United States District Court, W.D. Missouri, Western Division
SARAH W. HAYS, Magistrate Judge.
Pending before the Court is Defendant Wabash Memorial Hospital Association's Motion to Dismiss Complaint Pursuant to Federal Rule of Civil Procedure 12(b)(6) (doc #5). Defendant seeks to dismiss the Complaint for Breach of Contract based on the following:
In this case, St. Luke's is arguing that Wabash should be liable for state law breach of contract claims because Wabash breached a contract between St. Luke's and BCBS ("the Hospital Contract"). Essentially, St. Luke's seeks to impose on Wabash terms of a contract to which Wabash is not a party. St. Luke's wants the Hospital Contract to govern how Wabash should have paid the claims submitted by St. Luke's, as opposed to Wabash's plan document. However, Wabash's plan document controls how it pays claims. Because Wabash is an ERISA plan, and any legal duty owed by Wabash to St. Luke's cannot be decided without reference to the plan documents, ERISA completely preempts St. Luke's breach of contract claims.
(Wabash Memorial Hospital Association's Suggestions in Support of Its Motion to Dismiss the Complaint Pursuant to 12(b)(6) (doc #6) at 5) Plaintiff has filed a memorandum in opposition to defendant's motion (doc #8) and defendant has filed reply suggestions (doc #11).
I. STANDARD FOR MOTION TO DISMISS
In order to meet the pleading standard set forth in Rule 8 of the Federal Rules of Civil Procedure and survive a motion to dismiss under Rule 12(b)(6), "a complaint must contain sufficient factual matter, accepted as true, to state a claim to relief that is plausible on its face." Braden v. Wal-Mart Stores, Inc., 588 F.3d 585, 594 (8th Cir. 2009)(quoting Ashcroft v. Iqbal, 556 U.S. 662, 678 (2009)).
Plaintiff's Complaint for Breach of Contract (doc #1) set forth the following factual allegations:
2. Defendant ("Wabash") [is] a non-profit Health and Welfare Trust Association....
3. Wabash provides health insurance to its members throughout the United States, and specifically to members located within the State of Missouri.
4. Wabash contracts with Blue Cross/Blue Shield (including specifically Blue Cross/Blue Shield of Kansas City) to provide its members participating provider organization services.
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9. On or about October 16, 2011, St. Luke's admitted a patient known as David Francis ("Patient") a resident of Missouri.
10. Said individual was, at the time of admission to the hospital a member of and covered by the Wabash health insurance plan. Blue Cross/Blue Shield is ...