King v. ProMedica Health System, Inc.
129 Ohio St. 3d 596
Ohio2011Background
- Virginia King injured in an automobile accident on December 1, 2007 and was treated at Toledo Hospital.
- King informed hospital she was covered by Aetna and provided health-insurance information.
- Appellants ProMedica Health System, Inc. and Toledo Hospital billed Safeco Insurance Company of Illinois (King's auto insurer) for services.
- King filed a Civ.R. 23 class action alleging violations of R.C. 1751.60(A) and other claims based on billing the insurer instead of the health-insuring corporation.
- The trial court dismissed the claims for failure to state a claim; the Sixth District reversed, holding that providers under PPAs can bill only the health-insuring corporation and cannot bill other payors; this Court granted review on the statutory interpretation and coordination-of-benefits questions.
- The majority holds that R.C. 1751.60(A) applies only when a provider seeks payment from a health-insuring corporation’s insured and does not conflict with Ohio’s coordination-of-benefits regime under R.C. 3902.11 et seq.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Does RC 1751.60(A) prohibit charging an insured’s auto insurer or only prohibit charging the insured directly? | King argues the statute forbids seeking payment from the insured; charging Safeco violates the statute. | ProMedica argues the statute applies to providers seeking payments from the insured via the health-insuring corporation contract, not from insurers. | RC 1751.60(A) applies only when seeking payment from the health-insuring corporation’s insured. |
| Does RC 1751.60(A) conflict with coordination-of-benefits laws under RC 3902.11 et seq.? | King contends the statute creates conflict with coordination rules governing multiple payors. | ProMedica contends coordination rules govern separate claims and RC 1751.60(A) does not conflict. | No conflict; coordination of benefits governs multiple payors, RC 1751.60(A) governs the contractual relationship with the insurer. |
Key Cases Cited
- King v. ProMedica Health Sys., Inc., 2010-Ohio-2578 (6th Dist. Ohio 2010) (statutory interpretation of RC 1751.60(A) limited to contract-based payments)