Lead Opinion
delivered the opinion of the Court,
Damages for wrongful personal injury include the reasonable expenses for necessary medical care, but it has become increasingly difficult to determine what expenses are reasonable. Health care providers set charges they maintain are reasonable while agreeing to reimbursement at much lower rates determined by insurers to be reasonable, resulting in great disparities between amounts billed and payments accepted. Section 41.0105 of the Texas Civil Practice and Remedies Code, enacted in 2003 as part of a wide-ranging package of tort-reform measures,
Aaron Glenn Haygood sued Margarita Garza De Escabedo for injuries he sustained when the car he was driving collided with Escabedo’s minivan as she was pulling out of a grocery store parking lot. Haygood’s injuries required surgeries on his neck and shoulder. Both were successful, but some impairment remains.
Twelve health care providers billed Hay-good a total of $110,069.12, but he was covered by Medicare Part B, which generally “pays no more for ... medical and other health services than the ‘reasonable charge’ for such service.”
Invoking section 41.0105, Escabedo moved to exclude evidence of medical expenses other than those paid or owed. Haygood, asserting the collateral source rule, moved to exclude evidence of any amounts other than those billed, and of any adjustments and payments. The trial court denied Escabedo’s motion and granted Haygood’s. At trial, Haygood offered evidence from each of his health care providers that the charges billed were reasonable and the services necessary. The jury found that Escabedo’s negligence caused the accident and that Haygood’s damages were $110,069.12 for past medical expenses, $7,000 for future medical expenses, $24,500 for past pain and mental anguish, and $3,000 for future pain and mental anguish. The trial court overruled Escabe-do’s objection to an award of past medical expenses in excess of those paid or owed and rendered judgment on the verdict.
The court of appeals reversed, holding that section 41.0105 precluded evidence or recovery of expenses that “neither the claimant nor anyone acting on his behalf will ultimately be liable for paying”.
II
The Legislature enacted section 41.0105 against a backdrop of health care pricing
A
Charges for health care, once based on the provider’s costs and profit margin, have more recently been driven by government regulation and negotiations with private insurers.
Although reimbursement rates have been determined to be reasonable under
In all these respects, the present case is entirely typical. The providers testified the charges billed to Haygood were reasonable, even though those charges were four times the amount they were entitled to collect.
B
As a general principle, compensatory damages, like medical expenses, “are intended to make the plaintiff ‘whole’ for any losses resulting from the defendant’s interference with the plaintiffs rights.”
Haygood contends that an adjustment in billed medical charges required by an insurer is a collateral benefit covered by the rule. We disagree. The benefit of insurance to the insured is the payment of charges owed to the health care provider. An adjustment in the amount of those charges to arrive at the amount owed is a benefit to the insurer, one it obtains from the provider for itself, not for the insured. Haygood argues that the adjustment reduces the insured’s liability, but the insured’s liability is for payment of taxes, if a government insurer, or premiums, if a private insurer, and for any deductible. Any effect of an adjustment on such liability is at most indirect and is not measured by the amount of the adjustment.
The collateral source rule reflects “the position of the law that a benefit that is directed to the injured party should not be shifted so as to become a windfall for the tortfeasor.”
Consistent with our views in Daughters of Charity, we hold that the common-law collateral source rule does not allow recovery as damages of medical expenses a health care provider is not entitled to charge.
C
With this background, we turn to the text of section 41.0105, which states simply: “In addition to any other limitation under law, recovery of medical or health care expenses incurred is limited to the amount actually paid or incurred by or on behalf of the claimant.”
Haygood argues that this construction is inconsistent with our decision in Black v. American Bankers Insurance Co.,
Haygood concedes that in Daughters of Charity,
Finally, Haygood argues that if the Legislature had intended to limit recovery, it would also have had to amend section 18.001 of the Civil Practice and Remedies Code, which states in part:
Unless a controverting affidavit is filed as provided by this section, an affidavit that the amount a person charged for a service was reasonable at the time and place that the service was provided and that the service was necessary is sufficient evidence to support a finding of fact by judge or jury that the amount charged was reasonable or that the service was necessary.52
But this statute is purely procedural, providing for the use of affidavits to streamline proof of the reasonableness and necessity of medical expenses. The statute does not establish that billed charges are reasonable and necessary; on the contrary, it expressly contemplates that the issue can
Accordingly, we hold that section 41.0105 limits a claimant’s recovery of medical expenses to those which have been or must be paid by or for the claimant. All the courts of appeals that have addressed the issue have reached the same conclusion,
D
Haygood argues that even if section 41.0105 precludes recovery of expenses a provider has no right to be paid, evidence of such expenses is nonetheless admissible at trial. “Evidence which is not relevant is inadmissible.”
