Karkare v. Cigna Life & Health Ins. Co.

MEMORANDUM & ORDER Cigna Life and Health Insurance Company (“Defendant”) moves, pursuant to Rule 12(b)(6) of the Federal Rules of Civil Procedure (hereafter “Rule”), to dismiss the Complaint of Nakul Karkare M.D. (“Plaintiff”) (hereafter, the “Motion”). (See Motion, in toto, ECF No. 17.) For the reasons that follow, Defendant’s Motion is GRANTED, and Plaintiff’s Complaint is DISMISSED. BACKGROUND¹ Plaintiff brings this action “on behalf of Patient D.P.” (hereafter the “Patient”) against Defendant. (See Compl.) Plaintiff asserts that he “received a Power of Attorney from the Patient.” (Id. 26.) Previously, on March 27, 2019, Patient underwent surgery performed by two doctors affiliated with AA Medical P.C. (hereafter “AA Medical”). (Id. 4.) Plaintiff is also affiliated with AA Medical. (Id. 2.) Specifically, Patient underwent “a bilateral C7-T1 and T1-T2 laminoforaminotomy and medical facetectomy, and a bilateral laminotomy at C7-T1 and T1- T2.” (Id. 4.) Subsequently, Plaintiff submitted an invoice to Defendant, of which Patient is a member. (Id. 12.) At all times, “AA Medical was an out-of-network provider.” (Id. 3.) “Defendant paid $1,039.51, leaving an unreimbursed amount of $340,406.34[].” (Id.) Defendant stated “[i]n its Explanation of Benefits (hereafter “EOB”), constituting its Adverse Benefit Determination,…that the ‘charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement.” (Id. 13.) Plaintiff avers that “there is no fee schedule” and “no contracted fee arrangement” because Plaintiff is out-of-network. (Id.