Opinion
Index No. 713748/2021 Mot. Seq. Nos. 3 4
05-27-2022
EAST COAST PLASTIC SURGERY, P.C., Plaintiff, v. OXFORD HEALTH INSURANCE CO., INC., OXFORD HEALTH INSURANCE, INC., OXFORD HEALTH PLANS (NJ), INC, OXFORD HEALTH PLANS (NY), INC, and OXFORD HEALTH PLANS, LLC, Defendants.
Unpublished Opinion
Motion Date: 05/04/2022
Present: Honorable Joseph J. Esposito Justice
SHORT FORM ORDER
JOSEPH J. ESPOSITO, J.S.C.
The following numbered papers read on this motion by the defendants for an Order pursuant to CPLR §3211(a) and (7), dismissing the amended Complaint of plaintiff, in its entirety and with prejudice and for such other and further relief as this court may deem just and proper Defendant further requests an Order striking portions of the affidavit of Kathleen Dammao dated October 14 2021, and the exhibits annexed thereto, and the Affirmation of Brendan J. Kearns dated March 17, 2022, and the exhibit thereto, submitted in Opposition to defendants motion to dismiss the Amended Complaint, as well as plaintiffs argument related thereto as set forth in plaintiffs memorandum of Law in opposition to defendants' motion to dismiss.
Papers Numbered
Notices of Motion - Affidavits- Exhibits Seq. 3 ...................
EF 32-39
Affirmation in Opposition Seq. 3 ..............
EF 40-45
Reply Affirmation Seq. 3 ....................
EF 47-48
Notice of Motion Seq 4 .................. .
EF 49 - 51
Affirmation in Opposition Seq 4 ..............
EF 52
Reply Affirmation Seq 4 ...................
EF 53
Plaintiff, East Coast Plastic Surgery, P .C. ("ECPS'), is a company that provides health services in the State of New York. According to the Complaint, plaintiff rendered a breast reduction to patient, M.H., (the" patient"), and thereafter submitted bills to Oxford for such services (Doc. No. 33). The patient was insured through her employer's employee health benefit plan that was fully funded by a group policy of insurance issued by Oxford, the Select, Express & Logistics, LLC Health Benefit Plan (the "Plan"), which is an employee welfare benefit plan governed by the Employee Retirement Income Security Act of 1974" ("ERISA") (Id.).
Plaintiff alleges the existence of an express contract between the parties in which plaintiff refers to as "network exception" that was purportedly issued by Oxford in a letter dated July 3, 2019. Said letter allegedly approved the patient's request for an in-network exception, which it claims is an "'agreement to pay an out-of-network medical provider to render a specific healthcare service or services during a specific period of time for a specific price in-network rate,"' which plaintiff alleges is 80% of their full-billed charges (Id.). Plaintiffs Amended Complaint alleges four counts against the defendants, all sounding in New York state law: (1) breach of contract; (2) unjust enrichment; (3) promissory estoppel; and violation of New York s Prompt Pay Law. Plaintiff notes that it isn't making an ERISA claim because ECPS s state law claims arise from an independent legal duty not created by ERISA.
Defendants argues that plaintiff s amended Complaint should be dismissed in its entirety and with prejudice on the ground that each of plaintiff s state law causes of action is expressly preempted by ERISA. Defendant notes that it is "well-settled that claims seeking to enforce rights to benefits under ERISA plans may only be brought pursuant to ERISA 502(a), 29 USC 1132(a) (Doc. No. 33; see also Pilot Life Ins. Co v Dedeaux, 481 U.S. 41,54 (1987). Defendants further state that "ERISA's Federal Preemption provision explicitly provides in pertinent part: "... the provisions of this subchapter... shall supersede any and all State laws insofar as they may now or hereafter relate to any employee benefit plan ...." (Id-, see also ERISA 514; 29 USC 11 (a)).
Firstly, this Court addresses defendants' separate motion (sequence number 4) to strike the affidavits proffered in plaintiffs opposition to defendant's motion to dismiss. The Court finds that such motion is improper and therefore, the motion is denied. Any argument relating to t e affidavits should have been made in defendant's reply affirmation. Defendant argues tha the plaintiff s opposition is rife with factual allegations and arguments that are not alleged in plaintiff s amended complaint. The Court finds that plaintiffs opposition was merely a response to he arguments made by the defendant. The exhibits, i.e., affidavits, are evidence that the plaintiff proffered to make their case in the instant motion. Therefore, the Court will consider the Damiano affidavit and the Kearns affirmations, and any allegations and arguments included therein. Secondly, this Court agrees with the defendants in that the instant action is preempted by ERISA. Opposition seeks to "enforce promises made by Oxford to ECPS' vis-a-vis the July 03 2019, letter (NYSCEF Doc No 38 & 45 -Letter & Memorandum of Law in Opposition). The said letter stated that the services performed by ECPS shall be treated as if performed by an in-network provider. As stated above, the plan is governed by ERISA and thus is subject to 29 USC~~ 144~a), which supersedes all state law claims. Thus, the state claims of (i) breach of contract· (ii) unjust enrichment; (iii) promissory estoppel; and (iv) violation of New York's prompt pay law are superseded and struck from the complaint. Without any other standing causes of action w1thm the complaint it is
ORDERED that defendant's motion to dismiss is granted and the complaint is dismissed in its entirety and with prejudice as against said defendants and the Clerk is directed to enter judgment accordingly in favor of said defendants; and it is further
ORDERED that defendant's motion to strike the affidavits proffered in support of plaintiffs opposition to defendant's motion is denied.
The foregoing constitutes the decision and Order of this Court.