Rowe Plastic Surgery of Long Island, P.C. and Norman Maurice Rowe, M.D., M.H.A., L.L.C. v. Aetna Life Insurance Company

CourtDistrict Court, S.D. New York
DecidedNovember 24, 2025
Docket1:22-cv-09328
StatusUnknown

This text of Rowe Plastic Surgery of Long Island, P.C. and Norman Maurice Rowe, M.D., M.H.A., L.L.C. v. Aetna Life Insurance Company (Rowe Plastic Surgery of Long Island, P.C. and Norman Maurice Rowe, M.D., M.H.A., L.L.C. v. Aetna Life Insurance Company) is published on Counsel Stack Legal Research, covering District Court, S.D. New York primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Rowe Plastic Surgery of Long Island, P.C. and Norman Maurice Rowe, M.D., M.H.A., L.L.C. v. Aetna Life Insurance Company, (S.D.N.Y. 2025).

Opinion

USONUITTEHDE RSTNA DTIESST RDIICSTT ROIFC TN ECWOU YROTR K ---------------------------------------------------------------------- X : ROWE PLASTIC SURGERY OF LONG ISLAND, P.C. : and NORMAN MAURICE ROWE, : M.D., M.H.A., L.L.C, : : Plaintiffs, : : 22 Civ. 9328 (JPC) -v- : : ORDER ADOPTING AETNA LIFE INSURANCE COMPANY, : REPORT AND : RECOMMENDATION Defendant. : : ---------------------------------------------------------------------- X

JOHN P. CRONAN, United States District Judge:

The instant case brought by Plaintiffs Rowe Plastic Surgery of Long Island, P.C. and Norman Maurice Rowe, M.D., M.H.A., L.L.C. is one of a horde filed against Defendant Aetna Life Insurance Company (“Aetna”) in this District and the Eastern District of New York. Plaintiffs claim that Aetna underpaid them for a surgery they performed by failing to honor a statement of coverage and benefit rates made during a benefits verification call, a claim which the Second Circuit and this Court’s peers have uniformly rejected. And despite Plaintiffs’ belated attempt to buck that trend by adding allegations to their Complaint, they still fail to state any claims. So the Court adopts the Honorable Ona T. Wang’s Report and Recommendation recommending dismissal of this case with prejudice and her Order denying reconsideration of that recommendation. I. Background1 In September 2022, Plaintiffs sued Aetna in the Supreme Court of New York, Bronx

1 The facts contained in this section, which are assumed true solely for purposes of this Opinion and Order, are taken from Plaintiffs’ Complaint. Cf. Interpharm, Inc. v. Wells Fargo Bank, Nat’l Ass’n, 655 F.3d 136, 141 (2d Cir. 2011) (explaining that on a motion to dismiss pursuant to Rule 12(b)(6), the court must “assum[e] all facts alleged within the four corners of the complaint to be true, and draw[] all reasonable inferences in plaintiff’s favor”). County, for issuing payments that were allegedly “not what was offered to induce [Plaintiffs’] performance” of a “procedure called reduction mammaplasty bilateral,” which they performed on HC, one of their patients. Dkt. 1, Exh. 1 (“Compl.”) ¶¶ 2-3. Plaintiffs allege that during a June 23, 2022 phone call, “Aetna’s employee represented that the total allowed amount for this service was based upon 80% usual and customary for covered services rendered to HC,” with “80% Usual and Customary” being “an industry term which means Aetna would pay an amount equal to 80% of the Usual and Customary percentile threshold for that service in the [geographic] area where the services were rendered.” Id. ¶¶ 27-28; see also id. ¶ 4. Plaintiffs claim that they “accepted Aetna’s offer by rendering bilateral reduction mammaplasty to HC” on August 18, and while they “billed Aetna a total of $150,000.00 for the services Dr. Rowe rendered to HC” on that date based

on the 80% Usual and Customary industry term, Aetna paid out only “$1,316.10” for Dr. Rowe’s services. Id. ¶¶ 29-35. In light of that alleged underpayment, Plaintiffs assert four causes of action against Aetna: breach of contract, id. ¶¶ 62-71, unjust enrichment, id. ¶¶ 72-81, promissory estoppel, id. ¶¶ 82-86, and a violation of New York’s Prompt Pay Law, N.Y. Ins. Law § 3224-a, Compl. ¶¶ 87-91. Aetna removed the case to this District on October 31, 2022, Dkt. 1, and filed an Answer to the Complaint on December 7, 2022, Dkt. 9. On August 17, 2023, the Court referred the case— as did several of this Court’s peers for other cases involving Plaintiffs—for general pretrial management to Judge Wang. Dkt. 28. Judge Wang held a status conference for those cases on December 20, 2023, to address the impact of the Honorable Jed S. Rakoff’s decision dismissing a

