Case 2:21-cv-13156 Document 1-2 Filed 06/30/21 Page 1 of 12 PageID: 8
`Case 2:21-cv-13156 Document 1-2 Filed 06/30/21 Page 1 of 12 PageID: 8
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`EXHIBIT “A”
`
`EXHIBIT “A”
`
`

`

`SUMMONS
`
`Attorney(s) Lawall & Mitchell, LLC
`
`Office Address 55 Madison Avenue
`
`Town, State, Zip Code Morristown, New Jersey 07960
`
`Telephone Number 973-285-3280
`
`Attorney(s) for Plaintiff
`
`EDISON SPINE CENTER
`
`Plaintiff(s)
`
`vs.
`
`AE'TNA, INC) JOHN DOES 1-10, JANE DOES
`
`1-10, AND ABC CORPORATIONS 1-10.
`Defendant(s)
`
`Superior Court of
`New Jersey
`
`Middlesex
`
` County
`
`Civil
`Division
`Docket No: MID-L-0029.12-2 I
`
`CIVIL ACTION
`SUMMONS
`
`From The State of New Jersey To The Defendant(s) Named Above:
`
`The plaintiff, named above, has filed a lawsuit against you in the Superior Court of New Jersey. The complaint attached
`to this summons states the basis for this lawsuit. If you dispute this complaint, you or your attorney must file a written
`answer or motion and proof of service with the deputy clerk of the Superior Court in the county listed above within 35 days
`from the date you received this summons, not counting the date you received it. (A directory of the addresses of each deputy
`clerk of the Superior Court is available in the Civil Division Management Office in the county listed above and online at
`http://www.njcourts.govifonns/10153 deptvelerklawrelodf.) If the complaint is one in foreclosure, then you must file your
`written answer or motion and proof of service with the Clerk of the Superior Court, Hughes Justice Complex,
`P.O. Box 971, Trenton, NJ 08625-0971. A filing fee payable to the Treasurer, State of New Jersey and a completed Case
`Information Statement (available from the deputy clerk of the Superior Court) must accompany your answer or motion when
`it is filed. You must also send a copy of your answer or motion to plaintiffs attorney whose name and address appear above,
`or to plaintiff, if no attorney is named above. A telephone call will not protect your rights; you must file and serve a written
`answer or motion (with fee of S175.00 and completed Case Information Statement) if you want the court to hear your
`defense.
`
`If you do not file and serve a written answer or motion within 35 days, the court may enter a judgment against you for
`the relief plaintiff demands, plus interest and costs of suit. If judgment is entered against you, the Sheriff may seize your
`money, wages or property to pay all or part of the judgment.
`
`If you cannot afford an attorney, you may call the Legal Services office in the county where you live or the Legal
`Services of New Jersey Statewide Hotline at 1-888-LSNJ-LAW (1-888-576-5529). If you do not have an attorney and are
`not eligible for free legal assistance, you may obtain a referral to an attorney by calling one of the Lawyer Referral Services.
`A directory with contact information for local Legal Services Offices and Lawyer Referral Services is available in the Civil
`Division Management Office in the county listed above and online at
`httEl/www.n.jcourts.goviforms;10153 de_ptyclerk la Wre
`
`/s/ Michelle M. Smith
`
`Clerk of the Superior Court
`
`DATED: May 18.2021
`
`Name of Defendant to Be Served:
`
`Aetna, Inc.
`
`Address of Defendant to Be Served: 151 Farmington Avenue, Hartford, Connecticut 06156
`
`

`

`MID L 002942-21 05/15/2021 4:37:01 AM Pg 1 of 1 Trans ID: LCV20211219235
`
`MIDDLESEX VICINAGE CIVIL DIVISION
`P 0 BOX 2633
`56 PATERSON STREET
`NJ 08903-2633
`NEW BRUNSWICK
`
`COURT TELEPHONE NO. (732) 645-4300
`COURT HOURS 8:30 AM - 4:30 PM
`
`TRACK ASSIGNMENT NOTICE
`
`DATE: MAY 14, 2021
`RE:
`EDISON SPINE CENTER VS AETNA, INC.
`DOCKET: MID L -002942 21
`
`THE ABOVE CASE HAS BEEN ASSIGNED TO: TRACK 2.
`
`DISCOVERY IS 300 DAYS AND RUNS FROM THE FIRST ANSWER OR 90 DAYS
`FROM SERVICE ON THE FIRST DEFENDANT, WHICHEVER COMES FIRST.
`
`THE PRETRIAL JUDGE ASSIGNED IS: HON DENNIS NIEVES
`
`IF YOU HAVE ANY QUESTIONS, CONTACT TEAM
`AT: (732) 645-4300 EXT 88371.
`
`003
`
`IF YOU BELIEVE THAT THE TRACK IS INAPPROPRIATE YOU MUST FILE A
`CERTIFICATION OF GOOD CAUSE WITHIN 30 DAYS OF THE FILING OF YOUR PLEADING.
`PLAINTIFF MUST SERVE COPIES OF THIS FORM ON ALL OTHER PARTIES IN ACCORDANCE
`WITH R.4:5A-2.
`
`ATTENTION:
`
`ATT: AARON A. MITCHELL
`LAWALL & MITCHELL
`55 MADISON AVE
`STE 400
`MORRISTOWN
`
`NJ 07960
`
`ECOURTS
`
`

