United States Second Circuit

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McCulloch Orthopaedic Surgical Services, PLLC v. Aetna Inc., 15‐2150

In a suit brought by a surgeon against a health insurance company under the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. sections1001 et seq., seeking reimbursement for a patient insured by defendant, the district court's dismissal of plaintiff's complaint is vacated where ERISA does not completely preempt an 'out‐of‐network' health care provider's promissory‐estoppel claim against a health insurer in cases where the provider: 1) did not receive a valid assignment for payment under a health insurance plan; and 2) received an independent promise from the insurer that he would be paid for certain medical services provided to the insured.

Appellate Information

  • Argued
  • Submitted
  • Decided
  • Published 2017/05/18




  • United States Second Circuit


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