The question remains whether such evidence has any other probative value. A few courts in other jurisdictions have expressed concern that limiting the evidence to amounts that have been or must be paid provides the jury an unfairly low benchmark with which to gauge the seriousness of the plaintiffs injuries and awarding non-economic damages, such as for physical pain and mental anguish.
Haygood argues that if the Legislature had intended to allow evidence of amounts
The dissent argues that the jury should consider only evidence of charges billed, without adjustments or credits required by insurers. Evidence of expenses paid or to be paid, the dissent urges, should be presented to the trial court post-verdict by the defendant. A fundamental rule is that “[t]o recover damages, the burden is on the plaintiff to produce evidence from which the jury may reasonably infer that the damages claimed resulted from the defendant’s conduct.”
Accordingly, we hold that only evidence of recoverable medical expenses is admissible at trial. We disapprove the cases that have reached conflicting deci
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We agree with the opinion of the court of appeals, and therefore its judgment is
Affirmed.
. Act of June 2, 2003, 78th Leg., R.S., ch. 204, § 13.08, 2003 Tex. Gen. Laws 847, 889.
. Tex. Civ. Prac. & Rem.Code § 41.0105.
. 283 S.W.3d 3 (Tex.App.-Tyler 2009).
. 42 C.F.R. § 405.501(a).
. 42 C.F.R. § 405.502(a).
. 42U.S.C. § 1395cc(a)(l)-(2).
. The record indicates that almost all of what has been paid was by insurance.
. 283 S.W.3d at 7.
. The court of appeals miscalculated the adjustments by $35. Id. at 5, 8.
. Id. at 8.
. Id. at 7 (citing Irving Holdings, Inc. v. Brown, 274 S.W.3d 926, 931-933 (Tex.App.Dallas 2009, pet. denied), and Gore v. Faye, 253 S.W.3d 785, 789-790 (Tex.App.-Amarillo 2008, no pet.)). Since then, two other courts have followed Brown. Arango v. Davila, Nos. 13-09-00470-CV, 13-09-00627-CV, 2011 WL 1900189, at *9 (Tex.App.-Corpus Christi May 19, 2011, no pet. h.); Frontera Sanitation, L.L.C. v. Cervantes, 342 S.W.3d 135, 140 (Tex.App.-El Paso 2011, no pet. h.).
. 53 Tex. Sup.Ct. J. 562 (Apr. 9, 2010).
. See Keith T. Peters, What Have We Here? The Need for Transparent Pricing and Quality Information in Health Care: Creation of an SEC for Health Care, 10 J. Health Care L. & Pol’y 363, 366 (2007) ("The price of a particular provider’s services depends on many factors including geography, experience, location, government payment methods, and the desire to make a profit. Hospital prices are supposed to be determined by the cost of providing care. However, the reimbursement rates for federal programs such as Medicare and Medicaid drive the list price of health care.") (footnotes omitted).
. See Uwe E. Reinhardt, The Pricing Of U.S. Hospital Services: Chaos Behind A Veil Of Secrecy, 25 Health Aff. 57, 62 (2006) ("Partly under pressure from consumers and lawmakers and partly on their own volition, many hospitals now have means-tested discounts off their chargemasters for uninsured patients, which bring the prices charged the uninsured closer to those paid by commercial insurers or even below. Some very poor patients, of course, have received hospital care free of charge all along, on a purely charitable basis.”) (footnote omitted).
. See George A. Nation III, Obscene Contracts: The Doctrine of Unconscionability and Hospital Billing of the Uninsured, 94 KY. L.J. 101, 120 (2005-06) ("While all uninsured patients are expected to pay the hospital's 'full charges,’ it appears that in fact less than five percent actually pay the full charge.”).
