Kimberly Pearson Ruby v. Lyndon Bain Carpenter

• Court: Louisiana Court of Appeal
• Decided: December 17, 2025
• Docket: 56,669-CA
• Status: Published

Opinion

Judgment rendered December 17, 2025. Application for rehearing may be filed within the delay allowed by Art. 2166, La. C.C.P.

No. 56,669-CA

COURT OF APPEAL SECOND CIRCUIT STATE OF LOUISIANA

*****

KIMBERLY PEARSON RUBY Plaintiff-Appellant

versus

LYNDON BAIN CARPENTER Defendant-Appellee

Appealed from the Third Judicial District Court for the Parish of Union, Louisiana Trial Court No. 49,943

Honorable Bruce E. Hampton, Judge

LAW OFFICES OF STREET & STREET Counsel for Appellant By: C. Daniel Street

DOLLAR LAW FIRM, LLC Counsel for Appellee By: Johnny E. Dollar

Before PITMAN, STONE, and ELLENDER, JJ. PITMAN, C. J.

Plaintiff Kimberly Pearson Ruby appeals the judgment of the trial

court dismissing her claim for damages brought under La. R.S. 22:1871, et

seq., the Health Care Consumer Billing and Disclosure Protection Act, a/k/a

Balanced Billing Act (“BBA”), and the Louisiana Unfair Trade Practices

Act (“LUTPA”) against her chiropractor, Defendant Lyndon Bain

Carpenter. For the following reasons, the judgment of the trial court is

affirmed.

FACTS

Plaintiff was involved in an automobile accident and suffered injuries

on March 9, 2019. She sought treatment for her spine injuries from

Defendant at his chiropractic clinic in Farmerville. Her treatment started on

May 19, 2019, and concluded on March 30, 2020. Her treatment from

May 19, 2019, through August 5, 2019, was paid for by her health insurer,

United Healthcare, through her employment with Century Link. Defendant

was contracted with United Healthcare; thus, that treatment was considered

“in network” and was provided to Plaintiff at the discounted contractual

price.

In August 2019, Plaintiff changed jobs and her coverage with United

Healthcare terminated. Because her chiropractic care continued, Plaintiff

informed Defendant that her bills were to be sent to State Farm, which was

the tortfeasor’s insurer for the automobile accident. She informed him that

State Farm had accepted responsibility and had authorized direct billing for

her medical treatment. Defendant verified this fact; and at her specific

order to do so, he began billing State Farm for her care and filed a medical

lien against her future settlement. Plaintiff obtained Blue Cross Blue Shield (“BCBS”) coverage

through her new employment, which went into effect on October 1, 2019.

Although she claims she informed Defendant’s office of this new coverage,

he did not have any record that BCBS was now to be billed for her

treatment, and he continued to bill State Farm. Upon her retention of an

attorney and Defendant’s receipt of his letter of representation dated

January 14, 2020, Defendant began billing her attorney.

The bill for the period of August 12, 2019, through January 10, 2020,

totaled $5,365. Treatment between January and March 30, 2020, totaled an

additional $2,220. Defendant provided Plaintiff’s attorney with a final

invoice in the amount of $7,585.00 on July 9, 2020. The personal injury

case settled on August 19, 2020, with checks being issued on August 28,

2020. Plaintiff’s attorney paid Defendant $5,365, which was based on an

earlier billing amount prior to completion of treatment. On September 1,

2020, Defendant notified the attorney that the check was $2,220 less than

he was owed, but the attorney told him that Plaintiff owed the difference

because she should have stopped treatment earlier. Eventually, Plaintiff

paid Defendant $2,220 under protest. This amount was partially funded by

a loan from her attorney.

On September 3, 2020, Defendant received a copy of Plaintiff’s

BCBS enrollment card effective October 1, 2019, with a notation for

coverage of her care after she “came off personal injury.” Defendant was

never informed of any BCBS coverage until September 3, 2020.

Plaintiff claims that the attorney was “forced to investigate the

matter” and discovered “about the payments made by United Healthcare

and found out about the BCBS coverage which revealed a violation of the 2 Balanced Billing Act.” Plaintiff filed suit seeking redress for the alleged

violations of the BBA. She claimed that had Defendant billed BCBS as he

should have, she would not have had to pay anything for treatment from

October 1, 2019, when the BCBS coverage went into effect, because that

coverage had no deductible and no copay required. She sought recovery of

damages, treble damages and attorney fees for violations of the BBA and

the LUTPA.

