DENNIS GIBSON, INDIVIDUALLY AND ON BEHALF OF ALL OTHERS SIMILARLY SITUATED
NATIONAL HEALTHCARE OF LEESVILLE, INC., D/B/A BYRD REGIONAL HOSPITAL
FROM THE THIRTIETH JUDICIAL DISTRICT COURT PARISH OF VERNON,
NO. 93, 228 HONORABLE VERNON BRUCE CLARK, DISTRICT JUDGE.
R. Bickford Lawrence J. Centola, III Martzell, Bickford &
Centola, PC, Counsel for Plaintiff/Appellee: Dennis Gibson.
Dunahoe Jared Dunahoe The Dunahoe Law Firm, Counsel for
Plaintiff/Appellee: Dennis Gibson.
Derrick G. Earles Laborde Earles Law Firm, Counsel for
Plaintiff/Appellee: Dennis Gibson.
Hoffoss, Jr. Claude P. Devall Donald W. McKnight Hoffoss
Devall, LLC, Counsel for Plaintiff/Appellee: Dennis Gibson.
R. Kelly, Thomas R. Temple, Jr., Chris D. Billings,
Breazeale, Sachse & Wilson, L.L.P., Counsel for
Defendant/Appellant:, National Healthcare of Leesville, Inc.
D/B/A Byrd Regional Hospital.
composed of Sylvia R. Cooks, Billy Howard Ezell, and Candyce
G. Perret, Judges.
HOWARD EZELL, JUDGE.
case raises the issue of whether certification of a class
action under La.R.S. 22:1874, the Balance Billing Act, was
proper. National Healthcare of Leesville, Inc. D/B/A Byrd
Regional Hospital (Byrd Regional) appeals the decision of the
trial court arguing that the trial court failed to conduct a
rigorous analysis of all the elements for class
certification. For the following reasons, we affirm the trial
Gibson was injured in an accident on April 25, 2011, when a
car ran into the motorcycle he was driving. He was taken to
Byrd Regional for treatment. At the time of his admission,
Mr. Gibson's account was designated as Financial Class
"L" which stood for "liability" and meant
he had been in a motor vehicle accident. The intake sheet at
Byrd Regional noted that Mr. Gibson worked for the Louisiana
Department of Agriculture and Forestry in DeRidder. Mr.
Gibson was covered by health insurance with the State of
Louisiana, Office of Group Benefits. That insurance was
provided by Blue Cross and Blue Shield of Louisiana.
Davis, director of patient financial services with Byrd
Regional since 1996, testified at the hearing on class
certification. She explained that prior to 2013, Byrd
Regional was instructed to bill the motor vehicle insurance
company as primary. This policy was effective in 2005. After
July 1, 2013, the health insurer was billed as primary. Ms.
Davis explained that Byrd Regional is a contracted healthcare
provider for various health insurance companies, including
Blue Cross. She stated that a Membership Provider Agreement
spelled out the obligations between Blue Cross and Byrd
Regional, and Byrd Regional agreed to accept the health
insurance rate in accordance with the contract. This is known
as the contracted reimbursement rate, which is less than the
charge master rate, or total charge.
Lynch, the lien unit department manager for Professional
Account Services Incorporated, (PASI), also testified at the
hearing. He explained that PASI handles claims for hospitals
involving automobile accidents. PASI will run a query on the
hospital system looking for accounts that indicate there was
a motor vehicle accident, or Class "L" accounts.
PASI will then begin working the case by filing a lien
against the at-fault insurer. This occurs before any attempt
to collect from the health insurer. "This practice of
rejecting insurance and collecting or attempting to collect
full charges is referred to as 'balance billing' and
is prohibited by law." Emigh v. West Calcasieu
Cameron Hosp., 13-2985, p. 2 (La. 7/1/14), 145 So.3d
369, 371; La.R.S. 22:1874.
Gibson's case, the total charges were $5, 292.55. A
notice of hospital lien was filed against Farm Bureau
Insurance Company, the liability insurer of the at-fault
driver, on May 6, 2011. On December 2, 2011, Farm Bureau paid
the entire bill, which is more than Blue Cross would have
paid pursuant to the contracted reimbursement rate. Byrd
Regional released the lien on December 14, 2011.
25, 2016, Mr. Gibson, individually and on behalf of others
similarly situated, filed a class action suit for damages
against Byrd Regional. Mr. Gibson asserted statutory
violations and breach of contract claims. Specifically, Mr.
Gibson alleged that Byrd Regional improperly refused to
submit medical bills to patient's health insurers and
attempted to collect payment from patients in violation of
Louisiana's Balance Billing Act, La.R.S. 22:1871 to
22:1881, and in violation of the Member Provider Agreement.
the hearing on September 28, 2017, the trial court certified
this matter as a class action. Reasons for ruling were issued
on October 10, 2017, and judgment was signed on October 27,
2017. The class was defined as (alterations in original):
persons currently and/or formerly residing in the State of
Louisiana during the ...