PHOENIX (LN) — Fortitude, an out-of-network surgical center, alleged Aetna authorized treatments and then serially denied payment after services were provided. The court granted Aetna's partial motion to dismiss.
On unjust enrichment, the court held Fortitude could recover payment from its own patients, defeating the impoverishment element. The surgical center argued it was suing as a patient assignee but had not pleaded the patients themselves were impoverished or lacked legal remedies.
The promissory estoppel claim failed because it relied on Aetna's promise to pay according to plan terms, making the claim dependent on the contract's validity. The court also said the promise lacked definiteness, with Fortitude unable to identify specific rates, conditions, or timelines.
The negligent misrepresentation claim was dismissed for failing to meet Rule 9(b)'s particularity standard. Fortitude identified only that Aetna representatives made statements during a general pre-treatment period, without specifying dates, locations, or which representatives participated. The court separately noted the claim impermissibly addressed future payment promises rather than present facts.
The implied-contract claim fell short because Fortitude admitted it did not know the reimbursement rate when it provided treatment and could only offer alternative formulations, such as a minimum rate equivalent to the usual and customary rate, or reimbursement in accordance with rates Aetna pays for other substantially identical claims submitted by other providers.
The court noted Fortitude made no meaningful changes to its state-law claims despite being told in September 2025 that many were obviously flawed. The court denied further leave to amend, citing its broad discretion where plaintiffs have previously amended.
Fortitude voluntarily dismissed a separate claim under the Federal Employees Health Benefits Act after Aetna moved to dismiss it.
The case remains active on ERISA claims. The court extended the dispositive-motions deadline to December 1, 2026, and ordered the parties to file a joint case management report within two weeks.