United States District Court, D. New Jersey
E. COAST ADVANCED PLASTIC SURGERY,, Plaintiff,
AETNA, INC., et al.,, Defendants.
WILLIAM J. MARTINI, U.S.D.J.
East Coast Advanced Plastic Surgery (“Plaintiff”)
asserts breach of contract and related claims against
Defendants Aetna, Inc. (“Aetna”), County of Essex
(“Essex County”), and other fictitious
individuals and entities, based on Aetna's refusal to
make full payment on Plaintiff's claims for medical
services provided to an Aetna member (“CH”). This
matter comes before the Court on Plaintiff's motion to
remand and Aetna's motion to dismiss. There was no oral
argument. Fed.R.Civ.P. 78(b). For the reasons below,
Plaintiff's motion to remand is DENIED
and Aetna's motion to dismiss is GRANTED in
part and DENIED in part.
is a healthcare provider based in Essex County, New Jersey.
Notice of Removal, Ex. 1, Compl. ¶ 1, ECF No. 1-1
(“Compl.”). Aetna is a Pennsylvania corporation
with its principal place of business in Hartford,
Connecticut. Notice of Removal ¶ 4, ECF No. 1; Compl.
¶ 5. At all relevant times, Essex County provided CH an
employer-sponsored Aetna health benefits plan (the
“Plan”). At all relevant times, CH participated
in the Plan, which Aetna administered. Id.
¶¶ 5, 9. And at all relevant times, Plaintiff was a
non-participating or out-of-network provider who had no
contract with Aetna. Id. ¶ 15.
a course of dealing as to CH, Plaintiff alleges Aetna
provided pre-authorization letters to indicate the Plan would
cover Plaintiff's medical services. Id.
¶¶ 20, 29. Plaintiff relied on and understood
Aetna's letters as promises to pay for the pre-authorized
procedures. Id. ¶¶ 40, 46, 57-58. To
Plaintiff's detriment, Aetna paid only a fraction of the
amount billed or the amount it was required to pay under the
Plan's terms. Id. ¶¶ 34-36, 47.
Plaintiff now seeks to recover the outstanding balance, which
it contends is the usual, customary, reasonable, and fair
value for its medical services.
filed a complaint against Defendants in New Jersey state
court, alleging (1) breach of contract, (2) promissory
estoppel, (3) account stated, and (4) fraudulent inducement.
Compl. ¶¶ 38-61. Aetna then removed the case here,
based on diversity jurisdiction. Notice of Removal ¶ 2.
But Plaintiff seeks remand, arguing Aetna failed to obtain
Essex County's consent for removal. See
Pl.'s Remand Mem. of Law 1-3, ECF No. 7-1. Aetna opposes,
arguing Plaintiff fraudulently joined Essex County in an
apparent attempt to defeat diversity jurisdiction and, in any
case, Essex County is a nominal party here with no real
interest at stake. Def.'s Remand Opp'n Br. 1-18, ECF
No. 10. In reply, Plaintiff argues Essex County is
financially responsible for claims made under the Plan and
that state law alone governs here, the latter point Aetna
never disputed. See Pl.'s Remand Reply Mem. of
Law 2-10, ECF No. 12.
the remand motion was pending, Aetna moved to dismiss,
arguing the pre-authorization letters in no way created an
implied-in-fact contract that compelled paying Plaintiff the
full amount charged for its services. That would defeat the
breach of contract and promissory estoppel claims.
See Def.'s Mot. to Dismiss Mem. of Law 7-12, ECF
No. 8-1. Aetna then argues the fraud claim fails to meet
heightened pleading requirements and is otherwise barred by
the economic loss doctrine. Id. at 12-15. Finally,
with no agreement as to the amount owed, Aetna finds
Plaintiff's account stated claim deficient. Id.
opposes, without citing a single case, statute, or other
legal authority. Plaintiff argues an implied-in-fact contract
arose when Aetna issued the pre-authorization letters. And it
was those pre-authorization letters that created a clear and
definite promise to pay Plaintiff the usual and customary
value for its medical services. See Pl.'s Mot.
to Dismiss Opp'n Br. 3-5, ECF No. 9. Plaintiff then
grounds its account stated claim in Aetna's refusal to
pay the invoiced amount. Id. at 5. As to the fraud
claim, Plaintiff contends it has pleaded with requisite
specificity. Id. at 6.
filed a reply, reiterating that the pre-authorization letters
only confirmed CH's eligibility for coverage under the
Plan and in no way represented a promise to pay, especially
at the rate Plaintiff billed. Def.'s Mot. to Dismiss
Reply Br. 1-2, ECF No. 11.
motion to remand, “[t]he removing party . . . carries a
heavy burden of showing that at all stages of the litigation
the case is properly before the federal court. Removal
statutes are to be strictly construed, with all doubts to be
resolved in favor of remand.” Brown v. Jevic,
575 F.3d 322, 326 (3d Cir. 2009) (citations omitted). In
actions raising only state law claims, federal courts have
subject matter jurisdiction when the dispute satisfies the
amount in controversy requirement and no plaintiff resides in
the same state as any defendant. See In re Briscoe,
448 F.3d 201, 215 (3d Cir. 2006) (citation omitted).
Rule of Civil Procedure 12(b)(6) allows dismissing a
complaint, in whole or in part, if the plaintiff fails to
state a claim upon which relief can be granted. The moving
party bears the burden of showing that no claim has been
stated. Hedges v. United States, 404 F.3d 744, 750
(3d Cir. 2005). In deciding a motion to dismiss, a court must
take all allegations in the complaint as true and view them
in the light most favorable to the plaintiff. See Warth
v. Seldin, 422 U.S. 490, 501 (1975). And a court will
usually consider documents filed with the complaint, such as
those integral to or explicitly relied upon in the
complaint.” Schmidt v. Skolas, 770 F.3d 241,
249 (3d Cir. 2014) (emphasis in original) (internal quotation
marks and citations omitted).
a complaint need not contain detailed factual allegations,
“a plaintiff's obligation to provide the
‘grounds' of his ‘entitlement to relief'
requires more than labels and conclusions, and a formulaic
recitation of the elements of a cause of action will not
do.” Bell Atl. Corp. v. Twombly, 550 U.S. 544,
555 (2007). Thus, the factual allegations must be sufficient
to raise a plaintiff's right to relief above a
speculative level, such that it “is plausible on its
face.” See Id. at 570; see also Umland v.
PLANCO Fin. Serv., Inc., 542 F.3d 59, 64 (3d Cir. 2008).
“A claim has facial plausibility when the plaintiff
pleads factual content that allows the court to draw the
reasonable inference that the defendant is liable for the
misconduct alleged.” Ashcroft v. Iqbal, 556
U.S. 662, 678 (2009) (citing Twombly, 550 U.S. at
556). While “[t]he plausibility standard is not akin to
a ‘probability requirement' . . . it asks for more
than a sheer possibility.” Iqbal, 556 U.S. at