. See Peters, supra note 13, at 366 ("The 'price' of health care ... can be divided into two prices. First, there is the list price[,] ... similar to the sticker price one might find when purchasing a new car — it serves only as a beginning point for the negotiations, for those who have the market share to negotiate. ... From these list prices, private insurers, Medicaid and Medicare, and other groups negotiate discounts to arrive at ... the 'actual price.’ Although the list price of health care varies widely across different regions of the country, the actual price paid is relatively static.”) (footnotes omitted).
. Daughters of Charity Health Servs. of Waco v. Linnstaedter, 226 S.W.3d 409, 410 (Tex.2007) (citing Nation, supra note 15, at 104 ("[A] hospital’s 'regular rates,’ 'full charges,' or 'list prices’ ... are generally at least double and may be up to eight times what the hospital would accept as payment in full for the same services from Medicare, Medicaid, HMOs, or private insurers. The labels for these charges, 'regular,' 'full,' or 'list,’ are misleading, because in fact they are actually paid by less than five percent of patients nationally.”) (footnotes omitted)).
. See, e.g., Vencor, Inc. v. Nat’l States Ins. Co., 303 F.3d 1024, 1029 n. 9 (9th Cir.2002) ("It is worth noting that in a world in which patients are covered by Medicare and various other kinds of medical insurance schemes that negotiate rates with providers, providers' supposed ordinaiy or standard rates may be paid by a small minority of patients.”).
. See Nation, supra note 15, at 119.
. See James McGrath, Overcharging the Uninsured in Hospitals: Shifting a Greater Share of Uncompensated Medical Care Costs to the Federal Government, 26 Quinnipiac L.Rev. 173, 183 (2007) ("Hospitals usually bill all patients at the list price for the same service, and then significantly discount these rates for third-party payers who contract with the hospital.”); Reinhardt, supra note 14, at 59 ("Typically, a hospital will submit, for all of its patients, detailed bills based on its charge-master, even to patients covered by Medicare. An advantage of these bills is that at least in principle, patients can check whether all of the supplies and services listed on the bill were actually delivered. A disadvantage, for hospitals, is that these bills are very lengthy and add up to large totals that do not bear any systematic relationship to the amounts third-party payers actually pay them for the listed services.”).
. Tex Civ. Prac. & Rem.Code § 18.001(b) ("Unless a controverting affidavit is filed as provided by this section, an affidavit that the amount a person charged for a service was reasonable at the time and place that the service was provided and that the service was necessary is sufficient evidence to support a finding of fact by judge or jury that the amount charged was reasonable or that the service was necessary.”); id. § 18.001(c) ("The affidavit must: (1) be taken before an officer with authority to administer oaths; (2) be made by: (A) the person who provided the service; or (B) the person in charge of records showing the service provided and charge made; and (3) include an itemized statement of the service and charge.”).
. Transp. Ins. Co. v. Moriel, 879 S.W.2d 10, 16 (Tex.1994).
. See Restatement (Second) of Torts § 920A cmt. b (1977) ("Payments made or benefits conferred by other sources are known as collateral-source benefits. They do not have the effect of reducing the recovery against the defendant. The injured party's net loss may have been reduced correspondingly, and to the extent that the defendant is required to pay the total amount there may be a double compensation for a part of the plaintiff's injury.”).
. Mid-Century Ins. Co. of Tex. v. Kidd, 997 S.W.2d 265, 274 (Tex.1999); Brown v. Am. Transfer & Storage Co., 601 S.W.2d 931, 934 (Tex.1980); Tex. & Pac. Ry. Co. v. Levi & Bro., 59 Tex. 674, 676 (1883).
. See Restatement (Second) of Torts § 920A(2) ("Payments made to or benefits conferred on the injured party from other sources are not credited against the tortfea-sor's liability, although they cover all or a part of the harm for which the tortfeasor is liable.”).
. Mid-Century, 997 S.W.2d at 274 ("The collateral source rule bars a wrongdoer from offsetting his liability by insurance benefits independently procured by the injured party.”); Levi, 59 Tex. at 676 ("The insurer and the defendant are not joint tort-feasors or joint debtors so as to make the payment or satisfaction by the former operate to the benefit of the latter; nor is there any legal privity between the defendant and the insurer so as to give the former the right to avail itself of a payment by the latter. The policy of insurance is collateral to the remedy against the defendant, and was procured solely by the plaintiff at his expense, and to the procurement of which the defendant was in no way contributory.... It cannot be said that the plaintiff took out the policy in the interest or behalf of the defendant, nor is there any legal principle which seems to require that it be ultimately appropriated to the defendant’s use and benefit.”) (internal quotation marks omitted).
