BROOKLYN, NY – A federal judge has dismissed a lawsuit filed by a New Jersey plastic surgery practice against insurance giant Aetna, ruling the clinic’s claims over a disputed breast reduction surgery payment were preempted by federal benefits law and failed to state a valid claim.
Rowe Plastic Surgery of New Jersey, LLC, and its affiliate Norman Maurice Rowe, M.D., M.H.A., LLC, sued Aetna in 2022, alleging the insurer unlawfully underpaid and delayed reimbursement for a bilateral breast reduction procedure performed on a patient insured through Aetna. The lawsuit, originally filed in New York state court and later removed to federal court, claimed breach of contract, unjust enrichment, promissory estoppel, and violations of New York’s Prompt Pay Law.
But in a decision filed Monday, U.S. District Judge Margo K. Brodie granted Aetna’s motion for judgment on the pleadings under Rule 12c, finding that the plaintiffs’ state law claims were expressly preempted by the federal Employee Retirement Income Security Act (ERISA), which governs employer-sponsored health plans.
According to the court’s opinion, the patient at the center of the dispute, identified as D.B., was covered under an Aetna-administered ERISA plan. The judge found that the plastic surgery providers failed to plead sufficient factual allegations to establish that their claims arose from any independent agreement with Aetna separate from the ERISA plan itself.
The providers argued that pre-surgical calls with Aetna representatives constituted promises to pay. But the court determined those conversations did not create an enforceable contract or legally binding promise under New York law, and that any dispute over payment stemmed from the administration of D.B.’s ERISA plan.
Judge Brodie also rejected the plaintiffs’ claim of fraudulent inducement, concluding that the amended complaint did not identify any specific, knowingly false statements made by Aetna or show that the providers reasonably relied on such statements.
Because the claims were all either preempted by ERISA or legally insufficient, the judge dismissed the case in its entirety.
The ruling marks another victory for insurers defending against out-of-network provider lawsuits over reimbursement, particularly when ERISA preemption is raised as a defense. Without a written contract between the provider and insurer, courts often find that disputes must be resolved under federal benefits law — not through state law tort or contract claims.
