Bert Martinez v. Beatrice Lynn Duarte, et al.

Summary

The United States District Court for the District of Arizona granted motions to dismiss filed by Beatrice Lynn Duarte and Kaiser Foundation Health Plan Incorporated in Bert Martinez's action concerning payment for an out-of-network air ambulance service. The court held that the No Surprises Act barred enforcement of the alleged contract to collect the unpaid balance from the insured and that the requested appointment of an arbitrator was not legally cognizable. The court also held that it lacked general and specific personal jurisdiction over Kaiser, dismissed the claims with prejudice, awarded Duarte entitlement to attorney fees under Arizona law, and directed the Clerk to close the case.

Holdings

1. The alleged contract provision requiring the insured to pay charges not covered by insurance is the type of balance billing prohibited by the No Surprises Act. Martinez therefore failed to state a legally cognizable breach-of-contract claim against Duarte and her husband, and amendment would be futile.
2. Martinez failed to state a legally cognizable claim to compel Duarte or her husband to participate in the No Surprises Act's independent dispute resolution process or to have the court appoint an arbitrator, because the statutory process applies to payment disputes between out-of-network providers and insurers and does not require the insured to participate.
3. The court lacked general personal jurisdiction over Kaiser. Kaiser's alleged registration to do business in Arizona, without more, did not establish that Kaiser was essentially at home in Arizona.
4. The court lacked specific personal jurisdiction over Kaiser because Martinez did not show that Kaiser purposefully directed activity toward Arizona or that his claims arose out of or related to sufficient forum contacts.
5. Duarte was entitled to seek attorney fees under Ariz. Rev. Stat. § 12-341.01(A) because the action arose out of a contract dispute, although the reasonableness of the fees would be addressed through the later fee process.

Questions Presented

1. Whether the alleged contract requiring the insured to pay charges not covered by insurance could support a breach-of-contract claim when the No Surprises Act limits an insured's liability for out-of-network air-ambulance services.
2. Whether Martinez stated a legally cognizable claim to compel Duarte and her husband to participate in the No Surprises Act's independent dispute resolution process or to obtain appointment of an arbitrator.
3. Whether the court had general personal jurisdiction over Kaiser based on its alleged registration to do business in Arizona.
4. Whether the court had specific personal jurisdiction over Kaiser based on Kaiser's payment of a claim to Air Ambulance, an Arizona corporation.
5. Whether Duarte was entitled to attorney fees under Ariz. Rev. Stat. § 12-341.01(A).

Disposition

dismissed