. Brown, 601 S.W.2d at 934.
. Restatement (Second) Of Torts § 920A cmt. b.
. 226 S.W.3d 409, 412 (Tex.2007).
. Id. at 410, 412.
. Id. at 410-411.
. Id. at 410.
. Id.
. Id.
. Daughters of Charity, 226 S.W.3d at 411 ("[A] lien against a patient’s tort recovery is just as much a claim against the patient as if it were filed against the patient’s house, car, or bank account.”).
. Id. at 412 ("Further, granting hospitals a lien in excess of the established guidelines for fair and reasonable rates would frustrate the Legislature’s effort to achieve effective medical cost control through the Labor Code.”).
. Id.
. Id.
. Courts in other jurisdictions have split on this issue. Some agree. Slack v. Kelleher, 140 Idaho 916, 104 P.3d 958, 967 (2004); Stanley v. Walker, 906 N.E.2d 852, 857-858 (Ind.2009); Martinez v. Milburn Enters., 290 Kan. 572, 233 P.3d 205, 222-223 (2010); Robinson v. Bates, 112 Ohio St.3d 17, 857 N.E.2d 1195, 1200-1201 (2006). Others do not. Helfend v. S. Cal. Rapid Transit Dist., 2 Cal.3d 1, 84 Cal.Rptr. 173, 465 P.2d 61, 69 (1970); Wills v. Foster, 229 Ill.2d 393, 323 Ill.Dec. 26, 892 N.E.2d 1018, 1030 (2008); Bozeman v. State, 879 So.2d 692, 701-702 (La.2004); Covington v. George, 359 S.C. 100, 597 S.E.2d 142, 144-145 (2004); Acuar v. Letourneau, 260 Va. 180, 531 S.E.2d 316, 322-323 (2000); Leitinger v. DBart, Inc., 302 Wis.2d 110, 736 N.W.2d 1, 14 (2007).
. Tex Civ. Prac. & Rem.Code § 41.0105.
. Franka v. Velasquez, 332 S.W.3d 367, 393 (Tex.2011).
. See, e.g., McIntyre v. Ramirez, 109 S.W.3d 741, 746 (Tex.2003) (holding that the adverb "ordinarily” in the phrase "a person who would ordinarily receive or be entitled to receive a salary, fee, or other remuneration for administering care” modifies both "receive” and "be entitled to receive”).
. 478 S.W.2d 434 (Tex.1972).
. Id. at 435.
. Id. at 435-436.
. Id. at 437.
. Id.
. 226 S.W.3d 409, 412 n. 22 (Tex.2007).
. Petitioner's Brief on the Merits at 8 n. 2 (emphasis omitted).
. Daughters of Charity, 226 S.W.3d at 412.
. Id. at 412 n. 22.
. Tex. Civ. Prac. & Rem.Code § 18.001(b).
. Arango v. Davila, Nos. 13-09-00470-CV, 13-09-00627-CV, 2011 WL 1900189, at *9 (Tex.App.-Corpus Christi May 19, 2011, no pet. h.); Frontera Sanitation, L.L.C. v. Cervantes, 342 S.W.3d 135, 140 (Tex.App.-El Paso 2011, no pet. h.); Progressive Cnty. Mut. Ins. Co. v. Delgado, 335 S.W.3d 689, 692 (Tex.App.-Amarillo 2011, no pet. h.); Pierre v. Swearingen, 331 S.W.3d 150, 155-156 (Tex.App.-Dallas 2011, no pet. h.); Tate v. Hernandez, 280 S.W.3d 534, 540-541 (Tex.App.-Amarillo 2009, no pet.); Matbon, Inc. v. Gries, 288 S.W.3d 471, 481-482 (Tex.App.-Eastland 2009, no pet.).
. Tex.R. Evid. 402.
