The US Court of Appeals for the Third Circuit recently confirmed that “anti-assignment” provisions — provisions prohibiting insureds from assigning their rights under a health plan to third parties, including medical providers — are enforceable as long as they are unambiguous.
In University Spine Center v. Aetna, Inc., No. 18-2842, 2019 WL 2149590 (3d Cir. May 16, 2019), a medical provider brought suit against Aetna under the Employee Retirement Income Security Act of 1974 29 U.S.C. § 1001, et seq., seeking reimbursement for surgical services rendered to a beneficiary of an Aetna-administered health plan.
The provider brought suit on the patient’s behalf, invoking an assignment under which the patient “transferred [to the provider] all of his rights to benefit payments under his insurance plan, as well as all of his related rights under [ERISA].” The District Court dismissed the provider’s complaint, holding that an anti-assignment provision in the patient’s plan was enforceable and deprived the provider of standing. The anti-assignment provision read: “Coverage and your rights under this plan may not be assigned. A direction to pay a provider is not an assignment of any right under this plan or of any legal or equitable right to institute any court proceeding.
On appeal, the Third Circuit affirmed dismissal of the provider’s ERISA claim, finding that the plan’s anti-assignment...
