IJKG OPCO LLC v. GENERAL TRADING COMPANY et al

Filing 246

OPINION. Signed by Judge Kevin McNulty on 3/6/2020. (sm)

UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF NEW JERSEY

IJKG OPCO LLC, d/b/a CAREPOINT
HEALTH-BAYONNE MEDICAL
CENTER,

Civ. No. 17-613 1 (KM) (JBC)
OPINION

Plaintiff,
V.

GENERAL TRADING COMPANY,
CONSOLIDATED HEALTH PLANS
INC., CIGNA CORPORATION, INC.,
ZELIS HEALTHCARE, INC. a/k/a
PREMIER HEALTH EXCHANGE, INC.,
FIRST CHOICE INSURANCE
SERVICES, L.L.C., and STANDARD
SECURITY LIFE INSURANCE
COMPANY OF NEW YORK,
Defendants.

KEVIN MCNULTY, U.S.D.J.:
The plaintiff, IJKG Opco LLC, doing business as CarePoint Health—
Bayonne Medical Center (“BMC”), brings suit to recover the costs of medical

care it provided to “Patient 1,” who experienced severe renal complications and
was hospitalized for approximately three weeks. The defendants named in the
Second Amended Complaint’ are General Trading Company (“General

The Second Amended Complaint (DE 212), will be cited herein as “2AC.” For
g
purposes of this motion, the allegations of the 2AC are accepted as true. The pleadin
and motion papers will be cited as follows:
Defendant Cigna’s Memorandum of Law in Support of Motion to
=
“Motion”
Dismiss Plaintiffs Second Amended Complaint. [DE 222.]
Plaintiff IJKG OPCO’s Opposition to Defendant Cigna’s Motion
=
“Opp.”
to Dismiss the Second Amended Complaint. [DE 2251
1

plan; Cigna
Trading”), which provided the patient’s employee welfare benefits
was
Corporation Inc. (“Cigna”); Consolidated Health Plans, Inc. (“CHP”), which
(“Zelis”),
a third-party administrator for the plan; and Zeus Healthcare, Inc.
contract
also known as Premier Health Exchange, Inc., which was the claims
negotiator.
Cigna
BMC previously filed an Amended Complaint (DE 51), as to which
Civ. p. 12(c),
filed a motion for judgment on the pleadings pursuant to Fed. R.
filed a
which I granted. (See Opinion (“Op.”), DE 161.) BMC subsequently
of fiduciary
Second Amended Complaint (“2AC”), which asserts only a breach
to dismiss the
duty claim against Cigna. Now before the court is Cigna’s motion
s stated
2AC pursuant to Fed. R. Civ. P. 12(b)(6). (DE 221.) For the reason
herein, Cigna’s motion is granted.
I.

Summary of Facts2

t at
In November 2013, Patient 1 received treatment for a kidney ailmen
t of
BMC. Plaintiffs treatment resulted in a medical bill in the amoun
nded employee welfare
$771,lgl.ss. (2AC ¶11 23—24) General Trading, a self-fu
27.) General
benefits plan (the “Plan”), provided coverage for Patient 1. (Id. ¶
for “preferred
Trading’s Plan provides coverage for “in-network benefits”
providers” based
providers” and for “out-of-network benefits” for “nonpreferred
provider under the
on Cigna’s insurance network. (Id.) BMC is a “nonpreferred”
providers are
terms of the Plan. (Id.) Unlike preferred providers, non-preferred
able amount” of
reimbursed for only a percentage of the “customary and reason
. (Id. ¶ 30.)
the services, supplies, and treatment provided to the patient
ency services,”
Treatments provided by nonpreferred providers for “emerg
copayment
however, are covered “at the same coinsurance percentage or

of
Defendant Cigna’s Reply Memorandum in Further Support
ed Complaint.
the Motion to Dismiss Plaintiffs Second Amend
(DE 234.J
Opinion. (See
2 A more detailed factual background can be found in my prior
DE 161.)
“Reply”

