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Ahn v. Cigna Health And Life Insurance Co.

United States District Court, D. New Jersey

October 21, 2019

JEFFREY M. AHN, M.D., Plaintiff,
v.
CIGNA HEALTH AND LIFE INSURANCE COMPANY, JANE DOES 1-10, AND ABC CORPORATIONS 1-10, Defendants.

          OPINION

          KEVIN McNULTY. U.S.D.J.

         This matter comes before the court on the motion of defendant Cigna Health & Life Insurance ("Cigna") to dismiss the complaint for failure to state a claim on which relief may be granted, pursuant to Federal Rule of Civil Procedure 12(b)(6). (DE 4). The plaintiff, Jeffrey M. Ahn, M.D., asserts claims under New Jersey common law for defamation per se, defamation, and tortious interference. His claims are based on Explanation of Benefits forms ("EOBs"), sent to Dr. Ann's patients by Cigna, which allegedly contain false statements to the effect that Dr. Ahn is not a licensed medical doctor. Alternatively, Cigna moves for summary judgment pursuant to Fed.R.Civ.P. 12(d) and 56, and for a more definite statement under Fed.R.Civ.P. 12(e).

         For the reasons explained below, Cigna's motion to dismiss pursuant to Fed.R.Civ.P. 12(b)(6) is granted in part and denied in part; its motion for summary judgment pursuant to Fed.R.Civ.P. 12(d) is denied; and its motion for a more definite statement under Fed.R.Civ.P. 12(e) is denied.

         I. Background [1]

         The plaintiff, Dr. Jeffrey M. Ann, M.D., is an otolaryngologist who treats patients in the New York and New Jersey regions. (Compl. ¶l). Defendant Cigna is a corporation whose headquarters is located in Philadelphia, Pennsylvania. (Compl. ¶2). Now and at all relevant times, Dr. Ahn was licensed by the New Jersey Board of Medical Examiners and the New York Department of Health to practice medicine. (Compl. ¶¶8-9). Information on licensing for medical providers can be verified by going to the New Jersey Division of Consumer Affairs website and the New York Department of Health website. (Compl. ¶¶ 19-20).

         At issue here are certain EOBs sent to Dr. Ahn's patients who had health insurance through Cigna or a plan administered by Cigna. (Compl. ¶IO). Dr. Ahn alleges that on or about 46 different occasions, starting from October 21, 2014, Cigna denied payments to Dr. Ahn for services he provided. The EOBs stated that the claims were denied because Dr. Ahn was not licensed to practice medicine. (Compl. ¶l 1). Twenty-two of those denials occurred within one year preceding the filing of Dr. Ahn's complaint. (Compl. ¶14).

         Specifically, on EOB sheet provided to Dr. Ahn's patients, Cigna denied payment based on Code "AO" or Code "XB2." Code AO is accompanied by the following narrative explanation:

Health Care Professional: The patients Cigna-administered plan doesn't allow payment of claims for services rendered by unlicensed health care professional or entities. Customer: See the definitions and/or exclusions pages of your Cigna-administered plan document. We can't pay a claim if the health care professional is not licensed. You should always check to be sure an out-of-network health care professional is licensed before receiving services.

(Compl. ¶ 16). Code XB2 provides that the Cigna-administered plan "doesn't allow payment of claims for services rendered by unlicensed health care professional or entities." (Compl. ¶17).

         Dr. Ahn alleges that on at least one occasion, he notified Cigna that the codes were incorrect and were causing him harm. (Compl. ¶12). Cigna allegedly acknowledged that the statements on the EOBs were untrue and needed to be corrected. Cigna continued, however, to print the incorrect codes on EOBs. (Compl. ¶13). Dr. Ahn alleges that he has been wrongfully denied payment in the amount of $14, 112.00 for medical services rendered. His practice, he says, has suffered financially. (Compl. ¶25). And as a result of Cigna's actions, he alleges, his reputation has been damaged, especially among the primarily Asian-American community his practice caters to. (Compl. ¶¶24, 26).

         Dr. Ahn filed a complaint against Cigna in New Jersey Superior Court alleging defamation per se, defamation, and tortious interference. Cigna properly removed this action based on diversity of citizenship. See 28 U.S.C. § 1332(a); Removal at 2. Dr. Ahn seeks to be reimbursed not just for unpaid services in the amount of $14, 112.00, but also for the damage done to his reputation, and lost profits and business opportunities in a total amount to be determined at trial, but no less than $2, 000, 000, and punitive damages in the amount of $ 1, 000, 000.

         II. Discussion

         A. Legal standardt.

         Federal Rule of Civil Procedure 8(a) does not require that a complaint contain detailed factual allegations. Nevertheless, "a plaintiffs 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." BellAtl. Corp. v. Twombly, 550 U.S. 544, 555 (2007); see Phillips v. Cnty. of Allegheny, 515 F.3d 224, 232 (3d Cir. 2008) (Rule 8 "requires a 'showing' rather than a blanket assertion of an entitlement to relief." (citation omitted)). Thus, the complaint's factual allegations must be sufficient to raise a plaintiffs right to relief above a speculative level, so that a claim is "plausible on its face." Twombly, 550 U.S. at 570; see also West Run Student Hous. Assocs., LLC v. Huntington Nat. Bank, 712 F.3d 165, 169 (3d Cir. 2013).

         That facial-plausibility standard is met "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." Id.

         Rule 12(b)(6) provides for the dismissal of a complaint if it fails to state a claim upon which relief can be granted. The defendant, as the moving party, bears the burden of showing that no claim has been stated. Animal Science Products, Inc. v. China Minmetals Corp., 654 F.3d 462, 469 n.9 (3d Cir. 2011). For the purposes of a motion to dismiss, the facts alleged in the complaint are accepted as true and all reasonable inferences are drawn in favor of the plaintiff. New Jersey Carpenters & the Trustees Thereof v. Tishman Const. Corp. of New Jersey, 760 F.3d 297, 302 (3d Cir. 2014).

         When deciding a motion to dismiss, a court typically does not consider matters outside the pleadings. However, a court may consider documents that are "integral to or explicitly relied upon in the complaint" or any "undisputedly authentic document that a defendant attaches as an exhibit to a motion to dismiss if the plaintiffs claims are based on the document[.]" In re Rockefeller Ctr. Props., Inc. Sec. Litig.,184 F.3d 280, 287 (3d Cir. 1999) (emphasis and citations omitted); see In re Asbestos Prods. Liab. Litig. (No. VI),822 F.3d 125, 133 n.7 (3d Cir. 2016); Schmidt v. Skolas,770 F.3d 241, 249 (3d Cir. 2014). In that regard, courts may consider matters of public record and exhibits attached to the complaint. Schmidt, 770 F.3d at 249 ("To decide a motion to dismiss, courts generally consider only the allegations contained in the complaint, exhibits attached to the complaint ...


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