Barbara Jackson v. Professional Radiology
864 F.3d 463
| 6th Cir. | 2017Background
- On April 7, 2014, Barbara Jackson was treated by Professional Radiology, Inc. (PRI) at University Hospital after an auto accident; PRI used M.D. Business Solutions (MDB) for billing.
- Jackson had UnitedHealthcare coverage; PRI/MDB did not bill UnitedHealthcare and instead sent multiple bills directly to Jackson seeking $1,066 and requested a letter of protection from her attorney.
- When Jackson did not pay, PRI placed the account with collection agency Controlled Credit Corporation (CCC); Jackson’s counsel later negotiated a settlement with CCC for $852.
- After settlement, PRI and/or MDB contacted Jackson seeking an additional $3.49, which she paid, and then brought a putative class action under Ohio Rev. Code § 1751.60(A) and related claims.
- District court granted CCC’s Rule 12(c) judgment on the pleadings and granted PRI/MDB’s Rule 12(b)(6) motion to dismiss; Sixth Circuit affirmed as to CCC but reversed as to PRI and MDB.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether CCC is subject to Ohio Rev. Code § 1751.60(A) | §1751.60 prohibits billing insureds; CCC collected from Jackson so it is bound | CCC is a collection agency, not a "provider" or "health care facility" that contracts with an insurer | CCC is not a provider/health care facility under statute; judgment for CCC affirmed |
| Whether PRI/MDB violated §1751.60(A) by billing Jackson directly | PRI/MDB directly billed Jackson instead of seeking payment from UnitedHealthcare or a third‑party insurer | PRI/MDB rely on cases about billing third‑party auto insurers and argue §1751.60 doesn’t bar their conduct | Facts plausibly show PRI/MDB directly billed the insured in violation of §1751.60; dismissal reversed |
| Applicability of King/Hayberg to direct billing to insureds | Plaintiff distinguishes those cases because they addressed billing third‑party insurers, not direct billing to insureds | Defendants argue King/Hayberg foreclose liability under §1751.60 | Court holds King/Hayberg are inapposite because they addressed third‑party insurer billing, not direct billing to an insured |
| Whether plaintiff waived arguments about collection of tort proceeds | Plaintiff argued CCC sought tort proceeds | Defendants say issue was not raised below and is waived | Court finds claim about tort proceeds not preserved and declines to consider it |
Key Cases Cited
- King v. ProMedica Health Sys., 955 N.E.2d 348 (Ohio 2011) (held §1751.60(A) bars seeking payment from a provider’s insured only when provider has a contract with the health‑insuring corporation; does not prohibit seeking payment from other insurers)
- Hayberg v. Robinson Mem. Hosp. Found., 995 N.E.2d 888 (Ohio Ct. App. 2013) (applied King to hold §1751.60(A) does not limit recovery from automobile insurers)
- Ashcroft v. Iqbal, 556 U.S. 662 (U.S. 2009) (pleading standard: complaint must state a plausible claim for relief)
- Bell Atl. Corp. v. Twombly, 550 U.S. 544 (U.S. 2007) (pleading standard requiring plausibility to survive dismissal)
- Rogers v. Miller Music, 477 F.3d 383 (6th Cir. 2007) (standard for reviewing Rule 12(c) judgment on the pleadings)