Lisa Roach v. Mail Handlers Benefit Plan, Cna, and Access Health, Inc.

Plaintiff Lisa Roach appeals from the district court’s summary judgment in favor of the Mail Handlers Benefit Plan (“Mail Handlers”), CNA, and Access Health, Inc (collectively “defendants”). Roach argues the district court erred by characterizing her medical malpractice claim as a denial of benefits claim preempted by the Federal Employees Health Benefits Act (FEH-BA), 5 U.S.C. §§ 8901-8914 (2002). We agree, and reverse and remand.

BACKGROUND

Between 1991 and 1999, Roach worked as a “hot shot” firefighter for the United States Forest Service. As a federal employee covered by the FEHBA, she elected to receive her health coverage from an FEHBA plan administered by Mail Handlers. Under the terms of that plan, Roach had to obtain pre-certification for hospital stays over 24 hours.

While visiting a friend on January 16, 1998, Roach injured her ankle jogging. By the next day, her ankle had not improved. She called a number on her Mail Handlers benefit card to find a “preferred provider” hospital. Using such a provider entitled her to higher rate of reimbursement for her expenses.

The number connected Roach to an advice nurse at a service administered by Access Health, which…