Holfinger v. Stonespring/Carespring, L.L.C.

2016 Ohio 7982
CourtOhio Court of Appeals
DecidedDecember 2, 2016
Docket27091
StatusPublished
Cited by9 cases

This text of 2016 Ohio 7982 (Holfinger v. Stonespring/Carespring, L.L.C.) is published on Counsel Stack Legal Research, covering Ohio Court of Appeals primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Holfinger v. Stonespring/Carespring, L.L.C., 2016 Ohio 7982 (Ohio Ct. App. 2016).

Opinion

[Cite as Holfinger v. Stonespring/Carespring, L.L.C., 2016-Ohio-7982.]

IN THE COURT OF APPEALS OF OHIO SECOND APPELLATE DISTRICT MONTGOMERY COUNTY

RICHARD HOLFINGER : : Appellate Case No. 27091 Plaintiff-Appellant : : Trial Court Case No. CVI 15-1238 v. : : (Civil Appeal from STONESPRING/CARESPRING, L.L.C. : Vandalia Municipal Court) : Defendant-Appellee : :

...........

OPINION

Rendered on the 2nd day of December, 2016.

RICHARD HOLFINGER, 1990 Woodcliffe Drive, Troy, Ohio 45373 Plaintiff-Appellant, pro se

JOSHUA F. DeBRA, Atty. Reg. No. 0083267, Calderhead, Lockemeyer & Peschke, 6281 Tri-Ridge Boulevard, Suite 210, Loveland, Ohio 45150 Attorney for Defendant-Appellee

.............

WELBAUM, J. -2-

{¶ 1} Plaintiff-Appellant, Richard Holfinger, appeals from a judgment rendered in

favor of Defendant-Appellee, Stonespring/Carespring, LLC. (“Stonespring”), in the

amount of $2,335.84, plus interest and costs. In support of his appeal, Holfinger

contends that the trial court erred by failing to be knowledgeable about a “Medicare

Advanced Beneficiary Notification (ABN).”

{¶ 2} We conclude that the trial court did not err in awarding judgment to

Stonespring on its counterclaim for damages. Holfinger failed to properly support his

assignment of error as required by App.R. 16(A)(7), and we are overruling the assignment

of error on that basis. Even if Holfinger had properly complied with the Ohio Appellate

Rules, the trial court made factual findings that Holfinger failed to properly challenge in

the trial court. Accordingly, the judgment of the trial court will be affirmed.

I. Factual Background

{¶ 3} On October 1, 2015, Richard Holfinger filed a small claims action in Vandalia

Municipal Court against Stonespring. Holfinger alleged that he had been a patient at

Stonespring from November 11, 2013, until December 13, 2013, and that Stonespring

had attempted to collect $2,600 from him. He stated that his insurance agent told him

that he did not owe the money and that Stonespring owed him $755. He, therefore,

asked for that amount. This was the extent of Holfinger’s complaint.

{¶ 4} On October 30, 2015, Stonespring filed an answer and counterclaim. The

counterclaim contained three counts: judgment on an account; unjust enrichment; and

breach of contract. According to the counterclaim, Holfinger was admitted as a resident -3-

at Stonespring from November 11, 2013, to December 14, 2013, and had signed an

admission agreement. He was allegedly provided services and failed to pay for them.

Stonespring claimed Holfinger owed $2,335.84, plus post-judgment interest of 18%, and

attorney fees and costs. Neither the complaint nor the counterclaim mentioned

Medicare.

{¶ 5} Stonespring attached the following items to the counterclaim: (1) the

Resident Agreement; (2) a copy of Holfinger’s account; and (3) the affidavit of Nancy

Burden, the records custodian for Stonespring.

{¶ 6} Stonespring filed a motion for default judgment in December 2015, based on

Holfinger’s failure to answer the counterclaim, but the trial court denied the motion. Trial

was then held before a magistrate on December 17, 2015. At the hearing, the magistrate

heard testimony from Holfinger and from Nancy Burden, Stonespring’s collection

manager.

