McArthur v. Randall

852 N.E.2d 198, 166 Ohio App. 3d 546, 2006 Ohio 777
CourtOhio Court of Appeals
DecidedFebruary 17, 2006
DocketNo. 2005-CA-2.
StatusPublished

This text of 852 N.E.2d 198 (McArthur v. Randall) 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
McArthur v. Randall, 852 N.E.2d 198, 166 Ohio App. 3d 546, 2006 Ohio 777 (Ohio Ct. App. 2006).

Opinion

Fain, Judge.

{¶ 1} Plaintiff-appellee, McArthur Chiropractic Center, brought an action in small-claims against its patient, Richard Randall, to recover the unpaid balance on Randall’s account. The Champaign County Municipal Court entered judgment in favor of McArthur Chiropractic Center, and Randall appeals.

{¶ 2} Randall contends that the trial court erred by failing to consider R.C. 1751.60 in its decision. He further contends that the judgment is against the manifest weight of the evidence.

{¶ 3} A crucial factual issue in this case is whether McArthur was a provider under contract with Randall’s health-care insurer. McArthur testified that he was not; Randall testified that he was. In finding for McArthur on this issue, the magistrate erroneously stated that Randall had testified that McArthur was not a provider under contract with Randall’s health-care insurer. We conclude that this constituted a fundamental factual error in the magistrate’s decision, which was pointed out to the trial court in Randall’s objections, but which was not addressed by the trial court. Under these circumstances, we conclude that the judgment is against the manifest weight of the evidence. The judgment of the trial court is reversed, and this cause is remanded for further proceedings.

I

{¶ 4} Brent McArthur, d.b.a. McArthur Chiropractic Center, filed suit in the Champaign Municipal Court alleging that Randall owed a total of $1,870 for services rendered during 2001 and 2002. The matter proceeded to a bench trial, during which the following evidence was adduced.

{¶ 5} Dr. Brent McArthur testified that he had treated Randall for problems arising from an automobile accident. The treatment continued for more than a year. At the end of the treatment, Randall was billed for services. McArthur testified that at the time the services were rendered, he was not under contract *548 with Randall’s insurance company, Anthem, and that he was not, at the time of the hearing, an Anthem provider. McArthur also testified that Randall did not provide a copy of his insurance card. Finally, McArthur testified as follows:

{¶ 6} “If you look on a HIPA form which is a health insurance care form, there’s a box that says is this care rendered due to work, auto or personal. Yeah, just general health. And this, this whole care has been rendered due to an accident, due to a car accident, lingering effects from a bad car wreck. Well, you, you can’t bill an insurance company for an automobile accident — health care insurance company for an automobile accident when it’s — it’s a totally different thing. And [Randall is] still pursuing, I would imagine, to, to settle this with his own car insurance.”

{¶ 7} In contrast, Randall testified that he had contacted his health-insurance carrier, Anthem, prior to treatment and was informed that McArthur had been under contract with Anthem since 1999. He further testified that he provided his health-insurance information to McArthur, but that McArthur had failed to bill Anthem.

{¶ 8} Following the trial, the magistrate decided in favor of McArthur, awarding $1,870 for services rendered. The decision included the following statement:

{¶ 9} “Both [McArthur and Randall] admit [Randall] received medical treatment from [McArthur]. [Randall] claims that [McArthur] was not a proper provider under his insurance. [McArthur] claims that he submitted proper paperwork for payment. [Randall] did receive medical treatment which should be paid for.”

{¶ 10} Randall filed objections to the magistrate’s decision. Along with his objection, he filed an exhibit purporting to be a photocopy of a page from Anthem’s web site, which showed McArthur as an Anthem provider. The trial court, without analysis, overruled the objections and rendered judgment in favor of McArthur and against Randall. From this judgment, Randall appeals.

II

{¶ 11} Randall’s First Assignment of Error states as follows:

{¶ 12} “The trial court erred as a matter of law in failing to conclude that R.C. 1751.60 precluded direct billing of the appellant by the appellee.”

{¶ 13} Randall contends that the trial court erroneously failed to consider the provisions of R.C. 1751.60 in determining this action.

{¶ 14} R.C. 1751.60 expressly states that providers cannot, under any circumstances, seek payment from enrolleés or subscribers, except for approved copayments and noncovered services. Parmatown Spinal & Rehab. Ctr., Inc. v. Lewis, *549 Cuyahoga App. No. 81996, 2003-Ohio-5069, 2003 WL 22208786, ¶24. “[The statute] imposes a mandatory requirement upon health care facilities [and providers] that contract with health insuring corporations to seek compensation for covered services solely from the [health] insurer, except for approved co-payments and deductibles.” Grandview/Southview Hosps. v. Monie, Montgomery App. No. 20636, 2005-Ohio-1574, 2005 WL 737393, ¶ 10, citing R.C. 1751.60(A). In other words, if McArthur is an Anthem provider, he cannot seek payment from Randall, an Anthem insured, for anything other than approved copayments or noncovered services. 1

{¶ 15} This statute must be considered when a doctor is a contract provider for an insurance company and that doctor treats the insured of that company. In this case, neither the magistrate nor the trial court made any reference to this statute, despite the fact that Randall raised it many times during the pendency of this action. We presume that the magistrate and trial court did not consider this statute because they found that Dr. McArthur was not an Anthem provider. 2 Dr. McArthur’s testimony would support this finding. Therefore, we decline to find error in this regard.

{¶ 16} The first assignment of error is overruled.

Ill

{¶ 17} Randall’s second assignment of error is as follows:

{¶ 18} “The trial court’s judgment was against the manifest weight of the evidence.”

{¶ 19} Randall contends that the judgment against him is not supported by the evidence. Specifically, he claims that the magistrate’s findings are erroneous and that the trial court erred by adopting the magistrate’s decision.

{¶ 20} Obviously, the key issue in this case is whether McArthur had a contract with Anthem to act as a provider of medical services for individuals insured by Anthem. If he was a provider, then the provisions of R.C. 1751.60 require that he bill Anthem rather than Randall. If he was not, then the provisions of that statute do not apply.

*550 {¶ 21} As noted above, the magistrate made only three findings with regard to her decision in favor of McArthur: (1) that McArthur provided medical treatment to Randall, (2) that Randall testified that McArthur was not an Anthem provider, and (3) that McArthur submitted the proper paperwork for payment.

{¶22} It appears that the magistrate’s decision was based, largely, upon a finding that McArthur was not an Anthem provider.

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Bluebook (online)
852 N.E.2d 198, 166 Ohio App. 3d 546, 2006 Ohio 777, Counsel Stack Legal Research, https://law.counselstack.com/opinion/mcarthur-v-randall-ohioctapp-2006.