Prentiss Baker and Sheryl Wiginton, Individually and on Behalf of All Others Similarly Situated v. Phc-Minden, L.P. D/B/A Minden Medical Center

167 So. 3d 528, 2015 La. LEXIS 699
CourtSupreme Court of Louisiana
DecidedMay 5, 2015
Docket2014-C -2243
StatusPublished
Cited by34 cases

This text of 167 So. 3d 528 (Prentiss Baker and Sheryl Wiginton, Individually and on Behalf of All Others Similarly Situated v. Phc-Minden, L.P. D/B/A Minden Medical Center) is published on Counsel Stack Legal Research, covering Supreme Court of Louisiana primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Prentiss Baker and Sheryl Wiginton, Individually and on Behalf of All Others Similarly Situated v. Phc-Minden, L.P. D/B/A Minden Medical Center, 167 So. 3d 528, 2015 La. LEXIS 699 (La. 2015).

Opinions

[531]*531KNOLL, Justice.

I,We granted this writ application to resolve a conflict among the appellate courts of this state on the issue of whether a class action is the superior method for adjudicating actions brought pursuant to the Health Care Consumer Billing and Disclosure Protection Act, La.Rev.Stat. § 22:1871 et seq. (“Balance Billing Act”). Baker v. PHC-Minden, L.P., 14-2243 (La.1/16/15), 157 So.3d 1113. Across the [532]*532state, plaintiffs are filing these actions against health care providers from whom they sought treatment following automobile accidents and with whom their health care insurers had contracted reimbursement rates for the services rendered. At issue is the legality of these providers’ policy of collecting or attempting to collect the undiscounted rate from the insured if a liability insurer may be liable, implemented through the filing of medical liens against plaintiffs’ lawsuits and settlements pursuant to the health care provider lien statute, La.Rev.Stat. § 9:4752. A review of the jurisprudence reveals plaintiffs in the Third Circuit Court of Appeal proceed pursuant to our class action provisions, while plaintiffs in the Second Circuit Court of Appeal have been denied class certification. After reviewing the record and the applicable law, we find the class action is superior to any other available method for a fair and efficient adjudication of the common controversy over the disputed billing and lien practices. Accordingly, we reverse the judgment of the court of | ¡.appeal, Second Circuit. Finding all other requirements for class certification properly met, we reinstate the judgment of the trial court.

FACTS

On July 13, 2011, plaintiffs Prentiss Baker,1 Sheryl Wiginton, and Judyette Allen filed this class action proceeding, alleging PHC-Minden, L.P. d/b/a Minden Medical Center (“Minden”) engaged in unlawful billing practices by billing them in an amount in excess of the agreed upon rate negotiated between the hospital and plaintiffs’ respective insurers. Specifically, plaintiffs alleged Minden had a collection policy in effect since at least 2000 for billing insured patients involved in automobile accidents where a third party was liable for the crash. This collection policy was implemented across-the-board, regardless of the health insurance issuer involved, through the following actions:

1. Upon admission or soon thereafter, Minden collected information from the patient about the offending driver’s liability insurance and the patient’s own automobile insurance;
2. If the patient did not know the infor-piation upon admission, Minden sent a form letter to the patient requesting the patient get the liability insurance information and contact Minden with that information;
3. Once the liability insurance information was obtained or the patient’s attorney was known, Minden would send á lien pursuant to La.Rev.Stat. § 9:4752 to the liability insurer and the patient’s attorney seeking to collect from the patient’s damage settlement the full and undiscounted rate.
4. If the time delays were such that Minden was close to running out of time to file with the patient’s health insurance, Minden would only then file a claim with the health insurance company, but not before it first asserted its lien on the patient’s settlement through the liability insurance company and the patient’s attorney.

Even if Minden filed a claim with and received payment through the health insurance company, Minden still allegedly attempted to collect the full rate from lathe patient’s settlement through the patient’s attorney and the liability insurer using medical liens. Plaintiffs allege hundreds of other patients have been subjected to this collection policy, which they argue vio[533]*533lates the Balance Billing Act. Below is a summary of the specific manner in which the collection policy was allegedly applied to the named plaintiffs individually.

Prentiss Baker

On January 31, 2007, Baker was admitted to Minden’s emergency room for injuries sustained in an automobile accident in Minden, Louisiana, and incurred medical expenses in the undiscounted amount of $1,394.56. At the time of treatment, Baker was insured under a Mail Handlers Benefit Plan (“Mail Handlers”) health insurance policy. On February 7, 2007, Baker’s medical bill was sent by Minden to Mail Handlers for payment. Because he was involved in an automobile accident, Minden also sent a letter to Baker asking for information regarding any automobile insurance that might have been available. On February 23, 2007, the hospital received a letter from Baker’s attorney, Kirby Kelly, requesting an itemized bill. The record reveals Minden quoted the full, un-discounted amount and also placed a lien against the proceeds of the lawsuit filed by Baker in which he sought damages, including medical expenses, from the adverse driver.

On June 19, 2007, Mad Handlers sent Minden a denial of the claim stating it had not received a copy of the plan reimbursement agreement. The hospital followed up by telephone, and Mail Handlers stated Baker had not returned the necessary sub-rogation forms; therefore, it denied the claim. Baker then called Minden on July 12, 2007, and indicated the bill was being turned over to State Farm, the third party insurer, and they would take care of the bill.

|4After apparently settling the lawsuit, Kirby Kelly’s office called Minden on August 20, 2007, and inquired into whether the hospital would reduce the bill by 50%. Ultimately, the hospital agreed to reduce the bill by 20% and accepted $1,115.72 as payment in full. The remaining balance was written off as a loss by Minden.

Sheryl Wiginton

Wiginton presented at Minden’s emergency room on March 31, 2008, for injuries sustained in an' automobile accident in Minden, Louisiana, and incurred medical expenses in the undiscounted amount of $2,087. At the time of treatment, Wigin-ton was insured under a Blue Cross Blue Shield of Louisiana (“Blue Cross”) health insurance policy.

On April 7, 2008, Minden billed Blue Cross for her medical treatment. Blue Cross issued an explanation of benefits setting forth the patient’s liability of $505.66, which was the copayment plus the deductible. However, the record indicates Wiginton paid $100 upon arrival at the emergency room, thus the balance of her liability was $405.66. She later paid $200 for a total payment by her of $300. As per its collection policy, the hospital also filed a lien against the proceeds of her lawsuit for the full undiscounted amount.

Wiginton’s attorney, Kirby Kelly, called Minden on November 20, 2008, and informed Minden his office was going to send a check for Wiginton’s medical bills in the amount of $1,773.95. Minden received this check on December 3, 2008, and a note was made by Minden to refund the patient all monies except her responsibility (deductible) under the insurance policy. Nevertheless, a clerical error was made on the part of Minden whereby it never reimbursed Wiginton’s payments.

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167 So. 3d 528, 2015 La. LEXIS 699, Counsel Stack Legal Research, https://law.counselstack.com/opinion/prentiss-baker-and-sheryl-wiginton-individually-and-on-behalf-of-all-la-2015.