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Greenville Hospital System v. Employee Welfare Benefit Plan, 4th Cir. (2015)
Greenville Hospital System v. Employee Welfare Benefit Plan, 4th Cir. (2015)
No. 14-2170
Appeal from the United States District Court for the District of
South Carolina, at Greenville. Timothy M. Cain, District Judge.
(6:14-cv-01919-TMC)
Argued:
Decided:
Before KING and HARRIS, Circuit Judges, and George Jarrod HAZEL,
United States District Judge for the District of Maryland,
sitting by designation.
wrote
the
ARGUED:
Linda C. Garrett, LADDAGA GARRETT, P.A., North
Charleston, South Carolina, for Appellant.
Deborah Whittle
Durban, NELSON MULLINS RILEY & SCARBOROUGH, LLP, Columbia, South
Carolina, for Appellee. ON BRIEF: William C. Wood, Jr., NELSON
MULLINS RILEY & SCARBOROUGH, LLP, Columbia, South Carolina, for
Appellee.
LLC
(Aetna)
entered
into
an
agreement
(the
Agreement
also
includes
an
arbitration
clause,
The district
I.
A.
Greenville, a provider of health-care services, and Aetna,
an insurer, entered into their Agreement in 2004.
Under the
In
most
circumstances,
Greenville
may
not
seek
reimbursement
direct-billing
rights
to
process
be
by
reimbursed
obtaining
for
assignments
health
services
of
patients
under
their
insurance plans.
Two provisions of the Agreement are of particular relevance
here.
give
Aetna
notice
before
admissions
for
inpatient
care.
to
resolve
participation
in
disputes,
Aetnas
beginning
internal
with
grievance
Greenvilles
procedure
and
J.A. 25.
(emphasis
added).
Emphasizing
the
importance
of
the
Hazelhurst
and
contemplated
by
fully
insured
by
the
Agreement,
Aetna
Plan). 2
(the
Greenville
obtained
As
from
the
It
is
that
[was]
denial
not
that
received
Greenville
in
timely
alleges
to
be
unsuccessfully
Aetnas
internal
appealing
the
grievance
process,
denial
in
of
its
May
of
claim
2014
Plan beneficiary: one for failure to pay benefits and one for
failure to provide Plan documents in a timely manner.
the
Plans
dismiss
underwriter,
the
suit,
moved
arguing
to
that
compel
the
Aetna, as
arbitration
Agreements
and
to
arbitration
district
court
agreed.
Greenville
filed
its
claim
held,
to
show
that
Greenvilles
That is enough,
claims
to
payment
are
in
favor
of
Greenville
broad
Hosp.
construction
Sys.
v.
Emp.
of
arbitration
Welfare
Benefits
2014).
Accordingly,
the
district
court
granted
Aetnas
Id. at *5.
This
II.
A.
We review the district courts arbitrability determination
de novo.
Inc., 303 F.3d 496, 500 (4th Cir. 2002) (quoting Volt Info.
Scis., Inc. v. Bd. of Trs. of Leland Stanford Jr. Univ., 489
U.S.
468,
47576
(1989)).
We
must
construe
the
arbitration
agreed
to
an
Id.
arbitration
clause,
court
should
order
covers
the
asserted
dispute.
United
Steelworkers
v.
Warrior & Gulf Navigation Co., 363 U.S. 574, 58283 (1960).
If
B.
We begin with the language of the arbitration clause, which
extends
to
[a]ny
controversy
or
claim
arising
out
of
or
of
an
expansive
reach.
Am.
Recovery
Corp.
v.
395,
398
(1967)).
Such
clause
does
not
limit
Textile,
S.A.,
863
F.2d
315,
321
(4th
Cir.
1988)
claims
against
Aetna.
Whether
Greenville
is
obligation
to
comply
9
with
The source of
precertification
to
follow
any
applicable
precertification
and/or
It follows,
primary
argument
is
that
because
its
claim
insurance
Plan,
it
does
not
aris[e]
out
of
or
We disagree.
We have no quarrel
of
the
apply
Agreement,
in
the
given
insurance plan.
particular
case
will
precertification
be
elaborated
by
rules
a
that
patients
cases
health-care
considering
agreements
whether
arise
certain
under
the
claims
Employee
contract
law,
for
purposes
10
of
federal
question
Aetna Health Inc., for instance, the Fifth Circuit held that
disputes over a right to payment require determinations under
individual insurance plans covered by ERISA, whereas disputes
regarding
the
appropriate
rate
of
payment
call
only
for
the right to payment side of the line, and thus arises under
the
patients
insurance
plan
rather
than
under
its
provider
The question in
ERISA-covered
insurance
plan,
for
purposes
of
establishing
See 579
F.3d at 53031.
not
claims
limited
to
that
arise
exclusively
or
indeed,
Whether or
the
Agreement,
commitment
under
it
clearly
that
relates
Agreement
to
unpersuaded
by
to
abide
Greenvilles
by
Aetnas
precertification rules.
We
are
similarly
Greenville's
second
Aetna.
The
claims
in
this
case
originated
with
Because
in
suit
the
arbitration
against
Aetna,
clause
would
Greenville
not
argues,
bind
the
it
also
should not bind Greenville when it steps into the shoes of that
patient to sue on his claim.
We disagree.
that
it
is
intended
to
exclude
from
its
scope
claims
that
because
they
rest
on
assignments.
Agreements
direct-payment
assignment,
obligating
assignments
Services
to
of
be
benefits
made
On
system
to
authorizing
to
contrary:
expressly
Greenville
directly
the
contemplates
obtain[]
payment
The
for
[Greenville].
signed
Hospital
J.A.
17.
susceptible
interpretation
of
an
that
covers
derivative
13
III.
For the reasons set forth above we affirm the decision of
the district court in all respects.
AFFIRMED
14