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

2016 Ohio 7982
Ohio Court of Appeals·Decided December 2, 2016·No. 27091·Published·Cited by 9 cases

Opinion

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.

{¶ 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

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

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

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,

p. 4.

{¶ 15} The Resident Admission Agreement states in paragraph 2 that the Facility will provide the resident with basic room and board and routine nursing services, which are referred to as “General Services.” This paragraph further indicates that these services are included in the Facility’s daily rate, which is noted in Attachment A to the agreement as $327 per day.

{¶ 16} Paragraph 2 of the agreement defines routine nursing care and lists items that are not included. This paragraph goes on to state that: “However, the Resident is financially responsible for any additional charges not covered by a third party payor (e.g., Medicare, Medicaid, or private insurance). If the scope of the General Services covered by the Facility’s Daily Rate is not clearly understood by the Resident, the Resident must contact the Facility’s business office immediately.” Stonespring Ex. A, p. 2.

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

2016 Ohio 7982 (Holfinger v. Stonespring/Carespring, L.L.C.) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

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