=

2

provider and allowed
amount as if the services were provided by a nonpreferred
at 100% of the billed amount.” (Id.)
” of the
Plaintiff alleges that Cigna provided “concurrent medical review
orized BMC to
treatment BMC provided to Patient 1 and “specifically auth
dates of service at
render the treatment it provided to Patient 1 for each of the
referred the claim to
issue in this claim. (Id. ¶ 37.) According to the 2AC, Cigna
further processing.
CHP, the Plan’s out-of-network claims administrator, for
”, also
39.) Pursuant to an Administrative Services Agreement (“ASA
that Cigna entered
referred to as the “Cigna Cost Savings Program” in the 2AC)
Program”
into with CHP, and specifically, the “Out-of-Network Savings
designee would
Schedule attached as an exhibit to the ASA, Cigna or its
document called the
provide pricing services to CHP. (Id. ¶ 41.) Based on the a
(Id.

¶

ng services to Zelis,
“Clinical Bill Review and Audit,” Cigna outsourced its prici
regarding Patient l’s bill.
and CHP adopted Zelis’s re-pricing recommendation
,358.05 of Patient
(Id. ¶ 42.) Here, General Trading reimbursed BMC for $175
of at least $595,833.53.
l’s total bill amount, leaving an unpaid balance due
(Id.

¶

36.)

d on January 29,
According to the explanation of benefits that CHP issue
negotiated
“discount.
2014, the majority of disallowances were labeled as
charge.” (Id. ¶ 45.)
through [Zelisi” or “[e]xceeds reasonable and customary
denied. CHP instead
BMC subsequently filed an appeal with CHP, which CHP
ing amount. (Id. ¶j 46—
directed BMC to balance bill Patient 1 for the outstand
Benefits” form that assigned
47.) Patient 1 however executed an “Assignment of
FITS ARISING OUT OF
“ANY AND ALL OF jHER] RIGHTS TO RECEIVE BENE
l))
ANY COVERAGE SOURCE.” (Id. ¶ 52 (emphasis in origina
appeal with CHP which
On January 13, 2015, BMC filed a second-level
.

48.) CHP advised BMC that appeals had to be filed
pany.
because Zelis was CHP’s third-party re-pricing com

was again denied. (Id.
directly with Zelis,

.

¶

instructed BMC to
(Id.) [n contrast, General Trading’s owner, Douglas Boyle,
1 and General Trading
re-submit the outstanding bill to Cigna because Patient
3

er responsible
had paid their deductibles and co-pays in full and were no long
ues of relief under
for the remaining balance. (Id. ¶ 50.) BMC exhausted all aven
Patient l’s bill. (Id.
the Plan in order to reclaim the outstanding $595,833.53 of

¶

56—57.)

nt Two of the
BMC now seeks to recover the outstanding bill amount. Cou
and ZeUs breached
2AC alleges that defendants General Trading, Cigna, CHP,
where BMC would
their fiduciary duties to Patient 1 by orchestrating a scheme
Cigna and other
be underpaid for the services it provided to Patient 1, and that
violation of ERISA
defendants would profit at BMC and Patient l’s expense, in
Specifically, Count Two
§ 502(a)(3), 29 U.S.C. § 1 132(a)(3). (Id. ¶( 40, 80—92.)
or its designee to
alleges that the ASA is a mechanism which allows Cigna
s for
receive a substantial commission in return for repricing claim
Plaintiff alleges that in
reimbursement for out-of-network carriers. (Id. ¶ 41.)
Zelis to re-price Patient
Patient l’s case, Cigna instructed CHP to contract with
mission. (Id. ¶ 42.) CHP
l’s claim in exchange for a substantial re-pricing com
CHP paid Zeus’s
adopted Zelis’s recommended re-pricing amount and
Cost Savings Program,
commission. Plaintiff further alleges that under Cigna’s
of claims payable to
Zelis and CHP have an incentive to reduce the amount
entage of savings. (Id.)
providers because their commission is based on the perc
asserted against
Count Two, alleging a fiduciary breach, is the only claim
balance of its bill, in the
Cigna. BMC now sues to recover the unreimbursed
amount of $595,833.53.
H.

