CLAIRE C. CECCHI, District Judge.
This matter comes before the Court on motion of Defendants Horizon Blue Cross Blue Shield and Blue Cross Blue Shield of South Carolina (collectively, "Defendants") to dismiss the Complaint filed by plaintiff Sanjeev Kaul ("Plaintiff"), on assignment from Steven. A., pursuant to Federal Rule of Civil Procedure 12(b)(6). ECF No. 8. The motion is decided without oral argument pursuant to Rule 78 of the Federal Rules of Civil Procedure. For the reasons set forth below, Defendants' motion is granted.
The following facts are accepted as true for the purposes of the instant motion. Plaintiff provided medical services to Steven A. between April 22, 2013 and April 28, 2013 in New Jersey. Complaint ("Compl."), ECF Nos. 1-1, 21-1 ¶¶ 1, 6. During that time, Steven A. had insurance coverage through a self-funded health benefits plan sponsored by his employer, Alent, Inc. (the "Alent Plan" or "Plan").
Steven A. executed a document purporting to assign his right to insurance benefits under the Alent Plan to Plaintiff.
On October 15, 2015, Plaintiff filed the instant Complaint against Defendants in the Superior Court of New Jersey, Bergen County, asserting the following claims: breach of contract (Count I); failure to make payments due under a plan governed by the Employee Retirement Income Security Act ("ERISA"), in violation of 29 U.S.C. § 1132(a)(1)(b) (Count II); breach of fiduciary duty and co-fiduciary duty under ERISA, in violation of 29 U.S.C. § 1132(a)(3), § 1104(a)(1), and § 1105(a) (Count III); and failure to establish or maintain reasonable claims procedures, in violation of 29 C.F.R. 2560.503-1. Compl. ¶¶ 19-50.
Defendant removed the action to this Court on November 24, 2015. ECF No. 1. On December 22, 2015, Defendants moved to dismiss Plaintiff's Complaint pursuant to Federal Rule of Civil Procedure 12(b)(6). ECF No. 8. Plaintiff opposed that motion on January 19, 2016. ECF No. 10. In his opposition, Plaintiff agreed to withdraw Count I.
For a complaint to survive dismissal pursuant to Federal Rule of Civil Procedure 12(b)(6), it "must contain sufficient factual matter, accepted as true, to `state a claim to relief that is plausible on its face.'"
In evaluating the sufficiency of a complaint, the Court must accept all well-pleaded factual allegations in the complaint as true and draw all reasonable inferences in favor of the non-moving party.
Defendants contend Plaintiff lacks derivative standing to collect payment as Steven A.'s assignee because the Alent Plan contains multiple anti-assignment clauses prohibiting the assignment of a Plan participant's rights or benefits. Plaintiff asserts the Plan's anti-assignment provisions are unenforceable because: (1) the anti-assignment provisions violate New Jersey law and "federal public policy"; (2) Defendants waived the anti-assignment provisions; and (3) Defendants are estopped from enforcing the anti-assignment provisions. For the reasons set forth below, this Court finds Plaintiff's Complaint fails to set forth facts showing the anti-assignment provisions are unenforceable and, accordingly, will dismiss the Complaint without prejudice.
Plaintiff first argues the anti-assignment provisions are void under a New Jersey statute governing insurance claims, which provides in relevant part: "in the event that the covered person assigns, through an assignment of benefits, his right to receive medically necessary health care services to an out-of-network health care provider, the carrier shall remit payment for the reimbursement directly to the health care provider..." N.J. Stat. Ann. 26:2S-6.1(c). Another court in this district previously rejected that argument, finding "[o]n its face, this statute merely regulates the method of payment when an assignment of benefits occurs. It does not address the question of whether an anti-assignment clause is enforceable."
Plaintiff next argues "there are strong federal public policy concerns against the absolute enforcement of anti-assignment clauses," citing to two related Fifth Circuit cases:
Plaintiff next argues Defendants waived the right to enforce the anti-assignment provisions because Defendants reimbursed him directly for Steven A.'s medical expenses in the amount of $352.32.
Finally, Plaintiff contends Defendants are estopped from enforcing the anti-assignment provisions. The elements of equitable estoppel under ERISA are: "(1) a material representation, (2) reasonable and detrimental reliance upon the representation, and (3) extraordinary circumstances."
For the foregoing reasons, Defendants' motion will be granted without prejudice. To the extent Plaintiff can cure the pleading deficiency by way of amendment, Plaintiff shall have thirty days to file an amended complaint. An appropriate Order accompanies this Opinion.