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Kelly v. Marketplace/Blue Cross Highmark Delaware

United States District Court, D. Delaware

December 11, 2019

ALEXANDRA B. KELLY, Plaintiff,
v.
MARKETPLACE/BLUE CROSS HIGHMARK DELAWARE, Defendant.

          Alexandra B. Kelly, Wilmington, Delaware. Pro Se Plaintiff.

          Geoffrey Graham Grivner, Buchanan Ingersoll & Rooney P.C., Wilmington, Delaware. Counsel for Defendant.

          MEMORANDUM OPINION

          NOREIKA, U.S. DISTRICT JUDGE

         Plaintiff Alexandra B. Kelly (“Plaintiff) appears pro se and has paid the filing fee. She commenced this action on July 22, 2019, against Defendant Market/Blue Cross Highmark Delaware (“Defendant”) and asserts jurisdiction by reason of a federal question pursuant to 28 U.S.C. § 1331. (D.I. 2). Before the Court is Defendant's motion to dismiss or for a more definite statement and Plaintiffs request for counsel. (D. I. 9, 11). Briefing is complete.

         I.BACKGROUND

         Plaintiff alleges that “her insurance - purchased through the Marketplace - is too high because it is taking into account her husband even though he is not on it . . . .” (Id. at 3). Plaintiff further alleges that she

applied for Obamacare through Marketplace and Highmark. When she did her taxes she found out she owes $26, 000 dollars in taxes. Her husband had insurance and was denied coverage through Highmark but they are using his income even though I wasn't on the policy. A person representing [H]ighmark led her to believe that they were not going to use his income. When she signed up her husband just had knee replacement surgery and was laid-off In the second half of the year he retired and got social security disability. This income was $5, 300 dollars a month and was applied by the IRS. I am Victic por Domestic Balen.[1]

(Id. at 4-5).

         Plaintiff alleges that she filed the Complaint because she was not informed the premiums would cost $2, 500 per month more than the premium payments. (Id. at 9). She alleges that the person who sold her the policy did not disclose information about extra payments. (Id.). The Civil Cover Sheet describes the action as “[f]raud charges for $30, 000 for IRS for taxes because of Highmark.” (D.I. 2-3).

         Plaintiff has filed numerous exhibits. (See D.I. 2, Exs. 4, 5; D.I. 3, Exs. 1, 2, 3, 6, 7; D.I. 7; D.I. 16). One exhibit advises Plaintiff by correspondence from Highmark Delaware dated February 8, 2019, that her health insurance coverage was terminated effective January 1, 2019 due to nonpayment of the required premium. (D.I. 2-1 at 4). Another exhibit indicates that Plaintiff was notified by Highmark Delaware by a February 11, 2019 account activity summary of the “member premium responsibility” in the sum of $1, 505.26 (adjusted to $1, 410.26 due to a previous balance) for the billing period March 1, 2019 to March 31, 2019. (D.I. 3). A third exhibit[2]provided information on premium tax credits and advised that the amount of premium tax credits is based on “the number of people in your household” which includes your spouse and any dependents claimed on your tax return and the household income for the year in which coverage is desired. (D.I. 3-1 at 1). The exhibit indicates that “the marketplace will send any advance of the premium tax credit directly to your insurance company, not to you.” (Id.). The exhibit also provides information regarding reporting tax credits on federal tax returns. (Id. at 2).

         For relief, Plaintiff “wants the IRS to just use her income to base her Obamacare Insurance.” (Id. at 7). In a separate filing, Plaintiff asks for $25, 000, as well as a refund, and interest. (D.I. 18).

         II. LEGAL STANDARDS

         A. Rule 12(b)(6)

         When a plaintiff proceeds pro se, her pleading is liberally construed and her complaint, “however inartfully pleaded, must be held to less stringent standards than formal pleadings drafted by lawyers.” Erickson v. Pardus, 551 U.S. 89, 94 (2007) (citations omitted). When presented with a motion to dismiss for failure to state a claim pursuant to Rule 12(b)(6), district courts conduct a two-part analysis. Fowler v. UPMC Shadyside, 578 F.3d 203, 210 (3d Cir. 2009). First, the court separates the factual and legal elements of a claim, accepting “all of the complaint's well-pleaded facts as true, but [disregarding] any legal conclusions.” Id. at 210-11. Second, the court determines ...


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