. E.g., State v. Wood Oil Distrib., Inc., 751 S.W.2d 863, 865 (Tex.1988) ("[T]he introduction of evidence on [non-compensable] damages ... is improper as a matter of law.... ”); Interstate Northborough P'ship v. State, 66 S.W.3d 213, 220 (Tex.2001) (same).
. Wills v. Foster, 229 Ill.2d 393, 323 Ill.Dec. 26, 892 N.E.2d 1018, 1031-1032 (2008); Covington v. George, 359 S.C. 100, 597 S.E.2d 142, 144-145 (2004); Leitinger v. DBart, Inc., 302 Wis.2d 110, 736 N.W.2d 1, 14 (2007).
. Tex.R. Evid. 403 (“Although relevant, evidence may be excluded if its probative value is substantially outweighed by the danger of unfair prejudice, confusion of the issues, or misleading the jury, or by considerations of undue delay, or needless presentation of cumulative evidence.”).
. Tex. Civ. Prac. & Rem.Code § 41.012.
. Texarkana Mem’l Hosp., Inc. v. Murdock, 946 S.W.2d 836, 838 (Tex.1997).
. Id. at 840-841.
. Id. at 841.
. Tex. Gov't Code § 311.021.
. Arango v. Davila, Nos. 13-09-00470-CV, 13-09-00627-CV, 2011 WL 1900189 (Tex.App.-Corpus Christi May 19, 2011, no pet. h.); Frontera Sanitation, L.L.C. v. Cervantes, 342 S.W.3d 135 (Tex.App.-El Paso 2011, no pet. h.); Irving Holdings, Inc. v. Brown, 274 S.W.3d 926 (Tex.App.-Dallas 2009, pet. denied); Gore v. Faye, 253 S.W.3d 785 (Tex.App.-Amarillo 2008, no pet.).
Dissenting Opinion
joined by Justice MEDINA, dissenting.
Today, the Court holds that a claimant may neither recover amounts written off and never paid, nor introduce evidence of such amounts during trial. I agree with the Court that section 41.0105 reflects the Legislature’s intent to restrict the amount of past medical expenses that may be recovered. However, I disagree with the Court’s conclusion that the Legislature intended to prohibit the introduction of evidence of amounts that are written off and never paid, as they represent collateral source benefits. Neither the “express terms” of the statute, which speak only to a claimant’s recovery of past medical expenses, “[n]or [any] necessary implications” support such a conclusion. Cash Am. Int’l, Inc. v. Bennett, 35 S.W.3d 12, 16 (Tex.2000) (citation omitted). Furthermore, one consequence of the Court’s decision is that juries may deliver insupport-ably divergent results as between those plaintiffs who are insured and those who are not, resulting in inconsistent appellate review of damages awards in some tort cases. I would hold that the court of appeals erred to the extent it held that section 41.0105 affects the admissibility of evidence of past medical expenses. It suggested a remittitur, but based on improper grounds. Therefore, I would reverse the court of appeals’ judgment and remand to that court.
I. ANALYSIS
I agree with the Court that section 41.0105 abrogates the collateral source rule as a rule of recovery by proscribing damages awards for amounts written off and never paid. While the precise issue was not before us, we implied as much in Daughters of Charity Health Services of Waco v. Linnstaedter, 226 S.W.3d 409, 410 (Tex.2007). However, while the Court’s reasoning as to recovery is solidly grounded, its holding as to the admissibility of evidence of adjusted charges finds scant support in the statute’s language, is contradicted by the statute’s legislative history, and runs counter to long-standing common law.
