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Sanat v. Sanghani, MD, LLC v. United Healthcare Services Inc.

United States District Court, W.D. Louisiana, Alexandria Division

February 8, 2018

SANAT V. SANGHANI, MD, LLC, Plaintiff
v.
UNITED HEALTHCARE SERICES, INC., Defendant

          DRELL JUDGE.

          REPORT AND RECOMMENDATION

          JOSEPH H.L. PEREZ-MONTES UNITED STATES MAGISTRATE JUDGE.

         Before the Court is a Motion to Dismiss or, in the Alternative, for Summary Judgment (Doc. 10) filed by Defendant, UnitedHealthcare Insurance Company of Illinois (“United”). United maintains that the claims asserted by Plaintiff, Sanat V. Sanghani, MD, LLC (“Sanghani”) under La. R.S. 22:1821, 22:1832, and 22:1973 are preempted by the Employee Retirement Income Security Act, 29 U.S.C. § 1001, et seq. (“ERISA”), or are otherwise subject to dismissal.

         United is correct. ERISA completely preempts Sanghani's claim to recover unpaid benefits under La. R.S. 22:1821. Sanghani's claims under La. R.S. 22:1832 and 22:1973 are not viable as a matter of law. Accordingly, United's motion to dismiss should be granted, and Sanghani's statutory claims should be dismissed with prejudice. United's request for summary judgment seeks, essentially, the same relief as its motion to dismiss: a ruling that United's plan is governed by ERISA, and therefore, that Sanghani's claims are preempted by ERISA or should otherwise be dismissed. Accordingly, United's motion for summary judgment should be denied as moot. And Sanghani's claim to recover unpaid benefits should proceed under ERISA.

         I. Background

         Sanghani originally filed suit in Alexandria City Court. According to Sanghani, United provided health insurance coverage to one of Sanghani's patients, “E.B.” United clarifies that E.B. is covered under an employee welfare benefit plan (the “Plan”) sponsored by E.B.'s employer, Kay and Associates, Inc.

         Sanghani is a specialist in radiation oncology. Sanghani claims he sought and received pre-authorization to provide services to E.B., provided services, and received an assignment of benefits from E.B. allowing Sanghani to pursue health benefits on E.B.'s behalf. Sanghani alleges a balance of $11, 711.06 remains outstanding and unpaid by United.

         Sanghani asserts claims against United under La. R.S. 22:1821, La. R.S. 22:2832, and La. R.S. 22:1973. Sanghani seeks the unpaid benefits, penalties, attorney's fees, interest, and costs. United removed, and shortly thereafter, filed the pending motion.

         In a statement of contested facts filed with the opposition, Sanghani listed five factual assertions not contained in the petition:

1. Defendant never furnished plaintiff a copy of the Summary Plan Description of the United Healthcare plan covering patient [E.B.].
2. Defendant never advised plaintiff that the health insurance plan was an ERISA one.
3. Defendant never gave notice to plaintiff referencing the specific plan provisions upon which the denial was based.
4. Defendant never advised plaintiff the additional materials required to receive payment.
5. Defendant never explained to plaintiff the basis of the non-payment of plaintiff's bill for services rendered to Mr. Brink despite defendant's ...

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