`

`MID-L-002942-21 05/14/2021 3:12:54 PM Pg 1 of 7 Trans ID: LCV20211214526
`
`X .
`
` SUPERIOR COURT OF NEW JERSEY
`: LAW DIVISION: MIDDLESEX COUNTY
`
`: DOCKET NO.:
`
`CIVIL ACTION
`
`Lawall & Mitchell, LLC
`Dara J. Lawall, Esquire (I.D. #028332008)
`55 Madison Avenue
`Morristown, New Jersey 07960
`Attorneys for Plaintiff
`973-285-3280
`
`EDISON SPINE CENTER,
`
`Plaintiff,
`
`VS.
`
`AETNA, INC., JOHN DOES 1-10, JANE
`DOES 1-10, AND ABC CORPORATIONS 1-
`10.
`
`• COMPLAINT, JURY DEMAND AND
`. DESIGNATION OF TRIAL COUNSEL
`
`Defendants.
`
`X
`
`Plaintiff Edison Spine Center, by and through its attorneys, Lawall and Mitchell, LLC and
`
`as and for its Complaint against Defendants Aetna, Inc., John Does 1-10, Jane Does 1-10, and
`
`ABC Corporations 1-10, says:
`
`THE PARTIES
`
`1.
`
`Plaintiff Edison Spine Center (hereinafter referred to as "ESC and "Plaintiff') with
`
`a business address of 10 Parsonage Road, Suite 500, City of Edison, County of Middlesex, and
`
`State of New Jersey, is now and was at all times relevant to this action, a company organized and
`
`operating under the Law of the State of New Jersey, providing healthcare services.
`
`2.
`
`Upon information and belief, at all relevant times, Defendant Aetna, Inc.
`
`(hereinafter referred to as "Aetna") was a corporation whose headquarters are located at 151
`
`

`

`MID-L-002942-21 05/14/2021 3:12:54 PM Pg 2 of 7 Trans ID: LCV20211214526
`
`Farmington Avenue, Hartford, Connecticut. which conducted and continues to conduct significant
`
`business in the State of New Jersey.
`
`3.
`
`At all times relevant, upon information and belief. fictitious Defendants John Does
`
`1-10, Jane Does 1-10 and ABC Corporations I - 10, are yet to be identified entities who directly
`
`and proximately caused damages to Plaintiff.
`
`JURISDICTION AND VENUE
`
`4.
`
`Plaintiffs office is located in Middlesex County. New Jersey, and all medical
`
`services which are the subject matter of this action were rendered in Middlesex County, New
`
`Jersey.
`
`5.
`
`Patient. "JF" herein identified only by Aetna Identification Number
`
`W21325477302 (hereinafter referred to as the "Patient") received medical benefits through
`
`defendant Aetna.
`
`6.
`
`At all relevant times, the Patient lived in Monmouth County, New Jersey.
`
`7.
`
`Plaintiff is proceeding on its own individual claims concerning medical services
`
`provided to the Patient.
`
`8.
`
`This matter is properly venued in State Court. None of Plaintiff's claims, as detailed
`
`infra, are governed by federal law, including the Employee Retirement Income Security Act
`
`("ERISA-). See. Pascack Valley Hosp. v. Local 464A UFCW Welfare Reimbursement Plan, 388
`
`F. 3d 393, 403-4 (3d Cir. 2004). (medical provider's claims not preempted by ERISA where (1)
`
`the medical provider's claims arose from a contract independent of the ERISA plan; (2) the patients
`
`were not parties to the contract between the provider and insurer; and (3) the dispute was limited
`
`to the amount of the payment, not the right to be paid.)
`
`9.
`
`The amount in controversy is at least $185;455.37.
`
`2
`
`