Discussion
a. Standard of Review

t, in whole or in
Rule 12(b)(6) provides for the dismissal of a complain
be granted. Cigna, as the
part, if it fails to state a claim upon which relief can
claim has been stated.
moving party, bears the burden of showing that no
., 654 F.3d 462, 469 n.9 (3d
Animal Science Thods., Inc. v. China Minmetals Corp
iss, the facts alleged in the
Cir. 2011). For the purposes of a motion to dism
inferences are drawn in favor
complaint are accepted as true and all reasonable
4

man Const. Corp.
of the plaintiff. N.J Carpenters & the Trustees Thereof v. Tish
of N.J., 760 F.3d 297, 302 (3d Cir. 2014).
led
Fed. I?. Civ. P. 8(a) does not require that a complaint contain detai
ide the
factual allegations. Nevertheless, “a plaintiffs obligation to prov
s and
‘grounds’ of his ‘entitlement to relief requires more than label
cause of action will
conclusions, and a formulaic recitation of the elements of a
. Thus, the
not do.” Bell AtI. Corp. u. Twombly, 550 U.S. 544, 555 (2007)
plaintiffs right to
complaint’s factual allegations must be sufficient to raise a
on its face.” Id. at
relief above a speculative level, so that a claim is “plausible
tington Nat. Bank,
570; see also W. Run Student Housing Assocs., LLC v. Hun
standard is met
712 F.3d 165, 169 (3d Cir. 2013). That facial-plausibility
t to draw the
“when the plaintiff pleads factual content that allows the cour
misconduct alleged.”
reasonable inference that the defendant is liable for the
550 U.S. at 556).
Ashcroft a Iqbal, 556 U.S. 662, 678 (2009) (citing Twombly,
ability requirement’.
While “ft]he plausibility standard is not akin to a ‘prob
at 678.
it asks for more than a sheer possibility.” Iqbal, 556 U.S.
not consider
When deciding a motion to dismiss, a court typically does
consider documents that
matters outside the pleadings. However, a court may
t” or any “undisputedly
are “integral to or explicitly relied upon in the complain
bit to a motion to
authentic document that a defendant attaches as an exhi
In re Rockefeller
dismiss if the plaintiffs claims are based on the document[.}”
(emphasis and
Ctr. Props., Inc. Sec. Litig., 184 F.3d 280, 287 (3d Cir. 1999)
(No. 171), 822 F.3d 125,
citations omitted); see In re Asbestos Prods. Liab. Litig.
241, 249 (3d Cir. 2014).
133 n.7 (3d Cir. 2016); Schmidt v. Skolas, 770 F.3d
ic record and exhibits
In that regard, courts may consider matters of publ
decide a motion to
attached to the complaint. Schmidt, 770 F.3d at 249 (“To
s contained in the
dismiss, courts generally consider only the allegation
ers of public record”);
complaint, exhibits attached to the complaint and matt
(D.N.J. 2009) (court
Arcand u. Brother Int’l Cop., 673 F. Supp. 2d 282, 292

5

that are essential to plaintiffs
may consider documents referenced in complaint
claim).
ert a motion to
Reliance on these types of documents does not conv
en a complaint relies on a
dismiss into a motion for summary judgment. “Wh
the document,
the plaintiff obviously is on notice of the contents
document
tly diminished.” Pension
and the need for a chance to refute evidence is grea
F.2d 1192, 1196—97 (3d
Benefit Quar. Corp. v. White ConsoL Jndus., Inc., 998
.

.

.

