Carroll v. QHG of Alabama, Inc.

9 F. Supp. 2d 1303, 1998 U.S. Dist. LEXIS 9792, 1998 WL 351206
CourtDistrict Court, M.D. Alabama
DecidedJune 17, 1998
DocketCivil Action 97-D-326-S
StatusPublished
Cited by1 cases

This text of 9 F. Supp. 2d 1303 (Carroll v. QHG of Alabama, Inc.) is published on Counsel Stack Legal Research, covering District Court, M.D. Alabama primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Carroll v. QHG of Alabama, Inc., 9 F. Supp. 2d 1303, 1998 U.S. Dist. LEXIS 9792, 1998 WL 351206 (M.D. Ala. 1998).

Opinion

*1304 ORDER

DE MENT, District Judge.

Before the court is Plaintiffs Motion To Remand (“Pl.’s Mot.”) filed March 25, 1997. Defendant Quorum Health Group (“Quorum”) filed its Response (“Def.’s Resp.”) on April 15, 1997. Plaintiff filed a Reply (“Pl.’s Reply”) on April 22, 1997. On February 25, 1998, the court issued an Order directing Plaintiff to submit a supplemental pleading clarifying her claims. This pleading, styled “Plaintiffs Further Memorandum Brief In Support Of Her Motion To Remand” (“Pl.’s Supp.”) was filed March 12,1998. On March 16, 1998, Plaintiff filed her First Amended Complaint, which further clarified her claims. Also before the court is Quorum’s Motion To Dismiss filed March 21, 1997. Plaintiff has not filed a response to this pleading.

After careful consideration of the arguments of counsel, relevant law, and the record as a whole, the court finds that Plaintiffs Motion To Remand is due to be granted because the court lacks jurisdiction over Plaintiffs claims. Consequently, the court will not consider Quorum’s Motion To Dismiss.

I. Factual Summary And Procedural History

Plaintiff Jan Carroll is employed at Tech-sonic Industries. Techsonic entered into a contract with Blue Cross Blue Shield of Alabama (“Blue Cross”) for the provision of major medical insurance coverage for Tech-sonic employees. Plaintiff, as a Techsonic employee, obtained coverage through the Blue Cross plan (“Plan”).

On May. 11, 1996, Plaintiff was involved in a traffic accident with an individual insured by Farmers Insurance Group (“Farmers”). Plaintiff was covered by her insurer — State Farm Mutual Automobile Insurance Company (“State Farm”). She was treated at Flowers Hospital (“Flowers”) for injuries sustained during the accident. Following Plaintiffs treatment, Flowers filed a hospital hen against her and contacted Farmers and State Farm. Farmer agreed to pay its policy limits, but issued a check made jointly payable to Plaintiff and Flowers. Plaintiff requested that Flowers submit her claim to Blue Cross, but Flowers refused, stating that they were entitled to the full amount of Plaintiffs bill. Flowers also requested that Plaintiff endorse Farmer’s check over to them. In addition, Flowers sent a collection letter to Plaintiffs attorney.

Plaintiff brought suit, on behalf of a class, alleging that under the terms of her Plan, her claims should have been submitted to Blue Cross. She alleges that Flowers refuses to submit claims to Blue Cross if there is the “possibility that the insured patient [has] a right to recover from a third-party tortfeasor.” (Pl.’s Mot. at 4.) Her Complaint alleges tortious interference with a contractual or business relationship between herself and the putative class members and Blue Cross, conversion of certain funds, and the wrongful filing of hens. (Pl.’s Mot. at 4, ¶ 4; see also Pl.’s Compl.)

Plaintiff states that she makes no allegation of wrongdoing:

in connection with the administration or management of an ERISA plan and does not seek benefits under an ERISA plan. QHG of Alabama and Quorum Health Group are not insurers/underwriters of or the administrators/managers of Jan Carroll’s employer-provided Blue Cross Blue Shield of Alabama major medical plan or of any similar plan covering the prospective class members. QHG of Alabama and Quorum Health Group are not fiduciaries of any subject ERISA plan.
Instead, QHG of Alabama and Quorum Health Group are simply medical care providers who entered into a contract with Blue Cross Blue Shield of Alabama which governed Flower’s Hospital’s cohecting of services rendered Blue Cross Blue Shield of Alabama insureds. If such an insured, like Jan Carroll, sought medical treatment at Flowers Hospital, QHG of Alabama and Quorum Health Group agreed to timely submit a claim for reimbursement to Blue Cross Blue Shield of Alabama and to not attempt to collect from the insured unless Blue Cross Blue Shield of Alabama failed to pay the claim within sixty days of submission of the claim. *1305 is not seeking to obtain insurance benefits due her from Blue Cross Blue Shield of Alabama. Instead, she is seeking to recover funds received by her from a settlement with a third-party tortfeasor’s liability carrier and with her uninsured/underinsured motorist carrier but which the defendants wrongfully deprived her.

*1304 (Pl.’s Mot. at 4-5 (emphasis in original).) Essentially, Plaintiff asserts that she:

*1305 (Pl.’s Mot. at 6, ¶8.) Basically, this suit is based on Flower’s alleged failure to comply with the terms of its contract with Blue Cross, not on Blue Cross’s failure to provide any benefits to Plaintiff contemplated under the Plan.

The contracts upon which Plaintiff relies are a series of “Preferred Outpatient Facility Contract[s]” and “Selective Contracting Facility Contractfs]” entered into between Blue Cross and QHG of Alabama, Inc. d/b/a Flowers Hospital, in 1992 and 1994. The 1992 “Preferred Outpatient Facility Contract” states that:

Hospital agrees to complete and file on a timely basis all claims for benefits for Outpatient Services rendered to Members. ... 1

(Pl.’s First Am. Compl., Ex. A, 1992 Preferred Outpatient Facility Contract at 4, ¶4.2.) Paragraph 4.4 of the 1992 contract provides:

Hospital agrees to make no charge for Outpatient Services except to the extent permitted by this Agreement and the Member’s Benefit Agreement. Hospital may bill the Member for any co-payment and co-insurance amounts applicable under the member’s Benefit Agreement to Outpatient Services but the total amount payable by both the Member and Corporation shall not exceed the amount payable under Article VI for such Outpatient Services. Hospital may bill the Member for services which are not covered under the Member’s Benefit Agreement (typical examples being services for experimental or investigative treatment, and preexisting conditions). Hospital will not bill Members directly for amounts due from Corporation for Outpatient Services. 2

(Id., ¶4.4 (emphasis added).) Plaintiff contends that under ¶ 4.4, Flowers “agreed not to bill Members (like Plaintiff) directly for amounts due from the Corporation (BlueC-ross) [sic] for Outpatient' Services.” (Pl.’s First Am. Compl., ¶ 3.)'

Under the' terms of the 1994 “Selective Contracting Facility Contract:”

Hospital agrees to make no charge for Inpatient Services except to the extent permitted by this Agreement, and the Member’s C Plus Contract. Hospital may bill the Member for services which are not covered under the Member’s C Plus contract because of exclusions and limitations in the C Plus Contract (typical examples being services for experimental or investigative treatment, and cosmetic surgery). Hospital will not bill Members directly for amounts due from Corporation. 3

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9 F. Supp. 2d 1303, 1998 U.S. Dist. LEXIS 9792, 1998 WL 351206, Counsel Stack Legal Research, https://law.counselstack.com/opinion/carroll-v-qhg-of-alabama-inc-almd-1998.