United States District Court, W.D. Louisiana, Alexandria Division
SANAT V. SANGHANI, MD, LLC, Plaintiff
UNITED HEALTHCARE SERVICES, INC., Defendant v.
REPORT AND RECOMMENDATION
H.L. PEREZ-MONTES UNITED STATES MAGISTRATE JUDGE
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.
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.
originally filed suit in Alexandria City Court. According to
Sanghani, United provided health insurance coverage to one of
Sanghani's patients, “S.A.” United clarifies
that S.A. is covered under an employee welfare benefit plan
(the “Plan”) sponsored by S.A.'s employer,
is a specialist in radiation oncology. Sanghani claims he
sought and received pre-authorization to provide services to
S.A., provided services, and received an assignment of
benefits from S.A. allowing Sanghani to pursue health
benefits on S.A.'s behalf. Sanghani alleges a balance of
$8, 846.00 remains outstanding and unpaid by United.
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
statement of contested facts filed with the opposition,
Sanghani listed five factual assertions not contained in the
1. Defendant agreed to pay plaintiff for his services at the
network level in preapproving plaintiff's services.
2. Defendant never furnished plaintiff a copy of the Summary
Plan Description of the United Healthcare plan covering
patient Steve Aldrich.
3. Defendant never advised plaintiff that the health
insurance plan was an ERISA one.
4. Defendant never gave notice to plaintiff referencing the
specific plan provisions upon which the denial was based.
5. Defendant never advised plaintiff the additional materials
required to receive payment.
6. Defendant never explained to plaintiff the basis of the
non-payment of plaintiff's bill for services rendered to
Mr. Aldrich despite defendant's ...