Cir. lgg3).
b. Fiduciary Duty Claim

to the Plan
BMC alleges that Cigna breached its fiduciary duty
whereby General Trading
beneficiaries under ERISA by devising a scheme
Zeus a commission for re
distributed Plan funds to CHP, which then paid
the scheme was not in the
pricing BMC’s claim for Patient 1. BMC alleges that
to maximize profits for
interest of the Plan’s beneficiaries, but was intended
BMC alleges that Cigna and
itself and other named defendants. Additionally,
m BMC of material information,
other defendants misled BMC by failing to infor
t under the Plan, and imposing
misrepresenting requirements for reimbursemen
not contemplated by the Plan.
unduly burdensome preconditions to payment
issed from the case because the
Cigna once again asserts that it must be dism
iary capacity in connection
2AC fails to factually plead that it acted in a fiduc
with the claim at issue.

charging breach of
As set forth in my prior opinions, “[i}n every case
the threshold question is not whether the
fiduciary duty [under ERISA}
ces under the plan adversely
actions of some person employed to provide servi
her that person was acting as a
affected a plan beneficiary’s interest, but whet
tion) when taking the action
fiduciary (that is, was performing a fiduciary func
530 U.S. 211, 226 (2000). Under
subject to the complaint.” Pegram v. Herd rich,
plan if it (i) ‘exercises any
ERJSA, “an entity is a fiduciary with respect to a
respecting management of such
discretionary authority or discretionary control
cting management or
plan or exercises any authority or control respe
.

.

.

6

ce for a fee or other
disposition of its assets’ or (ii) ‘renders investment advi
(iii) ‘has
or has any authority or responsibility to do so,’ or
compensation
the administration of
discretionary authority or discretionary responsibility in
65, 98 (3d Cir. 2012)
such plan.”’ National Sec. Sys., Inc. u. lola, 700 F.3d
n v. Lincoln Nat. Lzfe Ins.
(quoting 29 U.S.C. § 1002(21)(A)); see also Edmonso
status in functional,
Co., 725 F.3d 406, 413 (3d Cir. 2013) (defining fiduciary
.

.

if it has
not formal, terms). Conversely, an entity is not a fiduciary
pretations,
no power to make any decisions as to plan policy, inter
practices or procedures, but perform[s} the following
, within a
administrative functions for an employee benefit plan
tices and
framework of policies, interpretations, rules, prac
respect to the
procedures made by other persons, fiduciaries with
plan:
participation
(1) Application of rules determining eligibility for
or benefits;
its for
(2) Calculation of services and compensation cred
benefits;
rial;
(3) Preparation of employee communications mate
loyment
(4) Maintenance of participants’ service and emp
records;
agencies;
(5) Preparation of reports required by government
(6) Calculation of benefits;
cipants of
(7) Orientation of new participants and advising parti
their rights and options under the plan;
of contributions
(8) Collection of contributions and application
as provided in the plan;
ts’ benefits;
(9) Preparation of reports concerning participan
(10) Processing of claims; and

Op.

ions with
(11) Making recommendations to others for decis
respect to plan administration.
aged Care, LLP, 295 F.
Hospitalization & Med. Sews. v. Merck-Medco Man

2509.75—8). In order “[t]o
Supp. 2d 457, 463 (D.N.J. 2003) (citing 29 C.F.R. §
ERISA fiduciary, the Court
determine whether claims are asserted against an
employed to provide services
must ask not whether the actions of some person
7