The matter was set for trial and was heard on October 21, 2024, and

taken under advisement. On February 7, 2025, the trial court filed its

reasons for judgment and concluded that Plaintiff had not carried her

burden of showing any violations of double billing or Defendant’s failure to

participate in discount billing for medical treatment. Plaintiff had instructed

Defendant to bill State Farm as the tortfeasor’s insurer, and he did so. The

trial court found that despite Plaintiff’s claim that she had provided a copy

of her insurance card from BCBS to Defendant, he proved he did not know

about the BCBS coverage until September 3, 2020, and, thus, could not be

responsible to Plaintiff for the amount she was billed. The trial court found

that Defendant did not commit fraud or violate any unfair trade practices,

and there was no violation of either the BBA or the LUTPA. Judgment was

signed on April 11, 2025, with the trial court ruling in favor of Defendant

and against Plaintiff and dismissing her suit with prejudice.

This appeal followed.

DISCUSSION

Plaintiff argues that the trial court erred in failing to find Defendant

violated the BBA and dismissing the suit with prejudice. She also argues

that the BBA does not allow a qualified health care provider to charge a 3 patient an amount greater than the contractually agreed-upon amount. She

contends that by charging State Farm 100 percent of the costs of the

service, Defendant violated the BBA and the LUTPA. For that reason,

Plaintiff claims the trial court erred in not awarding damages and attorney

fees for Defendant’s alleged violations and in not awarding treble damages

provided for in the BBA and the LUTPA.

Defendant argues that the trial court correctly found that there were

no violations of the BBA or the LUTPA. He contends that the BBA only

applies to contracted providers billing health insurers, and when he became

aware of United Healthcare’s coverage, he billed them at the contracted

rate. Further, when Plaintiff informed him of the State Farm coverage

under the tortfeasor’s insurance liability policy, he began charging that

insurance company, and it agreed to cover her medical bills. He asserts that

the BBA does not apply because State Farm is not a “health insurance

issuer” under the Act.

Defendant also argues that the BBA does not apply to the amount

which could have been billed to BCBS because the trial court found that

Defendant did not learn of that coverage until September 3, 2020, months

after treatment ended and bills had been submitted to State Farm and

settled.

Defendant further argues that the trial court also correctly found there

was no violation of the LUTPA. He notes that he charged State Farm at the

appropriate rate and that his bill was paid by it from the settlement of

Plaintiff’s tort suit. He submitted his bill for the total amount owed of

$7,585, and Defendant’s attorney only paid a portion of that amount. He

4 points out that he never double billed Plaintiff or sought compensation to

which he was not entitled.

The BBA, La. R.S. 22:1871, et seq., prohibits a contracted healthcare

provider from collecting or attempting to collect amounts from an insured

patient in excess of the contracted reimbursement rate. DePhillips v. Hosp.

Serv. Dist. No. 1 of Tangipahoa Par., 19-01496 (La. 7/9/20), 340 So. 3d

817. La. R.S. 22:1874, titled “Billing by contracted health care providers,”

states in pertinent part as follows:

A. (1) A contracted health care provider shall be prohibited from discount billing, dual billing, attempting to collect from, or collecting from an enrollee or insured a health insurance issuer liability or any amount in excess of the contracted reimbursement rate for covered health care services. (2) No contracted health care provider shall bill, attempt to collect from, or collect from an enrollee or insured any amounts other than those representing coinsurance, copayments, deductibles, noncovered or noncontracted health care services, or other amounts identified by the health insurance issuer on an explanation of benefits as an amount for which the enrollee or insured is liable. (3) However, in the event that any billing, attempt to collect from, or the collection from an enrollee or insured of any amount other than those representing copayment, deductible, coinsurance, payment for noncovered or noncontracted health care services, or other amounts identified by the health insurance issuer as the liability of the enrollee or insured is based on information received from a health insurance issuer, the contracted health care provider shall not be in violation of this Subpart.

