SLEEP TIGHT DIAGNOSTIC CENTER, LLC v. AETNA, INC.

CourtDistrict Court, D. New Jersey
DecidedFebruary 27, 2020
Docket3:18-cv-03556
StatusUnknown

This text of SLEEP TIGHT DIAGNOSTIC CENTER, LLC v. AETNA, INC. (SLEEP TIGHT DIAGNOSTIC CENTER, LLC v. AETNA, INC.) is published on Counsel Stack Legal Research, covering District Court, D. New Jersey primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
SLEEP TIGHT DIAGNOSTIC CENTER, LLC v. AETNA, INC., (D.N.J. 2020).

Opinion

UNITED STATES DISTRICT COURT DISTRICT OF NEW JERSEY

: SLEEP TIGHT DIAGNOSTIC CENTER, : LLC, : : Plaintiff, : Civil Action No.: 18-3556 (FLW) v. : : OPINION AETNA INC., AETNA HEALTH INC., AND : AETNA LIFE INSURANCE : COMPANY, : : Defendants. : :

WOLFSON, Chief Judge: Plaintiff Sleep Tight Diagnostic Center, LLC, (“Plaintiff” or “Sleep Tight”) brings this action against Defendants Aetna, Inc., Aetna Health Inc., and Aetna Life Insurance Company (“Aetna” or “Defendants”), arising from a procedure which it provided to twenty-five patients (the “insureds”) who are covered under employee health insurance plans (the “Plans”) that Aetna administers.1 Presently before the Court is a Motion by Plaintiff, pursuant to Local Civil Rule 7.1(i), seeking reconsideration of the Court’s June 28, 2019 Opinion and Order, wherein the Court found that (a) Plaintiff’s common law claims contained in Counts I - IV of the First Amended Complaint (“FAC”) are subject to the express preemption provisions of the Employee Retirement Income Security Act (“ERISA”), and (2) Plaintiff lacked standing to pursue benefits on behalf of thirteen insureds, because their Plans contain enforceable anti-assignment provisions. For the reasons expressed herein, the Court finds that Plaintiff has failed to meet its burden of

1 The insureds include the following individuals: A.K., A.O., C.A., C.W., G.J., H.H., J.B., J.F., J.W., K.B., L.F., M.P., R.B., R.F., Ri. M., Rob. M., Rog. M., S.B., T.C., A.T., A.Y., P.D., R.T., S.L., and M.T. demonstrating that reconsideration of the prior decision is warranted, and thus, Plaintiff’s Motion is DENIED. I. FACTUAL BACKGROUND AND PROCEDURAL HISTORY Because the factual background of this matter is set forth in detail in the Court’s June 28, 2019 Opinion and Order, I will only recount the necessary facts for the resolution of this Motion. From February 24, 2016 to August 9, 2016, each of the insureds underwent a polysomnography2

at Sleep Tight, which owns and operates a six-bed facility in Spring, Texas. Before providing this medical procedure for the insureds, Sleep Tight contacted Aetna, the administrator of the Plans, and confirmed its eligibility to be paid as an out-of-network provider, and the availability of benefits for the required treatments for the insureds. Sleep Tight also received information which related to the Plans, in order to verify the amount in benefits payable for services rendered, including: (a) the reimbursement methodology for out-of-network services; (b) the applicable patient cost sharing obligations; and (c) the annual out-of-pocket maximums. Id. Despite these representations, Sleep Tight acknowledges that Aetna did not provide it with a guaranty of payment. After each of the insureds executed an assignment of benefits to Sleep Tight, it

administered the polysomnographies and submitted “CMS-1500” claim forms to Aetna, which referenced the assignments and sought more than $445,551.00 in payment for the provided sleep studies. Aetna denied these claims in a document entitled “Explanation of Payment,” following which Sleep Tight submitted a written appeal of the adverse benefits determinations to Aetna, in

2 A polysomnography is a sleep study that diagnoses sleep disorders by recording “brain waves, the oxygen level in blood, heart rate and breathing, . . . eye and leg movements,” as well as “sleep stages and cycles to identify if or when sleep patterns are disrupted and why.” FAC, ¶ 16. accordance with the advice of Liz, a customer service representative. On June 10, 2016, Sleep Tight received a letter from James C. Crumlish, Esq., whose law firm represents Aetna, in which he instructed Sleep Tight to direct all further inquires to either himself or his colleague, Colin O’Boyle, Esq. Thereafter, on an unspecified date, “Sleep Tight’s Administrator” provided Mr.

