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Phillip Butler v. Saint Alphonsus Reigional Medical Center

December 11, 2012

PHILLIP BUTLER,
PLAINTIFF,
v.
SAINT ALPHONSUS REIGIONAL MEDICAL CENTER, DEFENDANT.



The opinion of the court was delivered by: B. Lynn Winmill Chief Judge United States District Court

MEMORANDUM DECISION AND ORDER

INTRODUCTION

The Court has before it Defendants' Motion to Dismiss (Dkt. 5). For the reasons explained below, the Court will grant the motion.

BACKGROUND

Viewing the information in the Amended Complaint as true, which the Court must do pursuant to a 12(b)(6) motion, the facts are as follows. Phillip Butler was involved in a motor vehicle accident on or about July 1, 2012, suffering several injuries. Pl.'s Am. Compl., Dkt. 4 at 2. Butler was transported to Saint Alphonsus Regional Medical Center where he received medical treatment. Id.

St. Alphonsus is a participating network provider of TRICARE insurance and has agreed to provide TRICARE services for a set rate of reimbursement. Id.

St. Alphonsus must also be a "participating provider" for all TRICARE claims. Id. Additionally, the participation agreement prohibits St. Alphonsus from billing a beneficiary for services covered by TRICARE. Id. Finally, the participation agreement requires St. Alphonsus to accept TRICARE payments as payment in full for services rendered. Id.

Butler is an active member of the United States military and medically insured by TRICARE. Id. at 1-2. St Alphonsus was provided with Butler's TRICARE insurance information, but in lieu of submitting the charges to TRICARE, St. Alphonsus filed a hospital lien against Butler's personal injury cause of action. Id. at 3. Butler then filed this suit against St. Alphonsus.

Butler seeks (1) a declaration that Idaho's hospital lien statute is unconstitutional, and (2) an injunction ordering St. Alphonsus to bill TRICARE and release its lien. Id. at 4-5. St. Alphonsus asks the Court to dismiss Butler's claim under Rule 12(b)(6). Def.'s Mem., Dkt. 5 at 3-5.

LEGAL STANDARD

Federal Rule of Civil Procedure 8(a)(2) requires only "a short and plain statement of the claim showing that the pleader is entitled to relief," in order to "give the defendant fair notice of what the . . . claim is and the grounds upon which it rests." Bell Atlantic Corp. v. Twombly, 550 U.S. 544, 555, 127 S.Ct. 1955, 1964 (2007). While a complaint attacked by a Rule 12(b)(6) motion to dismiss "does not need detailed factual allegations," it must set forth "more than labels and conclusions, and a formulaic recitation of the elements of a cause of action will not do." Id. at 555. To survive a motion to dismiss, a complaint must contain sufficient factual matter, accepted as true, to "state a claim to relief that is plausible on its face." Id. at 570. A claim has facial plausibility when the plaintiff pleads factual content that allows the court to draw the reasonable inference that the defendant is liable for the misconduct alleged. Id. at 556. The plausibility standard is not akin to a "probability requirement," but it asks for more than a sheer possibility that a defendant has acted unlawfully. Id. Where a complaint pleads facts that are "merely consistent with" a defendant's liability, it "stops short of the line between possibility and plausibility of 'entitlement to relief.' " Id. at 557.

The Supreme Court identified two "working principles" that underlie Twombly in Ashcroft v. Iqbal, 556 U.S. 662, 678 (2009). First, the court need not accept as true, legal conclusions that are couched as factual allegations. Id. Rule 8 does not "unlock the doors of discovery for a plaintiff armed with nothing more than conclusions." Id. at 678-79. Second, to survive a motion to dismiss, a complaint must state a plausible claim for relief. Id. at 679."Determining whether a complaint states a plausible claim for relief will . . . be a context-specific task that requires the reviewing court to draw on its judicial experience and common sense." Id.

Providing too much in the complaint may also be fatal to a plaintiff. Dismissal may be appropriate when the plaintiff has included sufficient allegations disclosing some absolute defense or bar to recovery. See Weisbuch v. County of L.A., 119 F.3d 778, 783, n. 1 (9th Cir. 1997) (stating that "[i]f the pleadings establish facts compelling a decision one way, that is as good as if depositions and other . . . evidence on summary judgment establishes the identical facts").

A dismissal without leave to amend is improper unless it is beyond doubt that the complaint "could not be saved by any amendment." Harris v. Amgen, Inc., 573 F.3d 728, 737 (9th Cir. 2009) (issued 2 months after Iqbal).*fn1 The Ninth Circuit has held that "in dismissals for failure to state a claim, a district court should grant leave to amend even if no request to amend the pleading was made, unless it determines that the pleading could not possibly be cured by the allegation of other facts." Cook, Perkiss and Liehe, Inc. v. Northern California Collection Service, Inc., 911 ...


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