{¶ 7} Holfinger testified that he entered Stonespring as a patient on November 13,

2013, after a total hip replacement. Holfinger indicated that he made a partial payment

of $630 on December 2, 2013, and paid another $1,345 in April 2014. About a year

later, he received another bill for $2,607.32. After unsuccessfully challenging the bill with

Stonespring employees, Holfinger was told to contact his insurer, Anthem. According to

Holfinger, an insurance agent told him that he did not owe Stonespring, but had overpaid

it by $755.

{¶ 8} A law firm then sent Holfinger a letter dated September 24, 2015. The letter

indicated that from December 5, 2013, until Holfinger’s discharge on December 14, 2013,

Anthem had denied coverage as not medically necessary, and that all charges incurred -4-

during that time were Holfinger’s responsibility. Holfinger Trial Ex. 3. Holfinger was

informed at this time that he owed $2,953.00 for room and board, plus ancillary fees of

$137.84. After Holfinger was credited with payments he had made, the listed total was

$2,335.84.

{¶ 9} Upon receiving another letter from a law firm in December 2015, Holfinger

drove to the Anthem Center in Mason, Ohio, and spoke with Joseph Klein, the executive

counsel of litigation. According to Holfinger, Klein said that the Anthem contract for

network providers like Stonespring states that if a payor is denied coverage due to lack

of medical necessity, the provider must show the patient an estimate for self-pay charges

before service begins or the patient is not liable for any charges.

{¶ 10} Nancy Burden then testified. She stated that she takes care of private

accounts and takes them to the next step when they are uncollectible at the nursing

home. Holfinger indicated that she had knowledge of Holfinger’s account and had

reviewed the correspondence Holfinger provided, as well as the insurance denials. She

stated that Holfinger came into the nursing home under an Anthem policy, and then he

was “cut” by Anthem and owed privately. She identified the Resident Admission

Agreement and the attached schedule, which identified $327 as the daily rate for staying

at the facility. Burden further noted that Holfinger agreed to be responsible for that

amount in the event his coverage terminated.

{¶ 11} Burden also identified Stonespring Ex. B, which reflected the charges for

which Holfinger was liable due to the denial. This exhibit listed a charge beginning

December 5, 2013, for room and board of $2,953.00, plus incidental expenses, for a total

amount owed of $3,090.84. After Holfinger’s payments were credited, $2,335.84 was -5-

due.

{¶ 12} During Burden’s testimony, the Magistrate asked several questions.

Specifically, the following exchange occurred:

Magistrate: Okay. And then I also, just from briefly looking at the

Resident Admission Agreement, it talks about Medicare and Medicaid, I, I

assume from what you’ve said that none of that applies to this case, is that

correct?

Ms. Burden: No, it does not.

Magistrate: Okay.

Ms. Burden: Just the . . .

Magistrate: Would you agree with that, Mr. Holzfaster [sic], we’re

not talking about Medicaid or . . .

Mr. Holfinger: No, it’s because Anthem manages my Medicare.

Magistrate: Understood, okay. Alright, very good. Any, anything

else, I’m done with what I had. Anything else?

(Emphasis added.) Transcript of Trial Proceedings, p. 23.

{¶ 13} After hearing the testimony, the Magistrate issued a decision on December

17, 2015, concluding that Stonespring was entitled to recover $2,335.84, plus $664.10 in

attorney fees, and 18% interest from the date of judgment. A total judgment of $3,000

was recommended because that was the limit of the small claims jurisdiction.

{¶ 14} The Magistrate apparently did not credit Holfinger’s statement about

Medicare because the Magistrate relied on paragraph 3(E)(iii) of the Resident Admission

Agreement, which excludes Medicare as a factor. See Magistrate’s Decision, Doc. #13, -6-

p. 4.

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2016 Ohio 7982, Counsel Stack Legal Research, https://law.counselstack.com/opinion/holfinger-v-stonespringcarespring-llc-ohioctapp-2016.