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Vallare v. Ville Platte Med. Ctr., LLC

Court of Appeals of Louisiana, Third Circuit

November 5, 2014

GLORIA VALLARE, INDIVIDUALLY AND ON BEHALF OF ALL OTHERS SIMILARLY SITUATED
v.
VILLE PLATTE MEDICAL CENTER, LLC AND LOUISIANA HEALTH SERVICE AND INDEMNITY COMPANY D/B/A BLUE CROSS AND BLUE SHIELD OF LOUISIANA

APPEAL FROM THE THIRTEENTH JUDICIAL DISTRICT COURT PARISH OF EVANGELINE, NO. 72711-A. HONORABLE J. LARRY VIDRINE, DISTRICT JUDGE.

Kurt S. Blankenship, Robert I. Baudouin, Blue Williams, L.L.P., Metairie, LA, COUNSEL FOR DEFENDANT-APPELLANT: Ville Platte Medical Center.

Scott Bickford, Lawrence J. Centola, III, Jason Z. Landry, Martzell & Bickford, New Orleans, LA, COUNSEL FOR PLAINTIFF-APPELLEE: Gloria Vallare.

Derrick G. Earles, The Laborde Law Firm, Marksville, LA, COUNSEL FOR PLAINTIFF-APPELLEE: Gloria Vallare.

J. Lee Hoffoss, Jr., Claude P. Devall, Donald W. McKnight, Hoffoss Devall, LLC, Lake Charles, LA, COUNSEL FOR PLAINTIFF-APPELLEE: Gloria Vallare.

J. Clemille Simon, Simon Law Offices, Lafayette, LA, COUNSEL FOR PLAINTIFF-APPELLEE: Gloria Vallare.

Charles A. O'Brien, Baton Rouge, LA, COUNSEL FOR DEFENDANT: Blue Cross and Blue Shield.

Court composed of J. David Painter, James T. Genovese, and Phyllis M. Keaty, Judges.

OPINION

Page 985

[14-261 La.App. 3 Cir. 1] PAINTER, Judge.

Defendant, Ville Platte Medical Center, LLC (VPMC), appeals the trial court's certification of a class action in a suit involving allegations of unlawful billing practices. For the reasons that follow, we amend the class certification and affirm the trial court's ruling as amended.

FACTS AND PROCEDURAL HISTORY

Gloria Vallare was involved in a car accident and received treatment for injuries received therein at Acadian Medical Center in Eunice, Louisiana. Acadian Medical Center is a " branch campus" of VPMC. The bill for her treatment was $3,424.00. Vallare alleges that she had health insurance through Louisiana Health Service and Indemnity Company d/b/a Blue Cross and Blue Shield of Louisiana (Blue Cross) but that instead of billing her insurance carrier, VPMC sent a notice of lien to Farm Bureau Insurance, the insurer of the other party involved in the car accident. Pursuant to the lien, Farm Bureau issued a check made payable to Vallare and the hospital. Vallare took the position that the hospital was in violation of its agreement with Blue Cross by demanding an amount in excess of the contracted reimbursement rate set forth in the provider agreement. Vallare, individually and on behalf of all others similarly situated (Plaintiffs), filed suit against VPMC for violations of La.R.S 22:1874. Blue Cross was also made a defendant, and the claims against it were based on allegations that it did not enforce its provider agreement with VPMC.

In due course, Plaintiffs sought to have the class certified. The trial court held an evidentiary hearing and granted the motion to certify the class. The class was defined as follows:

All persons from January 1, 2004[,] to June 18, 2013[,] who received " covered health care services" as defined by La. R.S. 22:1872(8) provided by Eunice Community Medical Center/Acadian Medical [14-261 La.App. 3 Cir. 2] Center and all persons since April 1, 2010[,] who received " covered health care services" as defined by La.R.S. 22:1872(8) from VILLE PLATTE MEDICAL CENTER and its predecessors

Page 986

(" VPMC[" ]); and at the time of the covered health care services had " Health Insurance Coverage" as defined by La. R.S. 22:1872(18); and from whom VPMC attempted to recover any amount in excess of the " contracted reimbursement rate" as defined by La. R.S. 22:1872(7) and/or who paid VPMC in any manner including but not limited to liability insurance proceeds and/or from proceeds of a settlement or judgment, an amount in excess of the " contracted reimbursement rate" either directly and/or through their attorney and/or through a liability insurance carrier and/or any third party.

This class is composed of the following subclasses:

" Attempt to Recover" subclass: A subclass of persons who received covered health care services, and who had health insurance coverage, and from whom VPMC attempted to recover any amount in excess of the " contracted reimbursement rate" from January 1, 2004 [,] through June 18, 2013.
Payor subclass: A subclass of persons who received covered health care services, and who had health insurance coverage, and/or who paid VPMC in any manner including but not limited to liability insurance proceeds and/or from proceeds of a settlement or judgment, an amount in excess of the " contracted reimbursement rate" either directly and/or through their attorney and/or through a ...

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