423 P.3d 900
Wash. Ct. App.2018Background
- Patient Stephen Pitell, uninsured, was treated at EvergreenHealth and signed a consent-to-care form agreeing to be "personally responsible for the balance due" after any insurance payments; he did not request an estimate.
- EvergreenHealth billed using its chargemaster; initial bill was $32,324, reduced 20% for uninsured status to $25,859.20; Pitell had funds but sought charity care and was denied.
- Pitell refused to pay and sued on behalf of a class, seeking a declaration that the consent form is unenforceable for lacking a definite price term and asserting negligent and intentional concealment claims.
- EvergreenHealth counterclaimed to collect the unpaid bill; the trial court granted summary judgment for the hospital and ordered Pitell to pay the discounted amount plus costs.
- The appellate court reviewed de novo and considered whether the consent form’s reference to a "balance due" constitutes a definite price term by incorporating the hospital's chargemaster.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether the consent-to-care agreement has a definite price term | Pitell: reference to "balance due" is an open/indefinite price term and unenforceable | EvergreenHealth: the contract price is supplied by its existing chargemaster, making the term definite | Court: enforceable; chargemaster supplies the definite price term |
| Whether extrinsic evidence supports formation/price term | Pitell: contract lacks specific price; extrinsic evidence not needed or would not help | EvergreenHealth: extrinsic evidence (parties’ understanding, trade usage, plaintiff’s own testimony) supports chargemaster pricing | Court: extrinsic evidence (including Pitell's testimony that hospitals use chargemasters) reinforces that parties intended chargemaster prices |
| Whether hospital had duty to disclose its rates (concealment claims) | Pitell: hospital concealed nature of its rates and had a duty to disclose | EvergreenHealth: no duty to disclose beyond the consent form and available estimates | Court: concealment claims dismissed — no duty to disclose in these circumstances |
| Whether quantum meruit or other equitable relief applies to limit billed amount | Pitell: equitable doctrine should govern amount owed | EvergreenHealth: contract governs; plaintiff offered no evidence of a reasonable amount | Court: declined to decide on quantum meruit; enforced contract and noted plaintiff presented no evidence of a reasonable amount |
Key Cases Cited
- DiCarlo v. St. Mary Hosp., 530 F.3d 255 (3d Cir. 2008) (holding phrase "all charges" refers to hospital chargemaster and is sufficiently definite)
- Allen v. Clarian Health Partners, Inc., 980 N.E.2d 306 (Ind. 2012) ("the account" implies chargemaster; price need not be a specific dollar amount to be enforceable)
- Shelton v. Duke Univ. Health Sys., Inc., 633 S.E.2d 113 (N.C. Ct. App. 2006) ("regular rates" are definite by reference to chargemaster)
- Limberg v. Sanford Med. Ctr. Fargo, 881 N.W.2d 658 (N.D. 2016) (chargemaster provides base price; deductions vary by payer)