interest, but whether that
under a plan adversely affected a plan beneficiary’s
rming a fiduciary’ function)
person was acting as a fiduciary (that is, was perfo
(citing Mulder v. PCS Health
when taking the action subject to complaint.” Id.
rnal quotation marks
Sys., Inc., 216 F.R.D. 307, 313 (D.N.J. 2003) (inte
at 98 (noting that an entity
omitted)); see also National Sec. Sys., mc, 700 F.3d
ities, but not others; the
can be a fiduciary with respect to certain plan activ
acting as a fiduciary when
issue turns on whether some person or entity was
taking the particular action at issue.).
performs as a fiduciary
The determination of whether an entity or person
tasks they perform.
is highly fact-based and dependent on the particular
No. 12-3236, 2015 WL
NeurosurgicalAssocs. Of N.J., P.C. z’. QualCare Inc.,
t, rulings on this issue tend
4569792, at *2 (D.N,J. July 28, 2015). As a resul
iscoveiy motion to dismiss
“to occur after discovery rather than at the pre-d
A Litig., No. 03-1204, 2007
stage.” Id. (citing In re Schering-Plough Corp. ERIS
*7 (D.N.J. Aug. 15, 2007) (“Fiduciary status is a fact sensitive
WL 2374989, at
s at this early stage”.)) Still,
inquiry and courts generally do not dismiss claim
iciently plead[J defendants’
for the case to go forward, the complaint must “suff
complaint’s allegations of
ERISA fiduciary status.” Id. That means that the
hold of factuality and
fiduciary status must meet the Twombly/Iqbal thres
plausibility.
sense,” the threshold
Because Cigna is “not the insurer in the usual
fiduciary with respect to
question becomes whether Cigna functioned as a
ing Co., No. CV176131KMJBC,
Patient l’s claims. IJKG Opco LLC v. Qen. Trad
*4 (D.N.J, Sept. 6, 2018). I noted in my prior opinion that
2018 WL 4251858, at
claims administrator, and
the Plan is self-funded, CHP is the out-of-network
h adjusted and processed the
Zelis is the third party re-pricing company whic
motion to dismiss on the
claim at issue. Id. Previously, I granted Cigna’s
adequately alleged that Cigna
pleadings because I found that BMC had not
plaint only mentioned Cigna a
acted as a fiduciary. The (First) Amended Com

8

nt to meet the
handful of times, and the facts alleged were insufficie
Twornbly/Iqbal plausibility requirement.
Complaint. True,
The 2AC fails to cure the deficiencies of the Amended
to the alleged scheme which
the 2AC does provide more factual background as
. But the 2AC still fails to
BMC asserts constitutes a breach of fiduciary duty
iary in connection with the
plausibly allege that Cigna functioned as a fiduc
Cigna’s role was in
claim at issue. In fact, the 2AC fails to clarify what
connection with this particular claim.
its assertion that Cigna
The 2AC alleges the following facts to support
functioned as a fiduciary:
s the rates
28. Under the terms of the Plan, Cigna negotiate
iders are paid for
that preferred providers and nonpreferred prov
ided to Patient 1 in
emergency services, such as the services prov
this case.
rred Provider”
2. Specifically, the Plan defines a “Cigna Prefe
ce provider which has
as “a physician, hospital, or ancillary servi
a negotiated rate for
an agreement in effect with Cigna to accept
hasis in original).
services rendered to the covered persons.” (emp
w of the
37. Cigna provided concurrent medical revie
specifically
treatment that BMC provided to Patient 1 and
ided to Patient 1 for
authorized BMC to render the treatment it prov
’s claim.
each of the dates of service at issue in BMC
irmed that the
39. Upon information and belief, Cigna conf
covered out-ofservices billed by BMC on Patient l’s claim were
the claim to CHP, the
network services under the Plan and referred
, for further processing.
Plan’s out-of-network claims administrator
that it had
40. In fact, Cigna took these steps knowing
be dramatically
orchestrated a process by which BMC would
nt 1, and Cigna and
underpaid for the services it provided to Patie
BMC’s and Patient l’s
its business partners would be enriched at
expense.
inistrative
41. Specifically, Cigna entered into an Adm
“Out-of-Network
Services Agreement (“ASA”) with CHP. The
ram”) Schedule
Savings Program” (“Cigna’s Cost Savings Prog
Cigna or its
attached as an exhibit to the ASA provides that
CHP, and would receive
designee would provide pricing services to
9

