Fortitude Surgery Center LLC v. Aetna Health Incorporated, et al.

CourtDistrict Court, D. Arizona
DecidedMay 28, 2026
Docket2:24-cv-02650
StatusUnknown

This text of Fortitude Surgery Center LLC v. Aetna Health Incorporated, et al. (Fortitude Surgery Center LLC v. Aetna Health Incorporated, et al.) is published on Counsel Stack Legal Research, covering District Court, D. Arizona primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Fortitude Surgery Center LLC v. Aetna Health Incorporated, et al., (D. Ariz. 2026).

Opinion

1 WO 2 3 4 5 6 IN THE UNITED STATES DISTRICT COURT 7 FOR THE DISTRICT OF ARIZONA

9 Fortitude Surgery Center LLC, No. CV-24-02650-PHX-KML

10 Plaintiff, ORDER

11 v.

12 Aetna Health Incorporated, et al.,

13 Defendants. 14 15 Plaintiff Fortitude Surgery Center LLC (“Fortitude”) provided medical services to 16 patients and now seeks to recover payment for those services from defendants Aetna 17 Health, Inc. and Aetna Life Insurance Company (collectively, “Aetna”). Fortitude initially 18 filed a complaint asserting Employee Retirement Income Security Act (“ERISA”) and 19 state-law claims, but the court dismissed those claims in May 2025. Fortitude filed an 20 amended complaint and the court again dismissed all claims in September 2025, granting 21 leave to amend one final time. (Doc. 45.) Fortitude has now filed a Second Amended 22 Complaint (“SAC”) (Doc. 52), and Aetna has moved to dismiss some of the state-law 23 claims (Doc. 57).1 Its motion is granted. 24 I. Factual Background 25 Aetna is a health benefits insurer and insurance plan administrator that provided 26 and/or administered insurance plans for individuals who received services from Fortitude, 27 1 Aetna also requested the court dismiss a claim alleged under the Federal Employees 28 Health Benefits Act (“FEHBA”) (Doc. 57 at 1), but Fortitude voluntarily dismissed that claim (Doc. 60 at 1). 1 a surgical center. (Doc. 52 at 2-3.) Fortitude is out-of-network with Aetna, which in 2 practice means Fortitude “submit[s] claims to Aetna at [its] billed charges” rather than 3 using previously-negotiated rates for reimbursement. (Doc. 52 at 4.) Before providing 4 treatment, Fortitude contacted Aetna to verify the individual was covered by an Aetna- 5 insured or Aetna-administered plan and their coverage included out-of-network benefits 6 for the relevant treatment. (Doc. 52 at 6.) Fortitude also verified coverage for the specific 7 treatment via Aetna’s website, “personal communication between Fortitude and Aetna,” 8 and/or Aetna’s Clinical Policy Bulletins. (Doc. 52 at 6.) When Fortitude directly “sought 9 authorization from Aetna to provide [a specific] treatment,” Aetna either authorized the 10 treatment or, “more often, informed Fortitude that no preauthorization was necessary.” 11 (Doc. 52 at 7.) Fortitude also alleges it “verified Aetna’s position that the procedure was 12 considered reasonable and necessary.” (Doc. 52 at 6-7.) Fortitude would not have provided 13 the relevant services without Aetna’s authorization. (Doc. 52 at 8.) 14 Despite representing that coverage would apply to the services Fortitude planned to 15 provide, “Aetna began serially denying payment on the Fortitude bills” without warning 16 (Doc. 52 at 11) and without explanations sufficiently detailed for Fortitude to glean the 17 basis for the refusals or for the failed appeals Fortitude typically filed after a refusal (Doc. 18 52 at 56-57). Fortitude did, however, receive a letter sent on May 1, 2020 from an Aetna 19 claim investigator which requested information from Fortitude including medical records 20 of relevant patients and their treatment. (Doc. 52 at 11-12.) But Fortitude alleges it 21 responded in full and Aetna ultimately denied its claims “because Fortitude has common 22 ownership with certain other pain management providers in the Phoenix area which [] 23 previously had disputed unpaid claims with Aetna.” (Doc. 52 at 12.) 