WESLEY, Circuit Judge:
The issue in this appeal is whether doctors, as healthcare providers, are beneficiaries of their patients' health-insurance plans such that they have standing to seek relief under Section 502 of the Employee Retirement Income Security Act of 1974 ("ERISA"), 29 U.S.C. § 1132(a)(1)(B). Under the circumstances of this case, they are not.
Henry L. Rojas and Mitchell K. Rosen are physicians licensed in the State of New York and are co-owners of H & L Rojas, M.D., P.C. (collectively, "Rojas"). Rojas is an in-network healthcare provider with
Cigna's Benefit Plan covering its insureds states that "All Medical Benefits are payable to you [the patient]. However, at the option of [Cigna], all or any part of them may be paid directly to the person or institution on whose charge [the] claim is based.... When benefits are paid to you or your Dependent, you or your Dependent is responsible for reimbursing the Provider." J.A. 81.
Rojas's Cigna-insured patients assign to Rojas their right to collect payment for medical services directly from Cigna. According to the Complaint, the form signed by Rojas's patients states, in relevant part, as follows:
J.A. 14. Cigna regularly investigates its in-network physicians regarding reimbursement claims that may be inconsistent with Cigna's coverage regarding medical necessity. After an investigation involving Rojas and other practices, Cigna suspected that Rojas was ordering blood tests to measure allergies, instead of skin tests as typically required by Cigna's coverage. Cigna also "noted the frequency by which Dr. Rose[n] and Dr. Rojas submitted claims for blood tests for suspected allergies for each patient." J.A. 223. Rojas billed a blood panel test "repetitively for the same patient over a sustained period of time," which is inconsistent with normal allergy testing practice. J.A. 224.
Cigna expressed its concerns about the allergy tests in a letter from its national medical director for fraud and abuse; that letter initiated a letter exchange between Rojas and Cigna regarding the medical necessity of the allergy tests. Cigna determined that it had overpaid Rojas in the amount of $844,334.52 for allergy tests for about 150 patients and requested that Rojas return the full amount "for the claims paid in error." J.A. 130. That is when the lawyers got involved. Rojas's attorney objected to Cigna's demand. Cigna's attorney offered to arbitrate the dispute under the parties' provider agreement, but Rojas rejected the offer. Cigna's counsel then notified Rojas that Cigna would terminate Rojas as a healthcare provider in its network.
Rojas filed suit in the United States District Court for the Southern District of New York (Kenneth M. Karas, Judge) seeking, among other things, an injunction "prohibiting all retaliatory acts against [Rojas] including [the] termination of the provider agreements." J.A. 31. Rojas contended that Cigna had violated the anti-retaliation provision of ERISA, which makes it unlawful for "any person to ... discriminate against a participant or beneficiary for exercising any right to which he is entitled under the provisions of an employee benefit plan." 29 U.S.C. § 1140. Rojas's claim was for reinstatement as a provider, not for payment under the Benefit
We review "statutory standing de novo, provided the statutory standing questions are of a legal nature." Kendall v. Emps. Ret. Plan of Avon Prods., 561 F.3d 112, 118 (2d Cir.2009).
Section 502(a)(1)(B) of ERISA, codified in Title 29 of the United States Code, provides a federal cause of action for civil claims aimed at enforcing the provisions of an ERISA plan. See 29 U.S.C. § 1132. ERISA enumerates "[p]ersons empowered to bring a civil action ... 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." Id. § 1132(a)(1)(B). As relevant here, Section 502 is narrowly construed to authorize only two categories of persons to sue directly to enforce their rights under the plan: participants and beneficiaries. Id. § 1132(a)(1); see Franchise Tax Bd. of the State of Cal. v. Constr. Laborers Vacation Trust for S. Cal., 463 U.S. 1, 27, 103 S.Ct. 2841, 77 L.Ed.2d 420 (1983); see also Chemung Canal Trust Co. v. Sovran Bank/Md., 939 F.2d 12, 14 (2d Cir.1991) ("[I]n the absence of some indication of legislative intent to grant additional parties standing to sue, the list in § 502 should be viewed as exclusive.").
Rojas argues that it has standing. Rojas contends that because it is entitled to reimbursement from Cigna — a literal "benefit" — it is a "beneficiary" entitled to bring claims under Section 502. Rojas claims that its entitlement to receive "benefits" under the Plan is premised on two theories. One, Rojas presses that it is a "plan-designated beneficiary" by virtue of how the Benefit Plan structures payment. Appellants' Br. 36. Rojas points to a section of the Benefit Plan that provides that Cigna may pay Rojas directly for reimbursement for covered services. Thus, Rojas contends, it is a beneficiary under the terms of the Benefit Plan. In the alternative,
The core of Rojas's claim is that it wants to be reinstated as a Cigna participating provider.
"Beneficiary," as it is used in ERISA, does not without more encompass healthcare providers. Although the term "benefit" is not defined in ERISA, we are persuaded that Congress did not intend to include doctors in the category of "beneficiaries." Benefits to which a beneficiary is entitled are bargained-for goods, such as "medical, surgical, or hospital care," Kolasinski v. Cigna Healthplan of CT, Inc., 163 F.3d 148, 149 n. 1 (2d Cir.1998) (quoting 29 U.S.C. § 1002(1)(A)), rather than a right to payment for medical services rendered. A beneficiary is best understood as an individual who enjoys rights equal to the participant's to receive coverage from the healthcare plan. A participant's spouse or child is the most likely candidate for this term.
Our interpretation is consistent with every circuit that has considered this question. See, e.g., Spinedex Physical Therapy USA Inc. v. United Healthcare of Ariz., Inc., 770 F.3d 1282, 1289 (9th Cir.2014) ("As a non-participant health care provider, Spinedex cannot bring claims for benefits on its own behalf. It must do so derivatively, relying on its patients' assignments of their benefits claims."); Hobbs v. Blue Cross Blue Shield of Ala., 276 F.3d 1236, 1241 (11th Cir.2001) ("Healthcare providers such as physician assistants generally are not considered `beneficiaries' or `participants' under ERISA."); Ward, 261 F.3d at 627 (declining to include healthcare providers as possible beneficiaries under ERISA).
As an alternative to its plan-designated beneficiary theory, the Complaint alleges that Rojas has standing as its patients' assignee. The assignments allegedly executed by the patients, however, confer to Rojas only the right to pursue the participants' claims for payment, not other categories of ERISA claims.
Rojas's assignment argument also fails under common law principles. An "assignee acquires no greater rights
In light of our conclusion that Rojas lacked standing to bring an ERISA anti-retaliation claim under Section 502, we need not address the factors to be considered in deciding whether to award a preliminary injunction, and we affirm Judge Karas's decision dismissing the case. See Munaf v. Geren, 553 U.S. 674, 691-92, 128 S.Ct. 2207, 171 L.Ed.2d 1 (2008).
Healthcare providers are not "beneficiaries" of an ERISA welfare plan by virtue of their in-network status or their entitlement to payment. Patients may assign to their doctors the right to collect payment on their behalf in exchange for medical services, but the doctors in this case do not seek payment; instead, they seek to assert anti-retaliation protections which were not assigned to them. The judgment of the district court is AFFIRMED.