United States District Court, D. Massachusetts
SAMUEL S. HALBERG and C.M.H., Plaintiffs,
MCLEAN HOSPITAL, Defendant.
MEMORANDUM AND ORDER ON PLAINTIFFS' MOTION TO
REMAND AND DEFENDANT'S MOTION TO DISMISS
Dennis Saylor IV United States District Judge.
ERISA-related action arising from the treatment of a minor
child at McLean Hospital, a psychiatric hospital located in
Belmont, Massachusetts. C.M.H. was treated in defendant
McLean's 3East treatment program for approximately 18
months. Plaintiffs C.M.H. and her father, Samuel Halberg,
allege that McLean misrepresented to them that the treatment
was “medically necessary” and that it was not
covered by plaintiffs' health insurance company, United
Behavioral Health. Accordingly, they paid more than $400, 000
out-of-pocket for treatment, an amount they contend was
filed suit in state court to recover their expenses, raising
several state-law claims. McLean removed the action to this
Court on the basis of ERISA preemption. Plaintiffs have moved
to remand the action to state court, and McLean has moved to
dismiss the complaint for failure to state a claim. For the
following reasons, the Court finds that it lacks
subject-matter jurisdiction, and plaintiffs' motion to
remand will be granted.
facts are set forth as described in the complaint.
is a resident of Brooklyn, New York, and suffers from
significant mental-health issues. (Compl. ¶¶ 8,
19). Samuel Halberg is her father. (Id. ¶ 7).
relevant times, C.M.H. was a minor child insured by United
Behavioral Health. (Id. ¶ 8). The insurance
coverage was provided as an employee benefit through her
mother's employer, AXA Equitable Insurance Company.
(Id.). The employee-benefit plan includes coverage
for mental-health treatment that is “medically
necessary.” (Id. ¶¶ 18, 26).
Hospital operates residential mental and behavioral health
facilities in Belmont, Massachusetts. (Id. ¶
13). It is an in-network provider under the employee-benefit
plan with United. (Id. ¶ 14). McLean and United
have entered into a contract called a network participation
agreement. (Id. ¶¶ 14-15). Among other
provisions, that contract prohibits McLean from directly
billing United patients for services unless United has first
declined coverage. (Id. ¶¶ 15-16).
October 4, 2011, C.M.H. was admitted to McLean's 2East
residential treatment program after attempting suicide.
(Id. ¶ 19). She was treated at 2East for more
than two months before McLean staff recommended that she be
transferred to the 3East “intensive dialectical
behavior therapy program.” (Id.).
December 27, 2011, Samuel Halberg met with Sara Hunt, a
financial counselor at McLean. (Id. ¶ 20).
According to the complaint, Hunt informed Halberg that the
3East program was not covered under McLean's contract
with United and that he would be required to pay for the
treatment out-of-pocket. (Id.). Hunt allegedly also
told Halberg that he would have to sign a “Notice of
Non-Covered Services, ” which stated:
I am authorizing McLean Hospital to bill me directly for
services rendered during this admission. I understand that I
am fully responsible and agree to pay all charges at the
rates established. I understand that charges for these
non-covered services will not be submitted to my health
insurance plan by McLean Hospital.
(Id.). Hunt further told him that although McLean
would not submit the charges to United, it would assist with
any claims that Halberg independently submitted to United.
(Id. ¶ 21). Hunt also allegedly told him that
United “may eventually provide reimbursement for the
services C.M.H. would be receiving.” (Id.).
to the complaint, based on these representations, Halberg
signed the “Notice of Non-Covered Services.” He
also signed a separate document titled “McLean Hospital
Registration Agreement, ” which included the following:
I understand that I am financially responsible for all
charges, co-payments and deductibles remaining after
insurance payments, and for all hospital charges that are not
covered by my insurance company or third party payer.
(Id. ¶¶ 22, 23).
subsequently was treated at 3East from December 27, 2011,
through May 8, 2013, a period of approximately 18 months.
(Id. ¶ 24; Not. of Rem. ¶ 5)
did not request authorization from United prior to
transferring C.M.H. to 3East. (Compl. ¶ 24). It began
directly billing Halberg for the treatment. (Id.).
Sometime in 2012, Halberg prepared and submitted insurance
claims to United without assistance from McLean.
(Id. ¶ 25). United approved “coverage for
a small subset of plaintiffs' insurance claims, ”
which it paid to McLean. (Id. ¶¶ 4, 32).
However, McLean then remitted the money it received back to
United. (Id. ¶ 32).
deemed the bulk of C.M.H's treatment at 3East to be
medically unnecessary. (Id. ¶ 26). Coverage