partners Rest. Ltd. P’ship v. Zadikoff, 995 F. Supp. 929,
930–31 (N.D. Ill. 1998) (some alteration in original))).
Thus, we first address whether South Coast’s “Assignment
of Benefits” form is a valid assignment at all; and second, if
it is, we determine the scope of that assignment and whether
it permits South Coast’s suit.
     First, we conclude that South Coast’s form is a valid
assignment. South Coast’s form is entitled “Assignment of
Benefits.” Although “the terms ‘assign’ or ‘assignment’”
are not “necessary to effectuate an assignment of rights,” DB
Healthcare, 852 F.3d at 876, their explicit presence in the
title of a document certainly helps us to divine whether the
parties intend that the form operate as a valid assignment,
see Brown v. BlueCross BlueShield of Tenn., Inc, 827 F.3d
543, 544 n.1, 546–47 (6th Cir. 2016) (finding a limited
assignment of rights for an “Assignment of Benefits Form”
substantially resembling South Coast’s form); cf.
Almendarez-Torres v. United States, 523 U.S. 224, 234
(1998) (“We also note that ‘the title of a statute and the
heading of a section’ are ‘tools available for the resolution
of a doubt’ about the meaning of a statute.” (citation
omitted)). Additionally, South Coast’s form (1) authorizes
a patient’s insurance company to pay South Coast “for the
medical and surgical benefits allowable, and otherwise
payable to [the patient] under [the patient’s] current
insurance policy”; and (2) requires the patient to pay “any
charges not covered by the insurance payment.” This
wording tracks text that we have concluded conveys a valid
assignment. See, e.g., DB Healthcare, 852 F.3d at 876
(reasoning that a form authorizing the payment of benefits to
a physician was a valid assignment of the “limited rights to
payment under ERISA”); Spinedex, 770 F.3d at 1292
(finding a valid assignment in a form stating, in part, “[t]his
  SOUTH COAST SPECIALTY SURGERY CTR. V. BLUE CROSS OF CAL. 13

is a direct assignment of my rights and benefits under this
policy” (emphasis omitted)). The form’s wording clearly
conveys that South Coast and its patients intended that it
operate as a valid assignment for the payment of insurance
benefits.
    Second, we also conclude that the “Assignment of
Benefits” form assigned South Coast the right to sue for non-
payment of benefits. Admittedly, South Coast’s form does
not expressly state that South Coast may sue insurers on its
patients’ behalf. The form permits Anthem to pay South
Coast directly, via check, and indicates that the form relates
to South Coast’s willingness to fill out claims-processing
paperwork. Anthem argues that this provision means that
the form assigns only the right to direct payment and that it
does not encompass a legal right to sue for non-payment.
But an assignment of the right to benefits generally includes
the right to sue for nonpayment of benefits.
    As before, our decisions in Spinedex and DB Healthcare
guide us. In Spinedex, we addressed whether a plaintiff
healthcare provider suffered an injury in fact when it stood
in the shoes of its patients with respect to the payment of
insurance benefits through an assignment-of-benefits form.
770 F.3d at 1291. The Spinedex form provided, in part,
“[t]his is a direct assignment of my rights and benefits under
this policy.” Id. at 1292 (emphasis omitted). Although we
ultimately determined that the plaintiff lacked constitutional
standing, we confirmed that the plaintiff’s patients had
intended to assign it their “rights to bring suit for payment of
benefits” under ERISA. Id. Likewise, in DB Healthcare,
we held, albeit in a footnote, that “[a]n assignment of the
right to receive payment of benefits generally includes the
limited right to sue for non-payment under § 502(a)(1)(B),
which empowers a participant or beneficiary to bring a civil
14 SOUTH COAST SPECIALTY SURGERY CTR. V. BLUE CROSS OF CAL.

