214 So. 3d 45
La. Ct. App.2017Background
- Plaintiff Gloria Vallare received treatment at Acadian Medical Center (a branch of Ville Platte Medical Center, LLC — VPMC) after a car accident; the hospital sent a provider lien to the tortfeasor’s insurer rather than billing Vallare’s Blue Cross plan.
- Vallare filed a putative class action (certified on remand) asserting violations of the Balance Billing Act (La. R.S. 22:1871 et seq.), breach of contract, and related damages and injunctive relief.
- Class definition covered persons who received covered services from VPMC/branch and from whom VPMC attempted to collect amounts exceeding contracted reimbursement rates.
- On remand, VPMC and Blue Cross (BCBS) filed exceptions of prescription; VPMC also moved for summary judgment. The trial court overruled both prescription exceptions and denied VPMC’s summary judgment motion.
- VPMC sought writs challenging prescription and the denial of summary judgment; BCBS sought writs challenging the trial court’s denial of its prescription exception. The appellate court consolidated the writ applications.
- The court held the claims are contractual/quasi-contractual (not purely delictual), subject to a ten-year prescriptive period, and found genuine factual disputes precluded summary judgment for VPMC; writs were denied.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether claims alleging balance billing/breach are contractual (10-year prescription) or delictual (1-year) | Vallare: claims arise from insurance/provider contractual system (Art. 1977 / promesse de porte-fort / implied promise of discounted rates); therefore contractual, 10-year prescriptive period | VPMC: statutory/prohibitory nature of Balance Billing Act and consumer-protection analogy make claims tortlike subject to 1-year prescription | Court: claims are contractual/quasi-contractual (following Emigh/Anderson), so 10-year prescription applies; exception overruled |
| Whether VPMC’s assertion of a provider lien and alleged conduct supports a Balance Billing Act claim and precludes summary judgment | Vallare: asserting a lien can constitute "maintaining an action at law" under La. R.S. 22:1874(B); factual issues exist about whether VPMC attempted to collect above contracted rate | VPMC: it filed a medical provider’s lien to recoup from the third-party tortfeasor and did not bill or collect from Vallare; lien authorized by health care lien statutes; no statutory violation as a matter of law | Court: factual disputes (e.g., intent to collect, interaction of lien with Balance Billing Act) preclude summary judgment; motion denied |
| Whether BCBS policy’s 15-month contractual limitation bars suit (prescription) | Vallare: application of the 15-month term can leave insureds with less than one year from accrual to sue (void under La. R.S. 22:868); causes of action accrue when entitled to sue (not necessarily date of service) | BCBS: policy grants 15 months (longer than statutory minimum one year) and prior cases have enforced similar clauses; claim from 2004 is time-barred | Court: because claims are contractual and tied to balance-billing accrual principles, the 15-month provision cannot be applied to cut off the statutorily-required one-year accrual period for these claims; exception overruled |
| Whether appellate supervisory relief appropriate to reverse trial court on prescription/summary judgment | VPMC/BCBS: argue trial court rulings legally erroneous and should be reversed to terminate litigation | Vallare: disputes of fact and correct contractual characterization support trial rulings | Court: supervisory relief denied; trial court rulings affirmed given contractual characterization and factual issues |
Key Cases Cited
- Emigh v. W. Calcasieu Cameron Hosp., 145 So.3d 369 (La. 2014) (health insurer’s promesse de porte-fort and insureds’ entitlement to discounted rates under provider contracts)
- Anderson v. Ochsner Health Sys., 172 So.3d 579 (La. 2014) (asserting a lien can amount to maintaining an action at law and supports private remedies under Balance Billing statutes)
- Vallare v. Ville Platte Med. Ctr., 151 So.3d 984 (La. App. 3 Cir. 2014) (prior appellate decision affirming class certification)
- Herlitz Constr. Co. v. Hotel Investors of New Iberia, 396 So.2d 878 (La. 1981) (scope of appellate supervisory jurisdiction)
- Touro Infirmary v. Henderson, 666 So.2d 686 (La. App. 4 Cir. 1995) (enforcement of policy limitations provision where not shorter than statutory minima)