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Anjani Sinha Medical PC v. Empire HealthChoice Assurance Inc.

Action Plausibly Claims Additional Reimbursement Under Identified Plan Provisions

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MEMORANDUM AND ORDER Plaintiff Anjani Sinha Medical P.C. provided medical services to a patient covered by a health plan administered by defendant Empire HealthChoice Assurance, Inc. Sinha submitted claims to Empire for $79,252.34 and was reimbursed $1,312.64. Sinha then filed this lawsuit, alleging that Empire under-reimbursed Sinha in violation of the health plan’s terms. Empire moves to dismiss the operative second amended complaint. For the reasons explained below, the motion is granted in part and denied in part. BACKGROUND The following facts, which are taken from the second amended complaint and its exhibits, are assumed to be true for purposes of this order. Empire administers the Ornamental Iron Workers Local 580 employee health benefit plan (the “Plan”). Second Am. Compl. (“SAC”)

4-5, 42 (Dkt. #31). Sinha is an out-of-network medical provider, meaning that it does not have an agreement with Empire to receive payments at a negotiated rate. See id. at

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