action ‘to recover benefits due to her under the terms of the
plan.’” 852 F.3d at 877 n.7 (emphasis added). And we
concluded that the form—stating, “I Hereby Authorize My
Insurance Benefits to Be Paid Directly to the Physician”—
demonstrated the patients’ intent to assign “the right to
payment of benefits and the associated right to sue for non-
payment.” Id. at 876–77. It is true that, in DB Healthcare,
we determined that the healthcare providers lacked
“derivative authority to bring their claims.” Id. at 876. But
we held as much not because ERISA foreclosed the
possibility, but because the healthcare providers’ claims for
injunctive and declaratory relief, and for damages based on
recouped overpayments “f[e]ll outside the scope of those
assigned rights.” Id. Indeed, we held that plaintiffs’
derivative suits could not proceed because they sought relief
for ERISA violations and unlawful conduct far afield from
the validly assigned right to sue for non-payment. Id. at
876–77.
    Not so here. Following the logic in Spinedex and DB
Healthcare, the scope of South Coast’s patients’ assignment
of benefits clearly and necessarily includes the right to sue
for non-payment of benefits under section 502(a) of ERISA.
Like those cases’ assignment forms, each of which
transferred the right to benefits and the associated right to
sue for non-payment of benefits, South Coast’s “Assignment
of Benefits” transfers to South Coast the right to “medical
surgical benefits allowable, and otherwise payable to [its
patients] under [their] current insurance policy.” And,
unlike DB Healthcare’s plaintiffs, South Coast does not seek
a remedy beyond that payment.
   We thus conclude that South Coast’s patients assigned
South Coast the right to sue for non-payment of benefits
under section 502(a) of ERISA. Our conclusion aligns with
    SOUTH COAST SPECIALTY SURGERY CTR. V. BLUE CROSS OF CAL. 15

our sister circuits’ opinions regarding derivative authority to
sue via assignment under ERISA. See, e.g., Brown, 827 F.3d
at 546 (“[T]here is now a broad consensus that ‘when a
patient assigns payment of insurance benefits to a healthcare
provider, that provider gains [authority] to sue for that
payment under ERISA § 502(a).’” (quoting N. Jersey Brain
& Spine Ctr. v. Aetna, Inc., 801 F.3d 369, 372 (3d Cir.
2015))); Rojas v. Cigna Health & Life Ins. Co., 793 F.3d
253, 258 (2d Cir. 2015) (noting that an assignment of
benefits “confer[s] to Rojas only the right to pursue the
participants’ claims for payment”); Conn. State Dental Ass’n
v. Anthem Health Plans, Inc., 591 F.3d 1337, 1352 (11th Cir.
2009) (“[A]n assignment furthers ERISA’s purposes only if
the provider can enforce the right to payment.”); I.V. Servs.
of Am. v. Inn Dev. & Mgmt., 182 F.3d 51, 54 n.3 (1st Cir.
1999) (holding that the assignment of a right to payment
“easily clear[ed]” the low hurdle for derivative authority to
sue).4
    To construe South Coast’s “Assignment of Benefits”
form otherwise, as Anthem encourages us to do, makes
neither textual nor practical sense. Indeed, permitting South

4
  Anthem’s citation to our unpublished decision in Brand Tarzana
Surgical Institute, Inc. v. International Longshore & Warehouse Union-
Pacific Maritime Ass’n Welfare Plan, 706 F. App’x 442 (9th Cir. 2017),
and to the Eleventh Circuit’s unpublished decision in Sanctuary Surgical
Centre, Inc. v. Aetna Inc., 546 F. App’x 846 (11th Cir. 2013), does not
persuade us otherwise. The Brand Tarzana plaintiff could not bring a
derivative claim under ERISA because the underlying insurance policy
“unambiguously state[d] that Plan benefits are not subject to assignment
and any attempt to do so shall be void.” 706 F. App’x at 443. And the
court in Sanctuary Surgical Centre held that providers lacked authority
to sue when they attempted to rely on a direct-payment authorization
assignment to bring a claim for breach of fiduciary duty. 546 F. App’x
at 852. Neither situation is relevant here.
16 SOUTH COAST SPECIALTY SURGERY CTR. V. BLUE CROSS OF CAL.