La. R.S. 22:1872 contains the definitions relevant to the BBA as

follows:

(9) “Discount billing” means any written or electronic communication issued by a contracted health care provider that appears to attempt to collect from an enrollee or insured an amount in excess of the contracted reimbursement rate for covered services.

(10) “Dual billing” means any written or electronic communication issued by a contracted health care provider that

5 sets forth any amount owed by an enrollee or insured that is a health insurance issuer liability.

***

(18) “Health insurance coverage” means benefits consisting of medical care provided or arranged for directly, through insurance or reimbursement, or otherwise, and includes health care services paid for under any plan, policy, or certificate of insurance.

(19) “Health insurance issuer” means any entity that offers health insurance coverage through a policy or certificate of insurance subject to state law that regulates the business of insurance.

A court of appeal may not set aside a trial court’s or a jury’s finding of

fact in the absence of “manifest error” or unless it is “clearly wrong.” Rosell

v. ESCO, 549 So. 2d 840 (La. 1989). The issue to be resolved by a

reviewing court is not whether the trier of fact was right or wrong, but

whether the fact finder’s conclusion was a reasonable one. Stobart v. State

through Dep’t of Transp. & Dev., 617 So. 2d 880 (La. 1993).

La. R.S. 51:1405, LUTPA, is titled “Unfair acts or practices;

interpretation and rulemaking authority,” and it states as follows:

A. Unfair methods of competition and unfair or deceptive acts or practices in the conduct of any trade or commerce are hereby declared unlawful.

B. The attorney general may make rules and regulations interpreting the provisions of this Chapter consistent with the provisions in R.S. 51:1 through 461.1. Such rules and regulations shall be adopted in the form and manner prescribed by the Administrative Procedure Act, R.S. 49:950 et seq. The validity or applicability of a rule may be determined in an action for declaratory judgment in the district court of the parish in which the division is located or in the parish in which the plaintiff resides or is domiciled. Appeals may be had from any ruling of a district court in accordance with the Code of Civil Procedure, except that such appeals shall be given preference and heard in priority to other appeals.

6 Acts constituting unfair or deceptive trade practices are not

specifically defined in the LUTPA but are determined by the courts on a case-

by-case basis. Cupp Drug Store, Inc. v. Blue Cross & Blue Shield of

Louisiana, Inc., 49,482 (La. App. 2 Cir. 1/7/15), 161 So. 3d 860, writ denied,

15-0571 (La. 5/22/15), 171 So. 3d 249. In general, acts which comprise unfair

trade practices involve fraud, deception, misrepresentation, breach of fiduciary

duty or other unethical conduct. Id. The span of prohibited practices under

the LUTPA is extremely narrow. Id. To succeed on a LUTPA claim, the

plaintiff must show that the alleged conduct offends established public policy

and is immoral, unethical, oppressive, unscrupulous or substantially injurious.

Id.

Whether a defendant has violated the LUTPA is a factual

determination. Walker v. Hixson Autoplex of Monroe, L.L.C., 51,758 (La. App.

2 Cir. 11/29/17), 245 So. 3d 1088, citing Cupp, supra. An appellate court may

not set aside a trial court’s finding of fact in the absence of manifest error or

unless it is clearly wrong. Id. Where there is more than one allowable view of

the evidence, the fact finder’s choice among them cannot be manifestly

erroneous or clearly wrong. Id. Even though an appellate court may feel its

own evaluations and inferences are more reasonable than the fact finder’s,

reasonable evaluations of credibility and reasonable inferences of fact should

not be disturbed upon review where conflict exists in the testimony. Id., citing

Cole v. Department of Public Safety & Corrections, 01-2123 (La. 9/4/02),

825 So. 2d 1134.

The evidence shows Defendant never attempted to double bill any

insurance provider. Plaintiff’s attorney was aware that Defendant was billing

State Farm and that the total amount was $7,585. When the case was settled, 7 Defendant immediately notified the attorney that the initial payment of $5,365

was insufficient for the chiropractic services rendered and that $2,220 more

should have been paid out of the settlement. We find no manifest error in the

ruling of the trial court. The assignments of error are without merit.

CONCLUSION

For the foregoing reasons, the judgment of the trial court dismissing

Plaintiff Kimberly Pearson Ruby’s suit against Defendant Lyndon Bain

Carpenter is affirmed. Costs of this appeal are assessed to Plaintiff.