It is not the prerogative of the Court to second-guess the Legislature’s policy choices. Rather, it is the Court’s duty to discern and implement the law in accordance with, not in contravention of, the Legislature’s intent. Here, the Court ignores the obvious conflict between section 41.0105’s title and its text. In doing so, the Court reaches its conclusion without utilizing either the statute’s legislative history or any one of the enumerated statutory construction aids. See Tex. Gov’t Code § 311.023. When a statute’s text is only amenable to one reasonable interpre
A. Evidence of Past Medical Expenses
The collateral source rule has applied in Texas since 1883. Tex. & Pac. Ry. Co. v. Levi & Bro., 59 Tex. 674, 676 (1883). Under the common law, a tortfeasor was not entitled to a liability offset for proceeds procured as a result of the injured party’s independently bargained-for agreement with an insurance company or other source of benefits. See Mid-Century Ins. Co. of Tex. v. Kidd, 997 S.W.2d 265, 274 (Tex.1999); see also Brown v. Am. Transfer & Storage Co., 601 S.W.2d 931, 934 (Tex.1980). The rule was predicated on the notion that a tortfeasor should not benefit from an agreement to which the tortfeasor is not privy. Brown, 601 S.W.2d at 934. The collateral source rule has been applied to all manner of benefits, including payments received under a worker’s compensation policy, see Exxon Corp. v. Shuttlesworth, 800 S.W.2d 902, 907-08 (Tex.App.-Houston [14th Dist.] 1990, no writ), income received as part of veterans’ benefits, see Montandon v. Colehour, 469 S.W.2d 222, 229-30 (Tex.Civ.App.-Fort Worth 1971, no writ), and Social Security disability payments, see Traders and Gen. Ins. Co. v. Reed, 376 S.W.2d 591, 593-94 (Tex.Civ.App.-Corpus Christi 1964, writ ref'd n.r.e.). In this sense, the collateral source rule was a rule of recovery.
But the collateral source rule also has an evidentiary aspect; the defendant may not introduce evidence at trial of collateral sources of compensation for a plaintiffs injuries. See, e.g., Taylor v. Am. Fabritech, 132 S.W.3d 613, 626 (Tex.App.-Houston [14th Dist.] 2004, pet. denied) (holding that governmental assistance payments made to plaintiff were a collateral source and that trial court erred when it allowed evidence of such payments); Exxon Corp., 800 S.W.2d at 907-08 (excluding evidence of worker’s compensation benefits). As a rule of evidence, the collateral source rule has excluded such things as evidence of payments and downward adjustments in accordance with Medicare guidelines. See Matbon, Inc. v. Gries, 288 S.W.3d 471, 480-82 (Tex.App.-Eastland 2009, no pet.); Wong v. Graham, No. 03-00-00440-CV, 2001 WL 123932, at *11 (Tex.App.-Austin Feb. 15, 2001, no pet.) (not designated for publication); see also Briese v. Tilley, No. C 08-4233 MEJ, 2010 WL 3749442, slip op. at 7-10 (N.D.Cal. Sept. 23, 2010).
1. Is the rule implicated?
The Court concludes that the collateral source rule is not implicated by statutory or contractual adjustments to medical charges because the discounted amounts are “a benefit to the insurer,” not the insured. 356 S.W.3d 390, 395. While I agree the discounting of medical charges benefits insurers, I disagree that the rule is not otherwise implicated. Although medical expenses that are discounted and written off are not direct, out-of-pocket payments made on the plaintiffs behalf, the discount would not have occurred but
2. Legislature’s intent
I agree with the Court to the extent it concludes that the Legislature did not intend to abrogate the rule as it relates to payments made by collateral sources. Consequently, my analysis is confined to whether the Legislature intended to abrogate the common law prohibition of evidence of amounts written off and never paid that may be ascribed to collateral sources. In construing a statute, we always strive to give effect to the Legislature’s stated intent. Tex. Gov’t Code § 311.021; First Am. Title Ins. Co. v. Combs, 258 S.W.3d 627, 631-32 (Tex.2008). “The plain meaning of the text is the best expression of legislative intent unless a different meaning is apparent from the context or the plain meaning leads to absurd or nonsensical results.” Molinet v. Kimbrell, 356 S.W.3d 407, 411 (Tex.2011) (citing City of Rockwall v. Hughes, 246 S.W.3d 621, 625-26 (Tex.2008)). When the Legislature’s intent is not apparent from the plain meaning of a statute’s language, we may resort to other construction aids, including legislative history. Tex. Gov’t Code § 311.023(3); see also Galbraith Eng’g Consultants, Inc. v. Pochucha, 290 S.W.3d 863, 867-68 (Tex.2009). We further presume that the Legislature is aware of existing law when it enacts legislation. See Am. Transitional Care Ctrs. of Tex., Inc. v. Palacios, 46 S.W.3d 873, 877-78 (Tex.2001).
