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

District Court, D. Arizona·Decided May 28, 2026·No. 2:24-cv-02650·Unknown

Opinion

WO

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

Plaintiff, ORDER

v.

Aetna Health Incorporated, et al.,

Defendants. Plaintiff Fortitude Surgery Center LLC (“Fortitude”) provided medical services to patients and now seeks to recover payment for those services from defendants Aetna Health, Inc. and Aetna Life Insurance Company (collectively, “Aetna”). Fortitude initially filed a complaint asserting Employee Retirement Income Security Act (“ERISA”) and state-law claims, but the court dismissed those claims in May 2025. Fortitude filed an amended complaint and the court again dismissed all claims in September 2025, granting leave to amend one final time. (Doc. 45.) Fortitude has now filed a Second Amended Complaint (“SAC”) (Doc. 52), and Aetna has moved to dismiss some of the state-law claims (Doc. 57).1 Its motion is granted. I. Factual Background Aetna is a health benefits insurer and insurance plan administrator that provided and/or administered insurance plans for individuals who received services from Fortitude, 1 Aetna also requested the court dismiss a claim alleged under the Federal Employees Health Benefits Act (“FEHBA”) (Doc. 57 at 1), but Fortitude voluntarily dismissed that claim (Doc. 60 at 1). a surgical center. (Doc. 52 at 2-3.) Fortitude is out-of-network with Aetna, which in practice means Fortitude “submit[s] claims to Aetna at [its] billed charges” rather than using previously-negotiated rates for reimbursement. (Doc. 52 at 4.) Before providing treatment, Fortitude contacted Aetna to verify the individual was covered by an Aetna- insured or Aetna-administered plan and their coverage included out-of-network benefits for the relevant treatment. (Doc. 52 at 6.) Fortitude also verified coverage for the specific treatment via Aetna’s website, “personal communication between Fortitude and Aetna,” and/or Aetna’s Clinical Policy Bulletins. (Doc. 52 at 6.) When Fortitude directly “sought authorization from Aetna to provide [a specific] treatment,” Aetna either authorized the treatment or, “more often, informed Fortitude that no preauthorization was necessary.” (Doc. 52 at 7.) Fortitude also alleges it “verified Aetna’s position that the procedure was considered reasonable and necessary.” (Doc. 52 at 6-7.) Fortitude would not have provided the relevant services without Aetna’s authorization. (Doc. 52 at 8.) Despite representing that coverage would apply to the services Fortitude planned to provide, “Aetna began serially denying payment on the Fortitude bills” without warning (Doc. 52 at 11) and without explanations sufficiently detailed for Fortitude to glean the basis for the refusals or for the failed appeals Fortitude typically filed after a refusal (Doc. 52 at 56-57). Fortitude did, however, receive a letter sent on May 1, 2020 from an Aetna claim investigator which requested information from Fortitude including medical records of relevant patients and their treatment. (Doc. 52 at 11-12.) But Fortitude alleges it responded in full and Aetna ultimately denied its claims “because Fortitude has common ownership with certain other pain management providers in the Phoenix area which [] previously had disputed unpaid claims with Aetna.” (Doc. 52 at 12.) As a condition of receiving care at Fortitude, each patient assigned benefits and rights to Fortitude, including the rights to obtain information regarding coverage and to collect payments Aetna owed the member. (Doc. 52 at 8-9.) The validity of these assignments is uncontested. (Doc. 52 at 9.) Based on those assignments, Fortitude filed this suit asserting an ERISA claim on behalf of Aetna members on ERISA plans and state-law claims on behalf of Aetna members on non-ERISA plans. The court dismissed the ERISA claim in May 2025 (Doc. 30) and again in September 2025 (Doc. 45) because Fortitude had not provided sufficient information specific to the plans at issue to support its claims. The September order also dismissed the remaining state-law claims on jurisdictional grounds, but pointed out some had fundamental flaws. (Doc. 45 at 8.) It granted leave to amend one final time (Doc. 45 at 7) and Fortitude filed its SAC in November 2025 (Doc. 52). Aetna now moves to dismiss most of the state-law claims. (Doc. 57.) II. Legal Standard “To survive a motion to dismiss, a complaint must contain 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) (simplified). This is not a “probability requirement,” but a requirement that the factual allegations show “more than a sheer possibility that a defendant has acted unlawfully.” Id. A claim is facially plausible “when the plaintiff pleads factual content that allows the court to draw the reasonable inference that the defendant is liable for the misconduct alleged.” Id. “Determining whether a complaint states a plausible claim for relief . . . [is] a context-specific task that requires the reviewing court to draw on its judicial experience and common sense.” Id. at 679. III. Analysis Aetna moves to dismiss claims four through seven (Doc. 57 at 6), which allege unjust enrichment, promissory estoppel, negligent misrepresentation, and breach of implied contract (Doc. 52 at 62-70). Although portions of the complaint are unredacted solely in the version filed under seal, this order discusses only public portions. Fortitude apparently decided not to amend its state-law claims at all, despite the court’s warning many were “obviously flawed.” (Doc. 45 at 8.) A. Unjust Enrichment Fortitude alleges Aetna’s withholding of payment for Fortitude’s services to Aetna patients constituted unjust enrichment. (Doc. 52 at 62.) Unjust enrichment requires a plaintiff show (1) an enrichment, (2) an impoverishment, (3) a connection between the enrichment and impoverishment, (4) a lack of justification for the enrichment and impoverishment, and (5) the absence of a remedy provided by law. Ideasolv LLC v. Geante Rouge SARL, No. CV-21-01905-PHX-MTL, 2022 WL 3042858, at *4 (D. Ariz. Aug. 2, 2022). A party asserting a breach-of-contract claim may receive a remedy at law. Thus, given the final element, when a party asserts both unjust enrichment and breach of contract, the existence of a possible contractual remedy may foreclose their unjust enrichment claim. Brooks v. Valley Nat. Bank, 548 P.2d 1166, 1171 (Ariz. 1976); see also Physicians Surgery Ctr., 609 F. Supp. 3d 903, 939 (D. Ariz. 2022); Sutter Home Winery, Inc. v. Vintage Selections, Ltd., 971 F.2d 401, 408 (9th Cir. 1992). But a party may bring an unjust enrichment claim in the alternative “where her inability to enforce the contract leaves her without an adequate remedy at law,” Cheatham v. ADT Corp., 161 F. Supp. 3d 815, 833 (D. Ariz. 2016), and where the party has not received the benefit of the contractual bargain, Adelman v. Christy, 90 F. Supp. 2d 1034, 1045 (D. Ariz. 2000). See also Lopez v. Musinorte Ent. Corp., 434 F. App’x 696, 699 (9th Cir. 2011) (“a plaintiff can pursue an unjust enrichment claim as an alternative theory of recovery in conjunction with a breach of contract claim, subject, however, to only one recovery”). Because Fortitude pleads unjust enrichment in the alternative (Doc. 52 at 62) and it remains possible a jury could find no valid contract exists or Fortitude did not receive the benefit of its bargain, the claim is not doomed by Fortitude also alleging a contractual remedy. See Victory Ins. & Fin. Servs. LLC v. Ben Oberg Enters. LLC, No. CV-23-08015-PCT-DJH, 2025 WL 6

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

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