Advanced Reimbursement Solutions LLC v. Aetna Life Insurance Company

District Court, D. Arizona·Decided January 25, 2022·No. 2:19-cv-05395·Unknown

Opinion

WO

Advanced Reimbursement Solutions LLC, et No. CV-19-05395-PHX-DLR al., Plaintiffs, v. Aetna Life Insurance Company, et al., Defendants. Before the Court is Defendants The Aetna Life Insurance Company, Aetna, Inc., and Aetna Heath Inc.’s (collectively, “Aetna”) combined motion for judgment on the pleadings pursuant to Federal Rule of Civil Procedure 12(c) and motion to dismiss for lack of subject-matter jurisdiction pursuant to Rule 12(h)(3) (Doc. 104), which is fully briefed (Docs 144, 148).1 As explained below, the Court will grant the motion but will also allow Plaintiff Advanced Reimbursement Solutions, LLC (“ARS”) an opportunity to amend.2 I. Background This is an action brought by ARS not on its own behalf, but on behalf of 513 patients (“Patient Plaintiffs”) who receive their health insurance from Aetna or from self-funded ERISA plans for whom Aetna provides administrative services. (Doc. 1 ¶¶ 1, 11.) The 1 Oral argument is denied. See Fed. R. Civ. P. 78(b); LRCiv. 7.2(f). 2 Given this ruling, the Court will also deny without prejudice ARS’s motion for partial summary judgment (Doc. 204) and as moot Aetna’s motion for leave to file a sur- reply (Doc. 305). The Court cannot grant summary judgment, in whole or in part, unless and until it has the proper parties before it. Patient Plaintiffs all received non-surgical services at certain outpatient treatment centers (“OTCs”). (Id. ¶ 25.) Before providing medical treatment to the Patient Plaintiffs, the OTCs contacted Aetna to verify that the Patient Plaintiffs were in fact covered by a plan administered by Aetna and to seek authorization to provide such treatment. In each case, Aetna informed the OTCs that the Patient Plaintiffs were covered and either authorized the OTCs to provide medical services or informed the OTCs that no authorization was necessary. (Id. ¶ 26.) ARS, which contracts with the OTCs to provide billing and other back-office services, billed Aetna for the services provided by the OTCs at the OTCs’ customary billing rates. (Id. ¶¶ 10, 27.) Contrary to its representations, Aetna denied payment on the bills submitted by ARS, ostensibly because the OTCs did not meet provider requirements, even though on many occasions in years past, it paid the OTCs for the same services at issue. (Id. ¶¶ 28, 39.) In exchange for and in connection with the services provided by the OTCs, the Patient Plaintiffs each executed assignments of benefits to the OTCs (“Assignments”). (Doc. 1-1 at 2.) The Patient Plaintiffs also signed a separate document, entitled Authorization of Representation and Specific Power of Attorney, which purported to authorize ARS to take various actions on behalf of the Patient Plaintiffs. (Doc. 1-1 at 4-6.) ARS filed this action on behalf of the Patient Plaintiffs. Count One alleges that Aetna breached the relevant ERISA plan provisions by denying payment to ARS for the services rendered to the Patient Plaintiffs by the OTCs, thereby depriving the Patient Plaintiffs of their benefits under the terms of their ERISA plans. (Doc. 1 ¶¶ 52-56.) Count Two alleges that Aetna breached the relevant health insurance contracts by refusing to pay for the services rendered by the OTCs. (Id. ¶¶ 57-63.) Count Three alleges that Aetna has been unjustly enriched by its refusal to pay for the treatment provided to the Patient Plaintiffs by the OTCs. (Id. ¶¶ 64-69.) II. Legal Standard “After the pleadings are closed—but early enough not to delay trial—a party may move for judgment on the pleadings.” Fed. R. Civ. P. 12(c). A motion for judgment on the pleadings “is properly granted when, taking all the allegations in the non-moving party’s pleadings as true, the moving party is entitled to judgment as a matter of law.” Fajardo v. Cnty. of L.A., 179 F.3d 698, 699 (9th Cir. 1999). “Rule 12(c) is ‘functionally identical’ to Rule 12(b)(6) and . . . ‘the same standard of review’ applies to motions brought under either rule.” Cafasso v. Gen. Dynamics C4 Sys., 637 F.3d 1047, 1054 n.4 (9th Cir. 2011) (quoting Dworkin v. Hustler Magazine Inc., 867 F.2d 1188, 1192 (9th Cir. 1989)). A motion for judgment on the pleadings therefore should not be granted if the complaint is based on a cognizable legal theory and contains “sufficient factual matter, accepted as true, to state a claim to relief that is plausible on its face.” Ashcroft v. Iqbal, 556 U.S. 662, 678 (2009) (quotation and citation omitted). ARS argues it is premature for the Court to decide a motion for judgment on the pleadings because the pleadings are not closed. (Doc. 144 at 6.) The Court agrees. “Pleadings are closed upon the filing of a complaint and an answer, unless a counterclaim, cross-claim or third-party claim is interposed, or the court orders a third-party answer.” Whitson v. Bumbo, No. C 07-05597 MHP, 2009 WL 1515597, at *3 (N.D. Cal. Apr. 16, 2009) (citing Wright & Miller, Federal Practice and Procedure: Civil 3d § 1367 and Fed. R. Civ. P. 7(a)). Here, Aetna has filed counterclaims against ARS and the OTCs, and motions to dismiss those counterclaims remain pending. The pleadings therefore are not closed. But the Court still must address the substance of Aetna’s motion because Aetna has moved, as well, under Rule 12(h)(3), and unlike a motion for judgment on the pleadings, a motion to dismiss for lack of subject-matter jurisdiction may be asserted at any time. Indeed, “[i]f, on a motion for judgment on the pleadings, a party raises an issue as to the court’s subject matter jurisdiction, the district judge will treat the motion as if it had been brought under Rule 12(b)(1).” Kennard v. Lamb Weston Holdings, Inc., No. 18-cv-04665- YGR, 2019 WL 4278940, at *2 (N.D. Cal. Sept. 10, 2019) (internal quotation and citation omitted). Likewise, a motion for lack of subject-matter jurisdiction under Rule 12(h)(3) is treated as if brought under 12(b)(1). See Hamidi v. Serv. Emps. Int’l Union Local 1000, 386 F. Supp. 3d 1289, 1294 (E.D. Cal. 2019) (“The difference between a Rule 12(h)(3) motion and a motion to dismiss for lack of subject-matter jurisdiction under Rule 12(b)(1) is simply that the former may be asserted at any time and need not be responsive to any pleading of the other party.”) (internal quotation and citation omitted). The Court therefore will evaluate Aetna’s motion under the standards applicable to Rule 12(b)(1) motions. A challenge to a court’s subject-matter jurisdiction may be either “facial” or “factual.” Wolfe v. Strankman, 392 F.3d 358, 362 (9th Cir. 2004). “In a facial attack, the challenger asserts that the allegations contained in a complaint are insufficient on their face to invoke federal jurisdiction. By contrast, in a factual attack, the challenger disputes the truth of the allegations that, by themselves, would otherwise invoke federal jurisdiction.” Safe Air for Everyone v. Meyer, 373 F.3d 1035, 1039 (9th Cir. 2004). When considering a factual attack, “the court may look beyond the complaint without ha

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