Anthem BlueCard suit kept alive by federal court ruling

The lead plaintiff in the case, Columbia Hospital at Medical City Dallas, said in a complaint filed in March 2025 in the U.S. District Court for the Northern District of Texas that Anthem Health Plans of Virginia — a subsidiary of Elevance Health — had failed to pay BlueCard claims submitted to Blue Cross and Blue Shield of Texas on behalf of patients who had coverage through employer-sponsored health plans that were governed by the Employee Retirement Income Security Act.

Anthem said the hospital violated its coverage rules by failing to get prior authorization for the procedures provided and by providing care that was not medically necessary. It asked the court to dismiss the case.

U.S. District Judge Brantley Starr ruled in favor of letting the hospital continue with the suit, concluding that the hospital had "plausibly pled a claim for breach of contract."

Anthem had not signed a hospital agreement with the hospital, but it took actions, such as communicating with the hospital through Texas Blue, that might have implied that it was bound by Texas Blue's agreement with the hospital, according to a memorandum explaining the ruling.

"Although implied assumption is generally disfavored, courts frequently find it in cases where an out-of-state licensee refuses to pay under a general medical services agreement," the judge wrote.

The Texas Blue hospital agreement included an arbitration provision.

Brantley ordered the hospital, Anthem and the other parties to arbitrate the claims promptly and give him status reports every three months.

The ruling deals with the procedures governing how the courts and arbitrators handle the hospital's suit, not with the merits of hospital's suit

Representatives for the hospital and Elevance could not immediately be reached for comment.

What it means: The complaint, the ruling and other case documents could show what happens when claim disputes involving use of the BlueCard program end up in arbitration in Texas.