TEMPLE UNIVERSITY HOSPITAL, INC. v. Group Health, Inc.

413 F. Supp. 2d 420, 64 Fed. R. Serv. 3d 4, 2005 U.S. Dist. LEXIS 12865, 2005 WL 1532475
CourtDistrict Court, E.D. Pennsylvania
DecidedJune 29, 2005
DocketCiv.A. 05-102
StatusPublished
Cited by3 cases

This text of 413 F. Supp. 2d 420 (TEMPLE UNIVERSITY HOSPITAL, INC. v. Group Health, Inc.) is published on Counsel Stack Legal Research, covering District Court, E.D. Pennsylvania primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
TEMPLE UNIVERSITY HOSPITAL, INC. v. Group Health, Inc., 413 F. Supp. 2d 420, 64 Fed. R. Serv. 3d 4, 2005 U.S. Dist. LEXIS 12865, 2005 WL 1532475 (E.D. Pa. 2005).

Opinion

MEMORANDUM

PRATTER, District Judge.

Defendant Oxford Health Insurance, Inc. (“Oxford”) 1 filed a Motion to Dismiss on March 7, 2005 in response to Temple University Hospital’s (“Temple”) Amended Complaint filed January 26, 2005. Temple responded to the Motion on March 28, 2005.

Oxford makes two arguments for dismissal: failure to state a claim pursuant to Federal Rule of Civil Procedure 12(b)(6) and failure to join an indispensable party pursuant to Federal Rules of Civil Procedure 12(b)(7) and 19. In their failure to state a claim argument, Oxford contends that Temple has failed to state a viable contract claim because no contract existed between Temple and Oxford and Temple has not provided facts sufficient to demonstrate they were a third-party beneficiary to any contract between Oxford and another defendant, MultiPlan, Inc. Therefore, according to Oxford, Temple’s Amended Complaint fails to allege the basic elements necessary to satisfy a direct or a third-party beneficiary contract claim.

In their failure to join an indispensable party claim, Oxford asserts that Temple should have joined the actual patient, Fred Tremarcke, who received the medical treatment Temple is now seeking to be reimbursed for. Oxford argues that Mr. Tremarcke is a necessary party pursuant to Federal Rule of Civil Procedure 19(a) because complete relief may not be afforded without Mr. Tremarcke’s presence due to Mr. Tremarcke being potentially found liable for the payment. Additionally, going forward without Mr. Tremarcke may impede or impair his ability to protect his interests and poses a significant risk of double, multiple, or inconsistent obligations for Oxford. Further, Oxford asserts that Mr. Tremarcke is an indispensi-ble party pursuant to Federal Rule of Civil Procedure 19(b) because of the risk of another lawsuit on this same matter.

For the reasons discussed below, the Court denies Oxford’s Motion to Dismiss.

I. SUBJECT MATTER JURISDICTION

This Court has jurisdiction pursuant to 28 U.S.C. § 1332, since there is diversity of citizenship between the parties and the amount in controversy exceeds $75,000. Specifically, Temple is seeking to recover in excess of $10.5 million for services it rendered to Mr. Tremarcke. Temple is incorporated and has its principal place of business in Pennsylvania. The defendants are incorporated and have their principal places of business outside of Pennsylvania. Mr. Tremarcke is alleged to be a citizen of New Jersey. 2

*423 II. SUMMARY OF FACTS

Temple University Hospital is a large health system that is seeking to recover $10,950,162.12, plus interest and costs, for the treatment of Fred Tremarcke from September 6, 2002 to November 26, 2003 and again from March 24, 2004 to April 28, 2004. (Amended Complaint, at ¶¶ 18, 22, 28, & 30). Temple has sued three health insurers or related companies, Oxford Health Insurance, Inc., Group Health, Inc., and MultiPlan, Inc., that Temple asserts are obligated to reimburse Temple for the treatment of Mr. Tremarcke. Inasmuch as this memorandum is a discussion of a motion to dismiss, the summary of facts presented below are the facts as alleged by Temple in its Amended Complaint.

Temple entered into a contract with MultiPlan, which was in effect from September 5, 2002 to November 26, 2003. (Amended Complaint, at ¶ 11). This contract required Temple provide “services to Plan Members” and that MultiPlan would “reimburse [Temple] 90% of billed charges within thirty (30) days of receipt of claim or 100% of billed charges shall be due.” (Amended Complaint, at ¶¶ 12, 14). Between September 5, 2002 and April 28, 2004, Group Health and MultiPlan entered into a contract obligating Group Health to pay Temple in accordance with the Multi-Plan-Temple contract for medical care rendered to persons insured by Group Health. (Amended Complaint, at ¶ 15). Similarly, between March 31, 2003 and April 28, 2004, Oxford and MultiPlan entered into a contract obligating Oxford to pay Temple in accordance with the Multi-Plan-Temple contract for medical care rendered to persons insured by Oxford. (Amended Complaint, at ¶ 16).

Mr. Tremarcke was insured by all or some of the defendants for the relevant time periods. (Amended Complaint, at ¶¶ 19-21, 29). As such, the defendants are alleged to be obligated to pay for Mr. Tremarcke’s treatments. (Amended Complaint, at ¶¶ 25, 33). Thus, Temple notified the defendants by submitting notice statements (“UB-92’s”) for the charges incurred by Mr. Tremarcke. (Amended Complaint, at ¶¶23, 31). These notices were sent more than thirty days prior to the filing of this lawsuit. (Amended Complaint, at ¶¶ 23, 31). Defendants have refused to pay the balance due. (Amended Complaint, at ¶¶ 24, 32).

III. DISCUSSION

A. Failure To State A Claim

When deciding a motion to dismiss pursuant to Federal Rule of Civil Procedure 12(b)(6), the Court may look only to the facts alleged in the complaint and its attachments. Jordan v. Fox, Rothschild, O’Brien & Frankel, 20 F.3d 1250, 1261 (3d Cir.1994). The Court must accept as true all well-pleaded allegations in the complaint and view them in the light most favorable to the plaintiff. Angelastro v. Prudential-Bache Sec., Inc., 764 F.2d 939, 944 (3d Cir.1985). A Rule 12(b)(6) motion will be granted only when it is certain that no relief could be granted under any set of facts that could be proved by the plaintiff. Ransom v. Marrazzo, 848 F.2d 398, 401 (3d Cir.1988).

Initially, Oxford argues that Temple does not state a viable contract claim *424 against Oxford due to Oxford not being in privity of contract with Temple. Because it is clear that Temple is not arguing that it is making a direct breach of contract claim against Oxford, the Court will not discuss this argument further.

Oxford also contends that Temple failed to plead a claim that satisfies the requirements to establish that Temple was a third-party beneficiary of a Oxford’s alleged contract with MultiPlan. Oxford begins by arguing that the applicable law is New York due to a choice of law provision in the contract between Oxford and Multi-Plan. Choice of law clauses are generally given effect in Pennsylvania. 3 Echols v. Pelullo, 377 F.3d 272

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413 F. Supp. 2d 420, 64 Fed. R. Serv. 3d 4, 2005 U.S. Dist. LEXIS 12865, 2005 WL 1532475, Counsel Stack Legal Research, https://law.counselstack.com/opinion/temple-university-hospital-inc-v-group-health-inc-paed-2005.