Park Avenue Podiatric Care, P.L.L.C. v. Cigna Health and Life Insurance Company
- Alvin Hellerstein
- 1:22-cv-10312
- U.S. District Court · Southern District of New York
- 3
In Park Avenue Podiatric Care v. Cigna, Judge Hellerstein denied reconsideration of the dismissal based on ERISA preemption.
Park Avenue Podiatric Care, P.L.L.C. and Cigna Health and Life Insurance Company; the ruling left the prior dismissal based on ERISA preemption in place.
What happened
Park Avenue Podiatric Care sued Cigna Health and Life Insurance Company over payment for podiatric services provided to a health-plan beneficiary. Park Avenue said Cigna had promised to pay 80 percent of the customary rate but paid only $7,199 on bills totaling $197,350. It asserted contract, unjust-enrichment, promissory-estoppel, and New York prompt-payment claims.
The court had dismissed the case because deciding those claims would require examining the employee health plan, making them preempted by the Employee Retirement Income Security Act. Park Avenue asked the court to reconsider that decision, arguing that its communications with Cigna created an independent oral contract.
Judge Alvin K. Hellerstein denied the motion for reconsideration. He held that Park Avenue identified no controlling law or facts that the court had overlooked, and that Cigna’s alleged payment commitment remained connected to the plan’s terms. The clerk was directed to terminate the reconsideration motion.
The detailed version
- Park Avenue Podiatric Care, P.L.L.C. v. Cigna Health and Life Insurance Company · No. 1:22-cv-10312
- Alvin Hellerstein
- July 31, 2023
Background
Park Avenue Podiatric Care, P.L.L.C. sued Cigna Health and Life Insurance Company seeking payment for podiatric services provided to “SS,” a beneficiary of an employee health benefit plan governed by the Employee Retirement Income Security Act of 1974 (ERISA). Park Avenue was not part of a Cigna provider network. Before treating SS, Park Avenue contacted Cigna, identified itself as an out-of-network provider, and said it was willing to provide services. Park Avenue alleged that Cigna represented that payment for covered services would be based on 80 percent of the customary rate.
Park Avenue provided treatments and billed Cigna $197,350. Cigna paid $7,199. Park Avenue asserted claims for breach of an oral contract, unjust enrichment, promissory estoppel, and violation of New York’s Prompt Pay Law.
Earlier dismissal
On March 13, 2023, the court dismissed the case as preempted by ERISA section 514(a). The court had found that Park Avenue’s claims arose from Cigna’s coverage determinations under the ERISA-regulated plan. Resolving the claims would require the court to analyze the plan’s terms to determine what benefits were owed. The court therefore concluded that the claims required reference to the plan and rejected Park Avenue’s argument that its conversations with Cigna created an oral contract based on an independent legal duty unrelated to the plan.
The opinion also states that Park Avenue, as an out-of-network provider without an assignment of rights from SS, lacked standing to bring an ERISA action against Cigna because ERISA section 502(a) limits who may bring such an action.
Motion for reconsideration
Park Avenue moved for reconsideration of the March 13 dismissal. The court explained that reconsideration is available only when a party identifies an intervening change in controlling law, newly available evidence, or a need to correct clear error or prevent manifest injustice. The standard is narrowly applied to discourage repetitive arguments about issues the court has already considered.
Park Avenue cited no controlling case that the court had overlooked and identified no new facts. Instead, it disagreed with the court’s conclusion that the complaint showed that its claims arose from a coverage determination made under the plan. The court reiterated that Park Avenue had initially contacted Cigna as the plan administrator, and that Cigna’s alleged commitment to pay was inseparable from the plan’s terms. The court also stated that Park Avenue offered no new argument for applying a different ERISA preemption analysis under section 502 rather than the conflict-preemption analysis under section 514(a).
Ruling
Judge Alvin K. Hellerstein denied the motion for reconsideration. The court directed the clerk to terminate ECF No. 20. The opinion does not state that the denial was with or without prejudice.
Read the full 3-page opinion on CourtListener, the free public archive maintained by the Free Law Project.