Coast to recover plan benefits, but precluding it from suing
for the non-payment of those benefits by a single insurer,
leaves South Coast with little legal recourse after “fronting”
the costs of care. In this instance, South Coast would be
required first to seek reimbursement from Anthem; when
that fails (as it has here), it would have to file roughly 150
individual collection actions, seeking reimbursement from
its patients in amounts varying from $7,095.00 to
$116,920.55. Its patients could then pay South Coast; refuse
to pay; or seek coverage from Anthem, likely resulting in
potential individual actions against the insurer. The
inefficient result would be numerous small lawsuits.
    Such a reading not only contradicts our precedent and the
clear terms of South Coast’s “Assignment of Benefits” form,
but it stymies Congress’s purpose in enacting ERISA. See
Pilot Life, 481 U.S. at 54 (noting Congress’s intention to
develop “prompt and fair claim settlement procedures”
through ERISA). ERISA was intended to “protect . . . the
interests of participants in employee benefit plans.” 29
U.S.C. § 1001(b). Indeed, the “general goal” of ERISA is
furthered by comprehensive and effective assignments of
benefits. Cf. Misic, 789 F.2d at 1377; accord Davila, 542
U.S. at 208 (“The purpose of ERISA is to provide a uniform
regulatory regime over employee benefit plans.”). As the
Third Circuit noted, “[i]t does not seem that the interests of
patients or the intentions of Congress would be furthered by
drawing a distinction between a patient’s assignment of her
right to receive payment and the medical provider’s ability
to sue to enforce that right.” N. Jersey Brain & Spine Ctr.,
801 F.3d at 373. Recognizing derivative authority to sue, by
contrast, serves ERISA’s purpose by “making it unnecessary
for health care providers to evaluate the solvency of patients
before commencing medical treatment, and by eliminating
  SOUTH COAST SPECIALTY SURGERY CTR. V. BLUE CROSS OF CAL. 17

the necessity for beneficiaries to pay potentially large
medical bills and await compensation from the plan.” Misic,
789 F.2d at 1377. Construing an assignment of benefits as
including the right to sue for non-payment thus increases
patient access to healthcare and transfers any responsibility
of litigating unpaid claims to the provider—an entity that is
much better positioned to pursue those claims in the first
place.
     Of course, by confirming this general rule, we do not
hold that all assignments of the right to benefits—regardless
of who made the assignment and who received it—
necessarily confer the right to sue under ERISA. As we have
cautioned, concluding that Congress intended to authorize
suits in the wrong circumstances could “be tantamount to
transforming health benefit claims into a freely tradable
commodity,” involving the “endless reassignment of claims”
and permitting “third parties with no relationship to the
beneficiary to acquire claims solely for the purpose of
litigating them.” Simon v. Value Behav. Health, Inc., 208
F.3d 1073, 1081 (9th Cir. 2000), amended by 234 F.3d 428
(9th Cir. 2000), overruled on other grounds by Odom v.
Microsoft Corp., 486 F.3d 541 (9th Cir. 2007). We have thus
declined to extend authority to sue to an attorney “who
aggregated hundreds of unrelated claims from numerous
different health facilities, akin to a bill-collector.” Bristol SL
Holdings, Inc., 22 F.4th at 1090 (discussing and
distinguishing our decision in Simon). This case differs.
South Coast is a healthcare provider with a direct financial
stake in the outcome and an established relationship with its
patients through its “Assignment of Benefits” form. Finding
that its patients’ assignment of benefits includes the right to
file suit under ERISA for the non-payment of benefits is
consistent with our precedent, our sister circuits’ caselaw,
18 SOUTH COAST SPECIALTY SURGERY CTR. V. BLUE CROSS OF CAL.

and ERISA’s purpose. And our decision is limited to
whether section 502(a) of ERISA permits a healthcare
provider to bring a derivative suit, seeking the payment of
benefits, when it has been given a valid assignment to do so.
   REVERSED and REMANDED.