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Bay Area Surgical Group, Inc v. Anthem Blue Cross Life & Health As Moot Insur. Co.

April 19, 2011


The opinion of the court was delivered by: Lucy H. Koh United States District Judge


Plaintiff Bay Area Surgical Group, Inc. ("Plaintiff") brings the instant action against Defendants Anthem Blue Cross Life and Health Insurance Company ("Anthem"), Health Care 19 Service Corporation Illinois State PAC, NFP, and Blue Cross Blue Shield of Texas (collectively "Defendants"). In brief, Plaintiff alleges that, pursuant to a written assignment agreement, it is 21 entitled to receive full payment from Defendants for a surgical procedure it performed on a patient 22 as the patient's assignee. Defendants move to dismiss the complaint for failure to state a claim 23 upon which relief may be granted. Defendant Anthem also moves to strike portions of the 24 complaint. Although Plaintiff's oppositions were due no later than March 31, 2011, as of the date 25 of this Order, Plaintiff has not filed any oppositions. The Court deems these motions appropriate 26 for resolution without oral argument, and vacates the April 21, 2011 motion hearing and case 27 management conference. See Civ. L. R. 7-1(b). For the reasons explained below, Defendants' 28 motions to dismiss are GRANTED with leave to amend. Defendant Anthem's motion to strike is DENIED as moot. health care services at its facility in Santa Clara, California. See Compl. ¶ 9. On January 14, 2009, 6 a patient of Plaintiff underwent surgery. Plaintiff alleges that the patient was insured by a "health 7 benefits agreement" with Defendants. Id. at ¶ 11. Under that agreement, Defendants promised to 8 pay for certain costs of health care services incurred by the patient. Id. 9


In the Complaint, Plaintiff describes itself as an ambulatory surgery center that provides Plaintiff alleges that, on January 14, 2009, the patient executed an "Assignment of Benefits" to Plaintiff, which authorized Plaintiff, as the patient's assignee, to bill the insurance 11 carrier (Defendants) directly. Pursuant to the timely claim for payment. Id. at ¶ 13. However, according to Plaintiff, Defendants have not made 13 the full payment of the outstanding charges. 14

15 breach of contract; (2) implied covenant of good faith and fair dealing; and (3) common counts. 16

Presently before the Court are Defendants' motions to dismiss for failure to state a claim and 17 motion to strike portions of the complaint. 18 assignment agreement, Plaintiff alleges it submitted a United States District Court For the Northern District of California

Based on these allegations, Plaintiff brings suit for three California state law claims: (1)


Dismissal under Federal Rule of Civil Procedure 12(b)(6) for failure to state a claim is "proper only where there is no cognizable legal theory or an absence of sufficient facts alleged to 21 support a cognizable legal theory." Shroyer v. New Cingular Wireless Services, Inc., 606 F.3d 658, 22 664 (9th Cir. 2010) (quoting Navarro v. Block, 250 F.3d 729, 732 (9th Cir. 2001)). In considering 23 whether the complaint is sufficient to state a claim, the court must accept as true all of the factual 24 allegations contained in the complaint. Ashcroft v. Iqbal, 129 S.Ct. 1937, 1949 (2009). While a 25 complaint need not allege detailed factual allegations, it "must contain sufficient factual matter, 26 accepted as true, to "'state a claim to relief that is plausible on its face.'" Iqbal, 129 S.Ct. at 1949 27 (quoting Bell Atlantic Corp. v. Twombly, 550 U.S. 544, 570 (2007)). If the court concludes that the 28 complaint should be dismissed, it must then decide whether to grant leave to amend. "[A] district 2 court should grant leave to amend even if no request to amend the pleading was made, unless it 3 determines that the pleading could not possibly be cured by the allegation of other facts." Lopez v. 4

Cir. 1995)). 6

7 is preempted by the Employment Retirement Income Security Act of 1974 ("ERISA"), as 8 amended, 29 U.S.C. §§ 1001 et seq. Section 1144(a) of ERISA provides that ERISA provisions 9 Smith, 203 F.3d 1122, 1130 (9th Cir. 2000) (quoting Doe v. United States, 58 F.3d 494, 497 (9th 5 Defendants move to dismiss on the ground that each of Plaintiff's state law causes of action "supersede any and all State laws insofar as they may now or hereafter relate to any employee 10 benefit plan . . . ." See 29 U.S.C. § 1144(a). The provisions of ERISA "apply to any employee benefit plan if it is established or maintained--

(1) by any employer engaged in commerce or in any

12 industry or activity affecting commerce; or (2) by any employee organization or organizations 13 representing employees engaged in commerce or in any ...

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