claims for
a substantial commission in return for re-pricing
reimbursement to out-of-network carriers.
document
42. An audit or “Clinical Bill Review and Audit”
decision to
prepared by Zelis confirms that Cigna made the
by
outsource its re-pricing duties under the ASA to Zeus
turn earned a
instructing CHP to contract with Zeus, which in
g fee.” CHP adopted
substantial re-pricing commission, or “re-pricin
g any additional
Zeus’s recommended re-pricing without performin
icing Patient l’s
analysis. CHP paid Zeus’s commission for re-pr
er Cigna’s Cost
claims out of General Trading Plan funds. Und
ed to drastically
Savings Program, Zelis and CHP are incentiviz
use the
reduce claims amounts payable to providers beca
entage of savings.
commission they receive is calculated as a perc
48. During the claim appeal process] [t]he CHP
was paid by CHP based
representative stated that Patient l’s claim
the Cigna network and
on the out-of-network coverage provided by
that no further payment would be made.
11.)
(2AC ¶3128,29,37,39—42,28; see also Opp. at
erned an out-of-network
The 2AC concedes that the claim at issue conc
’s out-of-network claims
provider; that it was referred to CHP, the Plan
in processing the claim. (See
administrator; and that Cigna was not involved
Review and Audit’ document
2AC ¶31 39, 42.) Specifically, the “Clinical Bill

decision to outsource its re
prepared by Zeus confirms that Cigna made the

ructing CHP to contract with Zelis
pricing duties under the ASA to Zelis by inst
added).)
. . .“ (Id. (emphasis
the outsourced its re-pricing duties to Zeus.
and that Cigna outsourced its
Acknowledging that CHP processed the claim
st Plaintiffs argument that
review of out-of-network claims to Zelis cuts again
rol with respect to the
Cigna had any discretionary authority or cont
ts or in the administration of the
management or disposition of the Plan’s asse
Plan with respect to the claim.
d with healthcare
Plaintiff points to the fact that Cigna negotiate
for services rendered to
providers the rates at which they would be paid
28) Those rates, however, were
covered persons under the Plan. (See 2AC ¶
, not out-of-network providers
specifically negotiated for in-network providers
l0

ferred providers do “not have an
like BMC. The Plan explicitly notes that nonpre
ider Organization.” (Ex. A, DE
agreement in effect with the Cigna Preferred Prov
Cigna was a fiduciary with respect
69-2 at 22.) This fact does not suggest that
to out-of-network claims.
paid at Cigna’s in-network
BMC asserts that the claim should have been
was for “emergency services.”
rates since the healthcare provided to Patient 1
claim paid at Cigna’s in-network
However, the fact that BMC seeks to have the
ent with the administration
rate does not suggest that Cigna had any involvem
. As stated above, CHP, not
or payment of Patient l’s out-of-network claim
of out-of-network services; even
Cigna, was responsible for the administration
h was required to apply the inon BMC’s theory, it would have been CHP whic
network rates.
because Cigna (a) provided
Plaintiff also asserts that Cigna is a fiduciary
that BMC provided to Patient 1
“concurrent medical review of the treatment
the treatment it provided to Patient
and specifically authorized BMC to render
d by BMC on Patient l’s claim were
1” and (b) “confirmed that the services bille
Plan.” (2AC ¶ 37, 39.) But the
covered out-of-network services under the
“pure ‘eligibility decisions’ [which]
Supreme Court has distinguished between
condition or medical procedure for
turn on the plan’s coverage of a particular
h consist of “choices about how
its treatment” from “treatment decisions” whic
nt’s condition.” Pegram, 530 U.S. at
to go about diagnosing and treating a patie

