206 So. 3d 323
La. Ct. App.2016Background
- On Feb. 1, 2013 Irma Rabun was injured in a car accident and treated at St. Francis Medical Center; her sister signed intake/consent forms for her.
- Rabun was insured by UnitedHealthcare; St. Francis was a contracted provider with discounted reimbursement rates under a member-provider agreement.
- St. Francis placed a medical lien for the full, undiscounted charges ($9,452) against any recovery from the third-party tortfeasor instead of billing United; a subsequent claim to United was denied as untimely.
- Rabun filed a putative class action alleging the lien and billing practices violated Louisiana’s Balance Billing Act (BBA), which prohibits contracted providers from billing insured patients above the contracted reimbursement rate.
- The trial court granted summary judgment for St. Francis, finding Rabun had consented to billing a third party; the court of appeals reversed and remanded, concluding a genuine issue of material fact existed as to the amount owed.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether a contracted provider may assert a medical lien for full undiscounted charges against a third-party tortfeasor when the patient has insurance | Rabun: St. Francis must submit claims to United and limit recovery to contracted rate; attaching a full-value lien circumvents the BBA | St. Francis: Medical-lien statute authorizes lien for reasonable charges; lien pursuit against third party is statutory and not limited by the BBA; Rabun consented | Held: A contracted provider’s lien against a tortfeasor is limited to the contracted reimbursement rate; summary judgment improper on amount issue because genuine factual dispute exists |
| Whether a patient can waive protection under the BBA by consent on intake forms | Rabun: BBA protections cannot be waived; form language insufficient/no intent to waive | St. Francis: Rabun (via mandate) consented on the form to pursue insurance or third-party liability | Held: Court found express consent to pursue a lien, but held the patient cannot consent to be billed above the contracted rate; consent does not permit exceeding BBA limits |
| Interaction of BBA with medical lien statute — which governs recovery from tortfeasor | Rabun: BBA limits what provider may collect; lien cannot exceed contracted rate | St. Francis: Lien statute independently permits recovery of reasonable charges from tortfeasor, including undiscounted amount | Held: The BBA limits what a contracted provider may recover from the tortfeasor via lien to the contracted reimbursement rate |
| Appropriateness of summary judgment in favor of St. Francis | Rabun: Dispute over amount owed creates genuine issue of material fact | St. Francis: No genuine issue; consent and statutory lien authorize its actions | Held: Reversed — genuine factual dispute as to amount; remanded for further proceedings; trial court may consider other grounds not previously decided |
Key Cases Cited
- Schultz v. Guoth, 57 So.3d 1002 (La. 2011) (summary-judgment standard and review explained)
- Smitko v. Gulf S. Shrimp, Inc., 94 So.3d 750 (La. 2012) (appellate de novo review of summary judgment)
- Monroe Surgical Hosp., LLC v. St. Francis Medical, Inc., 147 So.3d 1234 (La. App. 2d Cir. 2014) (summary-judgment principles applied in related provider litigation)
- Garcia v. Lewis, 197 So.3d 738 (La. App. 2d Cir. 2016) (procedural summary-judgment discussion)
- Sassone v. Elder, 626 So.2d 345 (La. 1993) (discussing materiality in summary-judgment context)
- Hines v. Garrett, 876 So.2d 764 (La. 2004) (genuine-issue standard for summary judgment)
- Anderson v. Ochsner Health Sys., 172 So.3d 579 (La. 2014) (BBA provides a private right of action; discussed interplay of lien and contracted rates)
- Balter v. PHC-Minden, L.P., 167 So.3d 528 (La. 2015) (class action is superior method for BBA claims)