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Chesterfield Spine Center, LLC v. Cigna Health and Life Insurance Co.

United States District Court, E.D. Missouri, Eastern Division

July 30, 2015



NOELLE C. COLLINS, Magistrate Judge.

Before the court is the Motion to Dismiss Counts I-III of Plaintiff's Third Amended Complaint and Motion to Strike Jury Demand filed by Defendants. (Doc. 35). Plaintiff filed a Memorandum in Opposition (Doc. 43), and Defendants filed a Reply to Plaintiff's Response (Doc. 46). The parties have consented to the jurisdiction of the undersigned United States Magistrate Judge pursuant to Title 28 U.S.C. § 636(c). (Doc. 13).



Federal Rule of Civil Procedure 8(a)(2) requires "a short and plain statement of the claim showing that the pleader is entitled to relief." Fed.R.Civ.P. 12(b)(6) provides for a motion to dismiss based on the "failure to state a claim upon which relief can be granted." To survive a motion to dismiss a complaint must show "that the pleader is entitled to relief, ' in order to give the defendant fair notice of what the... claim is and the grounds upon which it rests." Bell Atlantic Corp. v. Twombly, 550 U.S. 544, 555 (2007) (quoting Conley v. Gibson, 355 U.S. 41, 47 (1957)). See also Erickson v. Pardus, 127 S.Ct. 2197, 2200 (2007).

"Threadbare recitals of the elements of a cause of action, supported by mere conclusory statements, do not suffice" to defeat a motion to dismiss. Ashcroft v. Iqbal, 556 U.S. 662, 678 (2009) (citing Twombly, 550 U.S. at 555). "[O]nly a complaint that states a plausible claim for relief survives a motion to dismiss." Iqbal, 556 U.S. at 679 (citing Twombly, 550 U.S. at 556). The pleading standard of Rule 8 "does not require detailed factual allegations, ' but it demands more than an unadorned, the-defendant-unlawfully-harmed-me accusation." Iqbal, 556 U.S. at 678 (quoting Twombly, 550 U.S. at 555).

"When ruling on a defendant's motion to dismiss, a judge must accept as true all of the factual allegations contained in the complaint." Erickson v. Pardus, 551 U.S. 89, 94 (2007). All reasonable references from the complaint must be drawn in favor of the nonmoving party. Schaaf v. Residential Funding Corp., 517 F.3d 544, 549 (8th Cir. 1999). Thus, the factual background to the pending Motion To Dismiss must be drawn from the factual allegations in Plaintiff Chesterfield Spine Center, LLC, d/b/a St. Louis Spine and Orthopedic Surgery Center's Third Amended Complaint, unless other matters are also incorporated by reference, integral to its claims, subject to judicial notice, matters of public record, orders, or in the record of the case. Miller v. Redwood Toxicology Lab., Inc., 688 F.3d 928, 931 n.3 (8th Cir. 2012) (citing 5B CHARLES ALAN WRIGHT & ARTHUR R. MILLER, FEDERAL PRACTICE AND PROCEDURE § 1357 (3d ed. 2007)).



Plaintiff Chesterfield Spine Center, LLC, d/b/a St. Louis Spine and Orthopedic Surgery Center initially filed its Petition For Damages in Missouri state court to recover payment for a procedure performed on a patient. (Pl.'s Petition for Damages, Doc. 1-1 at 2). Plaintiff attached several exhibits to its original Petition For Damages, which included a copy of the patient's medical plan and a Financial Agreement between the patient and Plaintiff. (Doc. 1-1 at 15; Doc. 1-3 at 1-75). The patient, who is identified as BH, was a participant in a healthcare plan governed by the Employee Retirement and Income Security Act (ERISA), 29 U.S.C. § 1001 et seq.[1] Defendants provided health insurance coverage to BH, who is not a party to this lawsuit. Prior to the procedure, Plaintiff sought and obtained preauthorization from Defendants Cigna Health and Life Insurance Company and Connecticut General Life Insurance Company ("Defendants") to perform anterior lumbar interbody fusions. As is the custom and practice in the health care industry, Plaintiff did not provide medical care to BH until after Defendants confirmed insurance coverage, authorized the medical care, and verified that Plaintiff would be paid for BH's medical care in the amount of $204, 128. Plaintiff performed the procedure on December 10, 2012. Plaintiff thereafter submitted a bill to Defendants for $204, 128. Defendants made a payment of $52, 463.69 to Plaintiff and retained Viant Payment Systems, Inc., (VPS) to negotiate a discount payment regarding the remaining balance of Plaintiff's bill. VPS communicated that Defendant would pay $82, 796.57. Plaintiff refused to accept this payment as satisfaction of Defendants' promise to pay the "fair and reasonable charge for the Medical care." (Doc. 30, ¶¶ 8-25). As of the filing of the Third Amended Complaint, the outstanding amount is $110, 838.79.

Defendants removed the matter to federal court prior to Plaintiff's filing the Third Amended Complaint. In its removal pleadings, Defendants contended both that ERISA preempted Plaintiff's claims, which triggered an automatic removal and that the requirements for diversity jurisdiction permitted removal. Plaintiff did not oppose removal. Subsequently, Plaintiff filed a Third Amended Complaint with no exhibits attached. The Third Amended Complaint does refer to the Plan that was attached as an exhibit to the original state Petition For Damages, along with a Provider Explanation of Medical Benefits Report. (Doc. 30, ¶¶ 45, 51). In addition, the Third Amended Complaint alleges that Plaintiff has derivative standing to bring Count IV (ERISA) pursuant to a financial agreement called the "Assignment" between Plaintiff and BH regarding BH's medical insurance claim for Plaintiff's performance of the December 10, 2012 procedure. (Doc. 30, ¶ 50). Counts I through III of the Third Amended Complaint are brought pursuant to Missouri law and allege negligent misrepresentation, equitable estoppel, and promissory estoppel, respectively. Count IV is brought pursuant to ERISA, although Plaintiff argues that Count IV is pled in the alternative.

Defendants have now moved to dismiss Counts I, II and III on the same grounds as they raised in the removal, arguing that Count IV (ERISA) preempts Plaintiff's state law claims, which are Counts I through III. In opposition to the pending Motion, Plaintiff argues that Counts I through III are not preempted by ERISA because the state law claims asserted in those Counts I through III are independent of the ERISA claim in Count IV, and because Plaintiff is not a Plan participant or beneficiary under 29 U.S.C. § 1132. As set forth below, the court agrees with Defendants that Counts I through III are preempted by ERISA. The court will give Plaintiff an opportunity to amend it Third Amended Complaint and plead any additional claims under ERISA.



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