Crumlish with copies of its “provisional accreditation” from the American Academy of Sleep Medicine (“AASM”). On January 8, 2017, after Sleep Tight provided proof of its “continued accreditation” with the AASM, Mr. Crumlish indicated that the claim for healthcare covered benefits would be processed for services rendered as of July 8, 2016, subject to the member’s relevant coverage conditions and Aetna’s coverage policies. However, because Aetna did not reprocess the disputed claims, Sleep Tight submitted a letter correspondence, through counsel, to Mr. Crumlish on February 7, 2017; therein, Sleep Tight set forth the alleged amount for services due, and it requested information from Aetna that pertained to the adverse benefit determinations. However, because a response was not provided from Mr. Crumlish or his firm, on April 25, 2017, Sleep

Tight resubmitted its earlier correspondence to him through email, but these efforts were also ignored. On March 14, 2018, Sleep Tight filed the instant action against Aetna, alleging wrongful denial of benefits pursuant to ERISA. On October 4, 2018, Sleep Tight amended its Complaint to assert four common law causes of action under Texas law, including: (1) breach of contract; (2) quantum meruit; (3) promissory estoppel; and (4) negligent misrepresentation. On June 28, 2019, the Court entered an Opinion and Order, in which I held that ERISA preempted the common law claims, and that Sleep Tight lacked standing to pursue benefits on behalf of the insureds whose Plans contained enforceable anti-assignment provisions.3 Now, Sleep Tight moves for reconsideration, contending that the Court erred in rendering both findings. II. DISCUSSION A. Standard of Review

Federal Rule of Civil Procedure 59(e) and Local Civil Rule 7.1 govern motions for reconsideration. More specifically, pursuant to Local Civil Rule 7.1(i), a litigant moving for reconsideration must “set[ ] forth concisely the matter or controlling decisions which the party believes the Judge or Magistrate Judge has overlooked[.]” L. Civ. R. 7.1(i). Moreover, motions for reconsideration are considered “extremely limited procedural vehicle[s].” Resorts Int’l v. Greate Bay Hotel & Casino, 830 F. Supp. 826, 831 (D.N.J. 1992). Indeed, requests for reconsideration “are not to be used as an opportunity to relitigate the case; rather, they may be used only to correct manifest errors of law or fact or to present newly discovered evidence.” Blystone v. Horn, 664 F.3d 397, 415 (3d Cir. 2011) (citing Howard Hess Dental Labs., Inc. v. Dentsply Int’l Inc., 602 F.3d 237, 251 (3d Cir. 2010)); see also N. River Ins. Co. v. CIGNA Reinsurance Co., 52 F.3d 1194,

1218 (3d Cir. 1995). A “judgment may be altered or amended [only] if the party seeking reconsideration shows at least one of the following grounds: (1) an intervening change in the controlling law; (2) the availability of new evidence that was not available when the court granted the motion for summary judgment; or (3) the need to correct a clear error of law or fact or to prevent manifest injustice.” Blystone, 664 F.3d at 415 (quotations omitted, alterations in original). “A party seeking reconsideration must show more than a disagreement with the Court’s decision, and ‘recapitulation

3 Following the Court’s June 28, 2019 Opinion and Order, Sleep Tight’s ERISA claims with respect to the Plans of the following insureds remain: A.K., A.O., C.A., C.W., J.B., K.B., R.F., and Rob M. of the cases and arguments considered by the court before rendering its original decision fails to carry the moving party’s burden.’” G-69 v. Degnan, 748 F. Supp. 274, 275 (D.N.J. 1990) (citation omitted).

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SLEEP TIGHT DIAGNOSTIC CENTER, LLC v. AETNA, INC., Counsel Stack Legal Research, https://law.counselstack.com/opinion/sleep-tight-diagnostic-center-llc-v-aetna-inc-njd-2020.