nearly identical action brought by Dr. Rowe against Aetna for failure to state a claim, see Rowe Plastic Surgery of N.J., L.L.C. v. Aetna Life Ins. Co. (“Rowe I”), 705 F. Supp. 3d 194 (S.D.N.Y. 2023). Dkts. 29, 31. On December 22, 2023, this case and several others were stayed while Plaintiffs appealed Judge Rakoff’s decision to the Second Circuit. Dkts. 31, 36. Before that appeal 2 was decided, the Honorable Denise L. Cote issued an opinion dismissing yet another strikingly similar complaint brought by Dr. Rowe against Aetna for “largely” the same reasons as Judge Rakoff and denied leave to amend for futility because the “plaintiffs have not explained how the proposed amendment would cure any of the deficiencies” in the operative complaint. Rowe Plastic Surgery of N.J., L.L.C. v. Aetna Life Ins. Co. (“Rowe II”), No. 23 Civ. 8529 (DLC), 2024 WL 382143, at *1-2 (S.D.N.Y. Feb. 1, 2024). On September 27, 2024, the Second Circuit affirmed Judge Rakoff’s decision. Rowe Plastic Surgery of N.J., L.L.C. v. Aetna Life Ins. Co. (“Rowe III”), No. 23-8083, 2024 WL 4315128 (2d Cir. Sept. 27, 2024) (summary order). As the panel explained, the plaintiffs’ breach-of- contract claim failed because their allegations fell “short of the definiteness typically required to

create an offer, such as details of the specific service and the price or an explicit undertaking of a duty,” and “[a]bsent an offer, there can be no contract.” Id. at *2-3. Their promissory-estoppel claim similarly failed because their allegations did “not plead a clear and unambiguous promise that is actionable under existing law.” Id. at *4. Their unjust-enrichment claim, held the Second Circuit, fell short because Aetna did not directly benefit from the plaintiffs’ services, nor had the plaintiffs alleged “that Aetna requested their services.” Id. at *3-4. And finally, the plaintiffs failed to state a claim for fraudulent inducement because they had “simply restated their breach of contract claim,” and “a fraud claim will not be sustained on a motion to dismiss where the plaintiff is simply using the claim ‘as a means of restating what is, in substance, a claim for breach of contract.’” Id. at *5 (quoting Wall v. CSX Transp., Inc., 471 F.3d 410, 416 (2d Cir. 2006)).2

On October 11, 2024, the parties in this case filed a status letter apprising the Court of the Second Circuit’s affirmance in Rowe III. Dkt. 33 (“Status Letter”). Plaintiffs insisted that as a

2 The plaintiffs in Rowe III did not plead a violation of New York’s Prompt Pay Law, unlike here. 3 summary order, the panel’s decision lacked “precedential effect.” Id. at 1. Plus, Plaintiffs sought “leave to conduct targeted discovery to aid in drafting an Amended Complaint in this action” because there were “multiple conversations that occurred between themselves and Aetna prior to the surgery at issue being performed,” while the Second Circuit’s decision was “based on a transcript of a single telephone call.” Id. at 2. Aetna, for its part, argued that “Plaintiffs’ Complaints should be dismissed with prejudice” as “the underlying basis upon which Plaintiffs’ cases rest is indistinguishable from the issue at the heart of the Second Circuit’s decision.” Id. at 3. Aetna also sought to stay discovery “while the parties engage in expedited motion practice to determine whether, consistent with the Second Circuit’s recent decision, the verification of benefits calls at issue were offers of payment to Plaintiffs.” Id. at 4.

Judge Wang denied Plaintiffs’ request for leave to conduct discovery on October 22, 2024. Dkt. 36. And on December 9, 2024, she granted Aetna’s request for expedited motion practice in part, Dkt.

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Bluebook (online)
Rowe Plastic Surgery of Long Island, P.C. and Norman Maurice Rowe, M.D., M.H.A., L.L.C. v. Aetna Life Insurance Company, Counsel Stack Legal Research, https://law.counselstack.com/opinion/rowe-plastic-surgery-of-long-island-pc-and-norman-maurice-rowe-md-nysd-2025.