R and R Surgical Institute v. Luminare Health Benefits, Inc.

I. BACKGROUND

On August 28, 2024, Plaintiff commenced this action in Los Angeles County Superior Court. (Notice of Removal (“NOR”), Ex. 1 (Docket No. 1) (“Complaint”) at 7). Plaintiff, an unincorporated association, alleges that it rendered medical treatment to a member of a health plan and submitted a reimbursement claim to Defendant, who is a claims processor for various employer-sponsored health plans. (Id. ¶ 4). Defendant contends, and Plaintiff does not dispute, that the patient Plaintiff rendered services to is a member of the health plan sponsored and funded by Plasma Technology, Inc. (“PTI”), which is governed by the Employee Retirement Income Security Act of 1974 (“ERISA”). (MTD at 7). Defendant serves as a claims processor for PTI. (Id.). Defendant does not pay plan benefits from its own funds but instead, pays benefits using the healthcare plans’ funds. (Id. at 10). After Plaintiff submitted the reimbursement claim, Defendant issued an Evidence of Payment (“EOP”), agreeing to pay $235,306.22 with a prepaid credit card subject to a 5% merchant processing fee. (Complaint ¶ 2). To avoid the 5% merchant processing fee, Plaintiff requested Defendant issue…