Gianetti v. Siglinger

900 A.2d 520, 279 Conn. 130, 2006 Conn. LEXIS 308
Supreme Court of Connecticut·Decided July 11, 2006·No. SC 17586·Published·Cited by 3 cases

Opinion

Opinion

PER CURIAM.

This appeal1 arises out of an action brought by the plaintiff, Charles D. Gianetti, a physician, against the defendants, Glenn Siglinger and Laura Sig-linger (Siglingers) and Foster M. Young, an attorney for the Siglingers, in which the plaintiff sought moneys that he claimed were due to him as compensation for medical services that he had provided to Allison Sig-[132] linger, the minor daughter of the Siglingers. The defendants filed counterclaims against the plaintiff alleging violations of General Statutes § 42-110b2 of the Connecticut Unfair Trade Practices Act (CUTPA), General Statutes § 42-110a et seq. After trial to the court, the trial court rendered judgment for the defendants on both the plaintiffs complaint and the defendants’ counterclaims. We affirm the judgment of the trial court.

The record reveals the following relevant facts and procedural history. On December 30, 1995, Allison Sig-linger was involved in an automobile accident. As a result of this accident, the plaintiff, a plastic surgeon, provided services to Allison twice: at the emergency room of Bridgeport Hospital on the day of the accident; and during an office visit on January 9, 1996.

At the time that treatment was rendered, both the Siglingers and the plaintiff had a relationship with Physicians Health Services of Connecticut, Inc. (Physicians Health), a health maintenance organization.3 The Sig-lingers were subscribers to the prepaid health care program issued by Physicians Health. Pursuant to their agreement, Physicians Health provided certain covered services in return for specified periodic payments. The [133] agreement explicitly provided that it was “not anticipated that a [m] ember [would] make payments other than any applicable [c]opayment to any person or institution providing benefits under this [c]ontract.”

The plaintiffs relationship with Physicians Health is more complicated. From 1977 through 1998, the plaintiff was a provider of Physicians Health services as a member of the Greater Bridgeport Individual Practice Association, Inc. (practice association), or its predecessors.4 This relationship was reflected in a series of agreements between the plaintiff and the practice association, all of which contain certain basic tenets of the arrangement.5 Under the agreements, the plaintiff, as a participating physician, was obligated to provide or arrange for the covered services designated by Physicians Health sub[134] scriber contracts and to submit bills for those services to Physicians Health. Physicians Health would then compensate the plaintiff for the medical services he provided to Physicians Health subscribers in accord with a fee schedule determined by Physicians Health. The plaintiff was not to bill Physicians Health subscribers for any amount above a nominal, predetermined co-payment. Specifically, under the agreement in effect at the time the plaintiff provided services to Allison Siglinger, the plaintiff “agreefd] that in no event . . . shall [p]hysician bill, charge, collect a deposit from, seek compensation, remuneration or reimbursement from, or have any recourse against [m] embers or persons . . . acting on their behalf for services provided pursuant to this [agreement.” Thus, “balance billing,” which is an attempt by a physician to collect the balance due from a subscriber over and above the amount that Physicians Health determined to be reasonable for covered services, was clearly prohibited under the arrangement.

The parameters of this arrangement were a matter of some contention between the plaintiff and the practice association up to and during the time that the plaintiff provided services to Allison Siglinger. Specifically, on more than one occasion, the plaintiff had billed Physicians Health subscribers directly for certain services that he had provided to them. The plaintiff subsequently sought payment through litigation. See, e.g., Gianetti v. Fischetti, Superior Court, judicial district of Fairfield at Bridgeport, Docket No. CV-98-0352010S (February 3, 2000), aff'd, 64 Conn. App. 902, 777 A.2d 213 (2001); Gianetti v. Mulroney, Superior Court, judicial district of Fairfield at Bridgeport, Docket No. CV-91-0290495S (July 10, 1995). In a September 6, 1991 letter, the practice association informed the plaintiff that the board of directors had determined that the plaintiff had a pattern of not fulfilling his contractual obligations to the prac[135] tice association with respect to billing issues. The letter warned that another occurrence of certain specified events, including balance billing of plan subscribers, would result in termination of his participation with Physicians Health. In letters dated February 14, 1995, and March 6, 1995, the practice association notified the plaintiff that it intended to terminate him as a Physicians Health provider due to his balance billing of a plan subscriber. The board eventually withdrew the termination notice after the plaintiff obtained legal representation and contested the action.

It is undisputed that the plaintiff did not inform the Siglingers at the time of treatment that he might claim compensation directly from them for his services, nor did he inform them of his disagreements with Physicians Health and other subscribers regarding compensation beyond that paid by Physicians Health. Indeed, the plaintiff submitted a request for payment to Physicians Health for the services that he performed for Allison Siglinger and received $1888.80 in July, 1996. The plaintiff requested a reconsideration of the amount paid to him, and by December, 1996, Physicians Health had adjusted his compensation for the care of Allison to $1980.80. The plaintiff has since filed an action against Physicians Health in small claims court, alleging “[ijncorrect payment of medical services rendered” and seeking an additional $481.60 in compensation.

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Gianetti v. Siglinger, 900 A.2d 520, 279 Conn. 130, 2006 Conn. LEXIS 308 (Colo. 2006).

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