ments outside the pleadings at
Although courts generally do not consider docu
ments that are “integral to or
the motion to dismiss stage, it may consider docu
“undisputedly authentic document that
explicitly relied upon in the complaint” or any
on to dismiss if the plaintiffs claims are
a defendant attaches as an exhibit to a moti
Props., Inc. Sec. Litig., 184 F.3d at 287
based on the document,” In re Rockefeller Ctr.
plaintiff is on notice of the contents the
(emphasis and citations omitted), because the
evidence is greatly diminished.” Pension
document, and the need for a chance to refute
graph 28 of the 2AC explicitly refers to
Benefit Guar. Corp., 998 F.2d at 1196—97. Para
in the Plan therefore does not convert
the terms of the Plan. Reliance on the language
ment. See Part II.a, supra.
this motion to dismiss into one for summary judg
3

11

er, treatment-based (as opposed to
228, 120 S. Ct. 2143, 2154 (2000). The latt
ciary in nature. id.4
coverage-based) decisions are not fidu
ciary by explaining that Mr.
Finally, Plaintiff alleges that Cigna is a fidu
tried to involve Cigna in the appeals
Boyle, the Plan administrator, repeatedly
na and referring BMC to Cigna for
process by sending correspondence to Cig
57—61.) In my prior opinion, I
reprocessing and payment of the claim. (Id. ¶7
us of the plan or claims administrator
noted that Cigna did not attain the stat
il.”
ause General Trading sent it an ema
or take on a fiduciary role “merely bec
mpted to involve Cigna in the appeals
(DE 161 at 7.) The fact that Mr. Boyle atte
h
allegation that Cigna is a fiduciary wit
process does not constitute a plausible
onstrate that Cigna had any sort of
respect to the Plan. More is needed to dem
not
this claim. As a result, Plaintiff has
discretionary authority with respect to
d as a fiduciary with respect to the
succeeded in alleging that Cigna acte
l’s claims.
administration and disposition of Patient
not plausibly alleged that Cigna is a
Because I have found that BMC has
IV of Cigna’s Motion to Dismiss on two
fiduciary, I do not reach Points Ill and

on is therefore legally inadequate
For the reasons given in text, the allegati
under Pegram, supra.
e confirms that it is treatment, not
Inspection of the actual decision at issu
y
rs is embodied in a Decision Summar
coverage, The decision to which plaintiff refe
l’s
Cigna authorized extension of Patient
t to Patient 1 by Cigna. It establishes that
sen
it
of all the information provided to them;
hospital stay, based on a medical review
by the Plan. (See
h treatment would be covered
does not reflect a review of whether suc
mary explicitly states that the
Ex. A, DE 109-2jlndeed, the Decision Sum
t of benefits under [thej plan.” (Id.
authorization “does not guarantee paymen
(emphasis added).)
ument, to the extent it may be required,
Reference to the Decision Summary doc
on to dismiss into one for summary
is proper and does not transform this moti
a
to “extractfl an isolated statement from
judgment. A plaintiff should not be able
while shielding the remainder of the
document and plac[e) it in the complaint”
Factory Sec. Litig., 114 F.3d 1410, 1426
ument from scrutiny. in re Burlington Coat
doc
explicitly cite the Decision Summary
(3d Cir. 1997). Although the 2AC does not
on that document. See fri. Moreover, a
document, the claims in the 2AC are based
which
ing at the texts of the documents on
plaintiff “cannot prevent a court from look
or explicitly cite them.” Id. See Part ha,
its claim is based on by failing to attach
supra.
4

12

nt of benefits from Patient 1 to
alternative grounds: namely, that the assignme
duty claim is redundant and
BMC is a limited one, and that Plaintiffs fiduciary
thus should be dismissed.
IV. Conclusion

dismiss for failure to state a
For the foregoing reasons, Cigna’s motion to
that further amendment
claim (DE 221) is GRANTED. Because it appears
nded Complaint as against
would be futile, this dismissal of the Second Ame
Cigna is entered with prejudice.
An appropriate order follows.

Dated: March 6, 2020

Kevin McNulty
United States District Ju

13