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United States District Court for the Central District of California
January 6, 2020, Decided; January 6, 2020, Filed
SACV 19-00709 AG (ADSx)
CIVIL MINUTES — GENERAL
[IN CHAMBERS] ORDER REGARDING MOTION TO DISMISS (DKT. NO. 44)
Plaintiff Bristol SL Holdings, Inc. ("Bristol"), as the assignee of Sure Haven, Inc. ("Sure Haven"), a substance abuse treatment center, sued Defendants Cigna Health and Life Insurance Company [*2] and Cigna Behavioral Health, Inc. (collectively, "Cigna") for their alleged failure to pay for covered substance abuse treatment services provided by Sure Haven to Cigna patients. (First Amended Compl. ("FAC"), Dkt. No. 42.) Bristol asserts one claim under the Employment Retirement Income Security Act ("ERISA") and ten state law claims.
Cigna now moves to dismiss Bristol's FAC. (Motion to Dismiss ("Motion"), Dkt. No. 44.) The Court previously dismissed Bristol's initial complaint for failing to plead sufficient facts. (Order, Dkt. No. 38.)
The Court GRANTS in part and DENIES in part Cigna's motion with leave to amend, subject to the limitations described in this order. A second amended complaint may be filed within 30 days.
1. BRIEF BACKGROUND
The following facts are taken from Bristol's FAC and, for the purposes of this motion, the Court assumes they're true.
Bristol is the successor in interest to Sure Haven, a now-bankrupt mental health and substance abuse treatment center. (FAC, Dkt. No. 42 at ¶¶ 1, 7.) Cigna is the purported provider of health benefits coverage to Sure Haven's patients. (Id. at ¶¶ 2, 14.)
Bristol alleges that, before admitting or providing treatment to any Cigna patient, [*3] Sure Haven would contact Cigna by phone to confirm Cigna would reimburse them for their services at an agreed upon rate. (Id. at TR 16-18.) Bristol claims no Cigna patient was admitted for treatment until this verification was complete. (Id. at ¶134-35.) Following admittance, Bristol alleges Sure Haven "routinely called [Cigna] at specific intervals ... to receive authorization to continue providing services to [Cigna] patient[s]." (Id. at ¶ 39.) But despite Cigna's continued authorization of service coverage, Bristol claims Cigna failed to pay Sure Haven for $8,618,068.26 in covered services provided by Sure Haven to Cigna patients. (id at ¶ 15.)
Based on these and other facts, Bristol asserts the following eleven claims against Cigna: (1) breach of express oral contract; (2) breach of implied contract; (3) promissory estoppel; (4) intentional misrepresentation; (5) negligent misrepresentation; (6) fraudulent concealment; (7) violation of California's Unfair Competition Law ("UCL"), California Business and Professions Code Section 17200; (8) negligent interference with prospective economic advantage; (9) recovery of plan benefits under ERISA, 29 U.S.C. Section 1132(a)(1)(B); (10) breach of written contract; and (11) breach of the implied covenant of good faith and [*4] fair dealing.
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2020 U.S. Dist. LEXIS 76342 *; 2020 WL 2027955
BRISTOL SL HOLDINGS, INC. ET AL. v. CIGNA HEALTH LIFE INSURANCE COMPANY ET AL.
Prior History: Bristol SL Holdings, Inc. v. Cigna Health Life Ins. Co., 2019 U.S. Dist. LEXIS 206816 (C.D. Cal., Sept. 24, 2019)
allegations, implied contract, patient, economic loss rule, pleadings, cause of action, authorization, covenant, promissory estoppel, motion to dismiss, leave to amend, verification, cases, phone, healthcare provider, written contract, tort claim, shotgun, argues