The plain language of section 41.0105 does not support the Court’s conclusion that the Legislature intended to alter the status quo with regard to the admissibility of evidence. The statute’s unambiguous text, which states that “recovery of medical or health care expenses incurred,” refers only to a limitation on recovery, and makes
When House Bill 4 reached the Senate State Affairs Committee, it expanded section 41.0105’s application beyond health care liability claims. The Senate further renamed the proposed statute “Evidence Relating to Amount of Economic Damages,” and included the following language:
Furthermore, reading section 41.0105 in context with other laws concerning the proof and presentation of damages evidence supports my conclusion that section 41.0105 did not abrogate the collateral source rule’s application as a rule of evidence. At the time section 41.0105 was enacted, section 41.012 directed that a court should instruct the jury with regard to several other provisions of chapter 41 establishing criteria and evidence to be considered in awarding exemplary damages. Tex Civ. Prac. & Rem.Code § 41.012. For instance, section 41.012 requires the jury to be instructed with regard to section 41.011, which limits the evidence that the trier of fact can consider in determining the amount of exemplary damages. Section 41.012 also requires that the jury be instructed with regard to section 41.003, under which exemplary damages may be awarded only if the claimant establishes by clear and convincing evidence that the claimant’s harm resulted from fraud, malice, gross negligence, or as otherwise specified by statute. If the Legislature intended to limit the evidence placed in front of the jury, as opposed to a plaintiffs recovery, it likely would have amended section 41.012 and also expressly directed that the jury be instructed with regard to section 41.0105. See id.
Significantly, the Legislature also chose not to amend section 18.001 of the Code, which has long governed procedures for proving damages in personal injury cases. Under that section, an uncontroverted affidavit in proper form attesting
that the amount a person charged for a service was reasonable at the time and place that the service was provided and that the service was necessary is sufficient evidence to support a finding of fact by judge or jury that the amount charged was reasonable or that the service was necessary.
Tex. Civ. Prac. & Rem.Code § 18.001. If the Legislature intended that evidence of reasonable and necessary damages would no longer be admissible, it likely would have excluded medical services from section 18.001. The Legislature’s decision to leave these sections unaltered, thus maintaining the status quo regarding evidence to a substantial degree, is telling. Furthermore, “a statute may be interpreted as abrogating a common-law principle only when its express terms or necessary implications clearly indicate the Legislature’s intent to do so.” Cash Am., 35 S.W.3d at 16 (citation omitted). Here, neither the statute’s words nor its context express clear legislative intent to modify the collateral source rule’s evidentiary aspect. The legislative history of section 41.0105 likewise nullifies any argument that abrogation is necessarily implicit in the statute’s language.
Moreover, the severity of the plaintiffs injury is a factor that enters into the review of the legal and factual sufficiency of evidence supporting mental anguish damages. See Fifth Club, Inc. v. Ramirez, 196 S.W.3d 788, 797-798 (Tex.2006); D. Burch, Inc. v. Catchings, 2009 WL 2581862, at *4 (Tex.App.-Dallas 2009, pet. denied). In Burch, for example, the court considered the amounts billed by various medical providers in evaluating the factual sufficiency of the evidence supporting the amount of mental anguish damages awarded. Consequently, insured plaintiffs whose medical charges are written off and never paid may find it more difficult to establish the sufficiency of evidence supporting the amount of any mental anguish damages awarded.
B. Application of Section 41.0105
Having determined that Section 41.0105 precludes a plaintiff from recovering past medical expenses that are discounted and written off, but does not abrogate the collateral source rule as it applies to the admissibility of evidence of such amounts, I now turn to the statute’s application. The Legislature’s limitation of a plaintiffs recovery for past medical expenses through section 41.0105 is not novel. The Civil Practice and Remedies Code contains several similar examples of limitations on a plaintiffs recovery. See Tex. Civ. Prac. & Rem.Code § 74.303 (limiting total recovery for wrongful death or survival action on a healthcare liability claim to $500,000, not including past and future medical expenses); id. § 75.004 (limiting liability in certain premises liability suits to $500,000 per person and $1 million in the aggregate); id. § 108.002 (limiting personal liability in suits against public servants to $100,000 where act or omission occurs during the course and scope of the public servant’s employment). Section 41.0105’s limitation on a claimant’s recovery is analogous to these and other statutory damages caps. Like other statutory damages caps, Section 41.0105 should be implemented by the trial court post-verdict. See Columbia Med. Ctr. of Las Colinas, Inc. v. Hogue, 132 S.W.3d 671, 677-79 (Tex.App.-Dallas 2004) (applying Chapter 74 statutory damages caps), rev’d on other grounds, 271 S.W.3d 238 (Tex.2008); Signal Peak Enterprs. of Tex., Inc. v. Bettina Invs., Inc., 138 S.W.3d 915, 926-29 (Tex.App.-Dallas 2004, pet. struck) (holding that trial court should reform judgment to comply with statutory damages caps on exemplary damages).
