Reported / Citable
Background
Texas hospital systems sued Community Insurance Company, doing business as Anthem Blue Cross and Blue Shield, over payment and coverage disputes involving nine Anthem subscribers treated at the hospitals. The hospitals alleged that their provider agreements with Blue Cross and Blue Shield of Texas governed services provided through the BlueCard Program, including services for members of other Blue Cross Blue Shield plans.
The hospitals asserted assigned claims on behalf of the subscribers, including an ERISA claim and state-law claims. Anthem moved to dismiss the state-law claims for lack of personal jurisdiction, arguing that its participation in the BlueCard Program did not establish sufficient Texas contacts and that the complaint did not identify which claims arose under ERISA plans.
The Court’s Holding
The court held that the complaint alleged facts sufficient to support specific personal jurisdiction over claims arising from Anthem’s insurance or administration of health plans covering Texas residents. Unlike cases involving insurers whose members merely received care outside their home states, the hospitals alleged that Anthem intentionally did business with Texas residents and listed Texas hospitals as in-network.
The court also held that ERISA’s nationwide-jurisdiction provision supplied jurisdiction over the ERISA claim, but pendent jurisdiction did not automatically extend to all claims involving the same insurer. It could extend to other claims assigned by the same subscriber who assigned an ERISA claim, because those claims would arise from the same treatment, hospital, and subscriber. The court granted Anthem’s motion in part because the complaint did not specify, claim by claim, the applicable jurisdictional basis, and gave the hospitals until October 16, 2026, to amend.
Key Takeaways
- An insurer’s participation in a national BlueCard-type program alone does not establish specific jurisdiction.
- Allegations that the insurer issued or administered plans for Texas residents can establish specific jurisdiction for related claims.
- Pendent jurisdiction over state-law claims requires a shared operative factual nucleus with an ERISA claim, not merely a common insurer.
Why It Matters
The decision draws a pleading-level distinction between nationwide ERISA jurisdiction, state-specific personal jurisdiction, and pendent jurisdiction in multi-patient provider reimbursement litigation. Hospitals pursuing assigned claims against out-of-state insurers must identify which subscriber claims arise under ERISA plans and which otherwise rest on the insurer’s forum-directed conduct.