MEMORANDUM & ORDER Plaintiff Surgicore of Jersey City (“Surgicore”) is an ambulatory surgery center based in New Jersey. In 2018, Surgicore performed certain medical services for its patient, G.S. Surgicore brings this action to recover money billed for those services. Surgicore’s complaint alleges that G.S. was covered under a health benefits plan issued by defendant Anthem Life & Disability Insurance Company (“Anthem”), but an affiliated insurance company — Empire HealthChoice Assurance, Inc. (“Empire”) — appeared in this action and said that it, not Anthem, actually administered G.S.’s health-benefits plan. See Defendant’s Opening Brief at 1, 5-6, ECF No. 16-1 (“Def. Br.”). The parties now agree that Empire is the proper defendant here, and the Court grants Surgicore’s request to substitute Empire as the defendant.1 The Complaint alleges that the Defendant insurer violated New York state law by refusing to reimburse the full amount that Surgicore billed for services rendered to G.S. Surgicore asserts claims for breach of contract, promissory estoppel, and equitable estoppel, and also alleges that Defendant violated New York Insurance Law §3224 — a (the “Prompt Pay Law”). Presently before the Court is Empire’s motion to dismiss. Empire argues, first, that Plaintiff lacks standing to assert any claim that is based on G.S.’s purported assignment to Surgicore of her right to reimbursement, because the insurance policy at issue expressly precludes such assignment. Empire also moves to dismiss all causes of action for failure to state a claim upon which relief can be granted under Rule 12(b)(6) of the Federal Rules of Civil Procedure. The Court finds that Surgicore has standing to pursue its claims. Nevertheless, for the reasons set forth below, I dismiss all causes of action for failure to state a claim. I. Factual Background The following facts are alleged in the Complaint (unless otherwise noted) and are accepted as true for purposes of this motion. Surgicore rendered certain surgical services to G.S. between October 19, 2018 and November 2, 2018. Complaint
13, 17, 33, ECF No. 1 (“Compl.”). G.S.’s insurance plan was called the “Empire Hospital Only PPO Plan for City of New York” (the “Plan”). See Declaration of Frances Shultz 9, ECF No. 16-2 (referencing the Plan at 64, ECF No. 16-3). Surgicore is outside of Empire’s network, meaning that it does not have an established contract with Empire for reimbursement at a predetermined and/or negotiated rate. As noted above, each of the Complaint’s allegations was made against Anthem — an affiliate of Empire.2 For example, Plaintiff alleges that its employees “confirmed with Anthem” that “it had indeed issued the Plan” under which G.S. was covered. Compl. 10. Surgicore alleges that Anthem’s employees further confirmed that G.S. “was eligible under the [P]lan for out-of-network medical benefits; that the services [Surgicore] was going to render were covered under the Plan, and [that] the Plan provided for payment to an ‘out-of-network’ medical provider.” Id. Plaintiff does not divulge, however, the names of any Anthem (or Empire) employee who made these statements, the precise content of these alleged communications, or the date(s) on which they occurred. And beyond the confusion about which company Surgicore’s personnel spoke to, the Complaint reads as bare-bones and perfunctory in several key respects — including with respect to how much Surgicore was to be reimbursed. Surgicore claims that the person or persons to whom it spoke “promised to pay” Surgicore the “maximum allowed rate” for the services at issue.3 Id. 11. But the Complaint does not claim that there was any discussion about how this maximum rate would be calculated. Instead, the Complaint elides this “maximum allowed rate” concept and a different, statutory reimbursement rate called the “usual, customary and reasonable [or UCR]” rate. See id. 11. Surgicore alleges that it — Surgicore — “uses the…[UCR] rate to determine the fee for the service rendered.” Id. 12. Though Surgicore does not claim to have described this practice to Anthem / Empire, Surgicore goes on to allege that that no one at Anthem / Empire denied that the UCR rate (or a percentage thereof) would be an appropriate reimbursement rate. See id.