Escabedo argues that implementing section 41.0105 post-verdict will not work. But the Legislature has adopted a scheme that necessitates the post-verdict adjustment of damages in other provisions of the Civil Practice and Remedies Code. See, e.g., Tex. Civ. Prac. & Rem.Code § 41.008 (applying limitation on plaintiffs recovery of exemplary damages post-verdict). When the Legislature enacted liability caps on a plaintiffs recovery in wrongful death and survival suits in health care liability claims, it also required the following jury instruction: “Do not consider, discuss, nor speculate whether or not liability, if any, on the part of any party is or is not subject to any limit under applicable law.” Id. § 74.303(e)(1); see also id. § 41.008(e). Thus, in other contexts in which the Legislature has placed a ceiling on a plaintiffs recovery, it has chosen not to apply the cap as a restriction on the amount of damages the jury can award. Instead, the jury determines damages and enters its verdict, then the trial court enforces the limitations when it renders judgment on the verdict.
I likewise am unpersuaded by Escabe-do’s argument that post-verdict modification could run afoul of our decisions in Crown Life Insurance, Co. v. Casteel, 22 S.W.3d 378 (Tex.2000), and Harris County v. Smith, 96 S.W.3d 230 (Tex.2002). Escabedo raised a hypothetical at oral argument in which a claimant receives treatment from two providers, one of whom has a contractual agreement with the hospital and one of whom does not. In the hypothetical, the jury is permitted to hear evidence of the total amount billed by both providers, as I propose, but the jury awards the plaintiff less than that amount. While Escabedo’s hypothetical could conceivably lead to a Casteel/Harris County issue, that likelihood can be accounted for through the submission of carefully tailored jury questions. See Greer v. Buzgheia, 141 Cal.App.4th 1150, 46 Cal.Rptr.3d 780, 785-86 (2006) (rejecting defendant’s motion for post-verdict reduction in damages awarded by jury because defendant failed to object to failure to segregate damages in verdict form). This post-verdict mechanism, though cumbersome, has been used by a number of California courts for over twenty years, and the case law does not reflect any pervasive problems with the process. See, e.g., Olsen v. Reid, 164 Cal.App.4th 200, 79 Cal.Rptr.3d 255, 256-57 (2008); see id. at 263-65 (Moore, Acting P.J., concurring).
II. CONCLUSION
For these reasons, I am compelled to respectfully dissent. I would hold that section 41.0105 does not affect the admissibility at trial of evidence of discounts, credits, adjustments to medical bills, or amounts actually paid but disallows the recovery of the discounted portion as a past medical expense. The court of appeals suggested a remittitur reflecting the discounts, but based on improper grounds.
. Medicare recipients become eligible for benefits either by contributing to Social Security for a specified period or by paying premiums. See 42 U.S.C. §§ 402(a), 426, 426-1, 1395c, 1395j, 1395o (2010).
. In some cases, a covered patient will receive medical services from an out-of-network medical provider. The insurance company will make payment to the provider for less than the full charges; however, the provider is not obligated to accept the insurer’s payment as satisfaction of the entire amount. In what is known as "balance billing,” the provider seeks the balance of the charges from the patient. See Miller v. Gorski Wladyslaw Estate, 547 F.3d 273, 282-83 (5th Cir.2008) (applying Louisiana law).
. Section 41.008(e) states that "[t]he provisions of this section may not be made known to a jury by any means, including voir dire, introduction into evidence, argument, or instruction”; section 41.011(b) states that "[e]v-idence that is relevant only to the amount of exemplary damages that may be awarded is not admissible during the first phase of a bifurcated trial."
