Empire Healthchoice Assurance, Inc., Dba Empire Blue Cross Blue Shield v. Denise F. Mcveigh, As Administratrix of the Estate of Joseph E. Mcveigh (547 U.S. 677)
U.S. Supreme Court · decided June 15, 2006 · Supreme Court Database (Spaeth)
- Citation
- 547 U.S. 677 · 126 S. Ct. 2121
- Decided
- June 15, 2006
- Term
- October Term 2005
- Vote
- 5–4
- Majority author
- Justice Ginsburg
- Issue area
- Judicial Power
- Disposition
- Affirmed
- Outcome
- Petitioning party lost
- Ideological direction
- Conservative
Opinion excerpt
Justice Ginsburg delivered the opinion of the Court. The Federal Employees Health Benefits Act of 1959 (FEHBA), 5 U. S. C. §8901 et seq. (2000 ed. and Supp. III), establishes a comprehensive program of health insurance for federal employees. The Act authorizes the Office of Personnel Management (OPM) to contract with private carriers to offer federal employees an array of health-care plans. See § 8902(a) (2000 ed.). Largest of the plans for which OPM has contracted, annually since 1960, is the Blue Cross Blue Shield Service Benefit Plan (Plan), administered by local Blue Cross Blue Shield companies. This case concerns the proper forum for reimbursement claims when a Plan beneficiary, injured in an accident, whose medical bills have been paid by the Plan administrator, recovers damages (unaided by the carrier-administrator) in a state-court tort action against a third party alleged to have caused the accident. FEHBA contains a preemption clause, §8902(m)(1), displacing state law on issues relating to “coverage or benefits” afforded by health-care plans. The Act contains no provision addressing the subrogation or reimbursement rights of carriers. Successive annual contracts between OPM and the Blue Cross Blue Shield Association (BCBSA) have obligated the carrier to make “a reasonable effort” to recoup amounts paid for medical care. App. 95, 125. The statement of benefits…
Excerpt of a 39,336-character opinion. The full text and citation network load in the interactive viewer above.