24 As a condition of receiving care at Fortitude, each patient assigned benefits and 25 rights to Fortitude, including the rights to obtain information regarding coverage and to 26 collect payments Aetna owed the member. (Doc. 52 at 8-9.) The validity of these 27 assignments is uncontested. (Doc. 52 at 9.) Based on those assignments, Fortitude filed this 28 suit asserting an ERISA claim on behalf of Aetna members on ERISA plans and state-law 1 claims on behalf of Aetna members on non-ERISA plans. The court dismissed the ERISA 2 claim in May 2025 (Doc. 30) and again in September 2025 (Doc. 45) because Fortitude 3 had not provided sufficient information specific to the plans at issue to support its claims. 4 The September order also dismissed the remaining state-law claims on jurisdictional 5 grounds, but pointed out some had fundamental flaws. (Doc. 45 at 8.) It granted leave to 6 amend one final time (Doc. 45 at 7) and Fortitude filed its SAC in November 2025 (Doc. 7 52). Aetna now moves to dismiss most of the state-law claims. (Doc. 57.) 8 II. Legal Standard 9 “To survive a motion to dismiss, a complaint must contain sufficient factual matter, 10 accepted as true, to state a claim to relief that is plausible on its face.” Ashcroft v. Iqbal, 11 556 U.S. 662, 678 (2009) (simplified). This is not a “probability requirement,” but a 12 requirement that the factual allegations show “more than a sheer possibility that a defendant 13 has acted unlawfully.” Id. A claim is facially plausible “when the plaintiff pleads factual 14 content that allows the court to draw the reasonable inference that the defendant is liable 15 for the misconduct alleged.” Id. “Determining whether a complaint states a plausible claim 16 for relief . . . [is] a context-specific task that requires the reviewing court to draw on its 17 judicial experience and common sense.” Id. at 679. 18 III. Analysis 19 Aetna moves to dismiss claims four through seven (Doc. 57 at 6), which allege 20 unjust enrichment, promissory estoppel, negligent misrepresentation, and breach of 21 implied contract (Doc. 52 at 62-70). Although portions of the complaint are unredacted 22 solely in the version filed under seal, this order discusses only public portions. Fortitude 23 apparently decided not to amend its state-law claims at all, despite the court’s warning 24 many were “obviously flawed.” (Doc. 45 at 8.) 25 A. Unjust Enrichment 26 Fortitude alleges Aetna’s withholding of payment for Fortitude’s services to Aetna 27 patients constituted unjust enrichment. (Doc. 52 at 62.) Unjust enrichment requires a 28 plaintiff show (1) an enrichment, (2) an impoverishment, (3) a connection between the 1 enrichment and impoverishment, (4) a lack of justification for the enrichment and 2 impoverishment, and (5) the absence of a remedy provided by law. Ideasolv LLC v. Geante 3 Rouge SARL, No. CV-21-01905-PHX-MTL, 2022 WL 3042858, at *4 (D. Ariz. Aug. 2, 4 2022). 5 A party asserting a breach-of-contract claim may receive a remedy at law. Thus, 6 given the final element, when a party asserts both unjust enrichment and breach of contract, 7 the existence of a possible contractual remedy may foreclose their unjust enrichment claim. 8 Brooks v. Valley Nat. Bank, 548 P.2d 1166, 1171 (Ariz. 1976); see also Physicians Surgery 9 Ctr., 609 F. Supp. 3d 903, 939 (D. Ariz. 2022); Sutter Home Winery, Inc. v. Vintage 10 Selections, Ltd., 971 F.2d 401, 408 (9th Cir. 1992). But a party may bring an unjust 11 enrichment claim in the alternative “where her inability to enforce the contract leaves her 12 without an adequate remedy at law,” Cheatham v. ADT Corp., 161 F. Supp. 3d 815, 833 13 (D. Ariz. 2016), and where the party has not received the benefit of the contractual bargain, 14 Adelman v. Christy, 90 F. Supp. 2d 1034, 1045 (D. Ariz. 2000). See also Lopez v. Musinorte 15 Ent. Corp., 434 F. App’x 696, 699 (9th Cir. 2011) (“a plaintiff can pursue an unjust 16 enrichment claim as an alternative theory of recovery in conjunction with a breach of 17 contract claim, subject, however, to only one recovery”).

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Fortitude Surgery Center LLC v. Aetna Health Incorporated, et al., Counsel Stack Legal Research, https://law.counselstack.com/opinion/fortitude-surgery-center-llc-v-aetna-health-incorporated-et-al-azd-2026.