Michigan Spine & Brain Surgeons, PLLC v. State Farm Mutual Automobile Insurance

OPINION

McKEAGUE, Circuit Judge.

This case presents the question of whether a health care provider can bring the Medicare Secondary Payer Act’s private cause of action against a nongroup health plan that denies coverage for a reason besides Medicare eligibility. We hold that it can.

I

This action arises out of an October 26, 2010 automobile accident in which State Farm’s insured, Jean Warner, 1 allegedly sustained injuries. Following the accident, Michigan Spine provided approximately $26,000 of neurological treatment to Warner. Michigan Spine submitted the claim to State Farm, but State Farm…