`

`MID-L-002942-21 05/14/2021 3:12:54 PM Pg 3 of 7 Trans ID: LCV20211214526
`
`1 0.
`
`For all the reasons stated above, this Court has jurisdiction over this matter and,
`
`further, it is the proper venue for this matter to be heard.
`
`FACTUAL BACKGROUND
`
`1 1.
`
`This dispute arises out of the Defendants' refusal to pay Plaintiff the money to
`
`which Plaintiff is entitled for providing necessary medical services to the Patient.
`
`1 2.
`
`At all relevant times. Plaintiff was a non-participating or out-of-network provider
`
`that rendered medically necessary services to the Patient.
`
`1 3. On October 9, 2018, the Patient presented to JFK Medical Center (hereinafter
`
`referred to as the "Hospital"), where Dr. Joseph Lombardi (hereinafter -Dr. Lombardi-) performed
`
`medically necessary services, including: posterior decompression, L3-L4 and L4-L5 with posterior
`
`fusion with 1LIF instrumentation and bone graft.
`
`14.
`
`Dr. Lombardi is a Board-Certified orthopaedic surgeon who is employed and/or
`
`contracted by the Plaintiff.
`
`1 5.
`
`Plaintiff, as part of its normal business practice. obtained authorization for the
`
`medically necessary treatment of the Patient. This authorization is also applicable to all
`
`physicians, including Dr. Lombardi, who is employed and/or contracted by the Plaintiff.
`
`1 6.
`
`Primary surgery, on October 9,2019, was performed by Dr. Lombardi.
`
`1 7.
`
`Dr. Lombardi was assisted by Dr. James Patti (hereinafter "Dr. Patti-), who is also
`
`employed and/or contracted by Plaintiff.
`
`1 8.
`
`Plaintiff billed Defendant Aetna for the primary and assistant surgeon charges a
`
`total of $188,440.00.
`
`3
`
`

`

`MID-L-002942-21 05/14/2021 3:12:54 PM Pg 4 of 7 Trans ID: LCV20211214526
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`19.
`
`The total billed charges of $188.440.00 for this medically necessary treatment
`
`represents normal and reasonable charges for the complex procedures performed by a Board-
`
`Certified Orthopaedic Surgeon, practicing in New Jersey, with an assistant.
`
`20.
`
`Defendants paid a total of $2,984.63 toward these reasonable charges. leaving a
`
`balance due on this bill of approximately $185,455.37.
`
`21.
`
`While Defendants were aware that Plaintiff was an out-of-network provider,
`
`Defendants never disclosed that it did not intend to pay the fair and reasonable value for said
`
`services. To the contrary, by issuing an authorization number for the services. Defendants
`
`accepted and approved the medically necessary services provided by Plaintiff, with the explicit
`
`knowledge that Defendants never intended to pay the amounts they were obligated to pay.
`
`FIRST COUNT
`(Breach of Contract)
`
`22.
`
`Plaintiff repeats, reiterates and re-alleges each and every allegation set forth in
`
`paragraphs "1" through "21" of this Complaint with the same force and effect as if fully set forth
`
`herein at length.
`
`23.
`
`Plaintiff hereby alleges that an implied in-fact contract has been created through
`
`Defendants' course of conduct and interaction with Plaintiff (hereinafter, the "Contract").
`
`24.
`
`By authorizing the surgery, Defendants agreed to pay the fair and reasonable rates
`
`for the medical services provided by Plaintiff and Plaintiff performed said services based upon
`
`those terms.
`
`25.
`
`This implied Contract indicated that Plaintiff would be paid by Defendants a fair
`
`and reasonable amount for the highly-skilled services provided by the Plaintiff.
`
`4
`
`

`

`MID-L-002942-21 05/14/2021 3:12:54 PM Pg 5 of 7 Trans ID: L0V20211214526
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`26.
`
`However, Plaintiff was paid only a fraction --$2,984.63-- of the fair and reasonable
`
`amount of $188,440.00 for the highly-skilled services provided to the Patient.
`
`27.
`
`Plaintiff has suffered significant damages as a result of Defendants' failure to pay
`
`the fair and reasonable value for the services.
`
`28.
`
`As a direct result of Defendants' breach of the Contract, Plaintiff has been damaged
`
`in an amount to be determined at trial, but not less than $185,455.37, plus interest, costs, and
`
`attorneys' fees.
`
`SECOND COUNT
`(Promissory Estoppel)
`
`29.
`
`Plaintiff repeats, reiterates and re-alleges each and every allegation set forth in
`
`paragraphs "1" through "28" of this Complaint with the same force and effect as if fully set forth
`
`herein at length.
`
`30. By providing a pre-surgery authorization to Plaintiff; Defendants promised that
`
`Plaintiff would be paid for its services at a fair and reasonable rate.
`
`31.
`
`Plaintiff relied upon this promise to its detriment by spending valuable time,
`
`resources, and energy in providing medical services to the Patient.
`
`32.
`
`As a direct result of Defendants' refusal to pay Plaintiff the fair and reasonable
`
`value for the services Plaintiff provided at the behest of Defendant, Plaintiff has been damaged in
`
`an amount to be determined at trial, but not less than $185,455.37, plus interest, costs, and
`
`attorneys' fees.
`
`5
`
`

`

`MID-L-002942-21 05/14/2021 3:12:54 PM Pg 6 of 7 Trans ID: LCV20211214526
`
`THIRD COUNT
`(Account Stated)
`
`33.
`
`Plaintiff repeats. reiterates and re-alleges each and every allegation set forth in
`
`paragraphs -1" through "32- of this Complaint with the same force and effect as if fully set forth
`
`herein at length.
`
`34.
`
`After providing the medical services, which were authorized by Defendants.
`
`Plaintiff submitted bills and requests for payment to Defendants in the sum total of $188.440.00.
`
`35.
`
`To date, Defendants, having acknowledged receipt of the bills, have paid a mere
`
`$2,984.63 of the invoices, but have not objected in any manner to the billed amounts, including,
`
`inter alia, the amount billed or to the services provided.
`
`36.
`
`Plaintiff has suffered significant damages as a result of Defendants' actions.
`
`37.
`
`As a direct result of Defendants' refusal to pay Plaintiff for the medical services
`
`provided and billed to Defendants, who acknowledged receipt without objection, Plaintiff has been
`
`damaged in an amount to be determined at trial, but not less than $185,455.37, plus interest, costs,
`
`and attorneys' fees.
`
`WHEREFORE, Plaintiff respectfully demands judgment against Defendants:
`
`1. As and for its First cause of action, for breach of an implied contract in an amount to
`
`be determined at trial, but not less than $185,455.37, along with its reasonable attorneys' fees,
`
`interest, costs and expenses; and
`
`2. As and for its Second cause of action under the theory of promissory estoppel in an
`
`amount to be determined at trial, but not less than $185,455.37. along with its reasonable
`
`attorneys' fees, interest, costs and expenses; and
`
`6
`
`

`

`MID-L-002942-21 05/14/2021 3:12:54 PM Pg 7 of 7 Trans ID: LCV20211214526
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`3. As and for its Third cause of action for an account stated in an amount to be determined
`
`at trial, but not less than $185.455.37, along with its reasonable attorneys' fees. interest costs
`
`and expenses; and
`
`4. Along with such other and further relief to plaintiff as this Court deems just, fair. and
`proper.
`
`JURY DEMAND
`
`Pursuant to R. 4:35-1, plaintiff hereby demands a trial by jury as to all counts.
`
`DESIGNATION OF TRIAL COUNSEL
`
`Pursuant to R.4:25-4, Dara J. Lawall, Esquire is hereby designated as trial counsel.
`
`CERTIFICATION
`
`1 hereby certify that pursuant to R. 4:5-1 that the matter in controversy is not the subject of
`
`any other action pending in any Court or of a pending arbitration proceeding related to claims
`
`arising from medical services provided from Plaintiff to the Patient. No such action or arbitration
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`proceeding is contemplated by plaintiff at this time.
`
`LA WALL & MITCHELL. LLC
`Attorneys jot. Plaintiff
`
`BY: 7.5/
`Dara J. Lawall, Esquire
`
`Dated: May 14, 2021
`
`7
`
`

`

`Case 2:21-cv-13156 Document 1-2 Filed 06/30/21 Page 11 of 12 PageID: 18
`
`Service of Process
`Transmittal
`06/01/2021
`CT Log Number 539645081
`
`TO:
`
`RE:
`
`FOR:
`
`Desiree Beatty
`Aetna, Inc.
`Law U23S, 1425 Union Meeting Road
`Blue Bell, PA 19422
`
`Process Served in Connecticut
`
`Aetna Inc.  (Domestic State: PA)
`
`ENCLOSED ARE COPIES OF LEGAL PROCESS RECEIVED BY THE STATUTORY AGENT OF THE ABOVE COMPANY AS FOLLOWS:
`
`TITLE OF ACTION:
`
`EDISON SPINE CENTER, Pltf. vs. AETNA Inc., et al., Dfts.
`
`DOCUMENT(S) SERVED:
`
`-
`
`COURT/AGENCY:
`
`NATURE OF ACTION:
`
`None Specified
`Case # MIDL00294221
`
`Insurance Litigation
`
`ON WHOM PROCESS WAS SERVED:
`
`C T Corporation System, East Hartford, CT
`
`DATE AND HOUR OF SERVICE:
`
`By Process Server on 06/01/2021 at 10:16
`
`JURISDICTION SERVED :
`
`APPEARANCE OR ANSWER DUE:
`
`ATTORNEY(S) / SENDER(S):
`
`ACTION ITEMS:
`
`Connecticut
`
`None Specified
`
`None Specified
`
`CT has retained the current log, Retain Date: 06/01/2021, Expected Purge Date:
`06/06/2021
`
`Image SOP
`
`Email Notification,  Desiree Beatty  beattyd@aetna.com
`
`Email Notification,  Jacqueline West  westj2@aetna.com
`
`Email Notification,  Piper Taylor  plperry@aetna.com
`
`REGISTERED AGENT ADDRESS:
`
`C T Corporation System
`67 Burnside Ave
`East Hartford, CT 06108
`800-448-5350
`MajorAccountTeam1@wolterskluwer.com
`The information contained in this Transmittal is provided by CT for quick reference only. It does not constitute a legal opinion, and should not otherwise be
`relied on, as to the nature of action, the amount of damages, the answer date, or any other information contained in the included documents. The recipient(s)
`of this form is responsible for reviewing and interpreting the included documents and taking appropriate action, including consulting with its legal and other
`advisors as necessary. CT disclaims all liability for the information contained in this form, including for any omissions or inaccuracies that may be contained
`therein.
`
`Page 1 of  1 / JP
`
`

`

`5/27/2021
`
`Commercial Recording Division
`
`Business Inquiry
`
`Business Details
`
`Business Name: AETNA INC.
`
`Citizenship/State Inc: Foreign/PA
`
`Business ID: 0668349
`
`Last Report Filed Year: 2020
`
`Business Address:
`
`151 FARMINGTON AVENUE, HARTFORD, CT,
`06156, USA
`
`Business Type: Stock
`
`Mailing Address:
`
`151 FARMINGTON AVENUE, RW61, HARTFORD,
`CT, 06156, USA
`
`Business Status: Active
`
`Date Inc/Registration: Dec 13, 2000
`
`Name in State of INC: AETNA INC.
`
`Commence Business Date: Dec 13, 2000
`
`Annual Report Due Date: 12/12/2021
`
`NAICS Code: Management of Companies and Enterprises (55)
`
`NAICS Sub Code: Offices of Other Holding Companies (551112)
`
`Principals Details
`
`Name/Title
`
`Business Address
`
`Residence Address
`
`CAROL ANN DENALE
`DIRECTOR/TREASURER
`
`151 FARMINGTON AVENUE, HARTFORD, CT,
`06156, USA
`
`151 FARMINGTON AVENUE,
`
`HARTFORD, CT, 06156, USA
`
`KAREN SUE LYNCH
`DIRECTOR/PRESIDENT
`
`151 FARMINGTON AVENUE, HARTFORD, CT,
`06156, USA
`
`151 FARMINGTON AVENUE,
`
`HARTFORD, CT, 06156, USA
`
`COLLEEN M. MCINTOSH
`DIRECTOR
`
`151 FARMINGTON AVENUE, HARTFORD, CT,
`06156, USA
`
`151 FARMINGTON AVENUE,
`
`HARTFORD, CT, 06156, USA
`
`IMPORTANT: There are more principals for this business that are not shown here.
`
`View All Principals(5)
`
`Agent Summary
`
`Agent Name C T CORPORATION SYSTEM
`
`Agent Business Address 67 BURNSIDE AVE, EAST HARTFORD, CT, 06108-3408
`
`Agent Residence Address NONE
`
`Agent Mailing Address NONE
`
`https://www.concord-sots.ct.gov/CONCORD/online?sn=PublicInguiry&eid=9740
`
`1/1
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