Searching over 5,500,000 cases.


searching
Buy This Entire Record For $7.95

Download the entire decision to receive the complete text, official citation,
docket number, dissents and concurrences, and footnotes for this case.

Learn more about what you receive with purchase of this case.

Gibson v. National Healthcare of Leesville, Inc.

Court of Appeals of Louisiana, Third Circuit

March 7, 2019

DENNIS GIBSON, INDIVIDUALLY AND ON BEHALF OF ALL OTHERS SIMILARLY SITUATED
v.
NATIONAL HEALTHCARE OF LEESVILLE, INC., D/B/A BYRD REGIONAL HOSPITAL

          APPEAL FROM THE THIRTIETH JUDICIAL DISTRICT COURT PARISH OF VERNON, NO. 93, 228 HONORABLE VERNON BRUCE CLARK, DISTRICT JUDGE.

          Scott R. Bickford Lawrence J. Centola, III Martzell, Bickford & Centola, PC, Counsel for Plaintiff/Appellee: Dennis Gibson.

          Edwin 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.

          J. Lee Hoffoss, Jr. Claude P. Devall Donald W. McKnight Hoffoss Devall, LLC, Counsel for Plaintiff/Appellee: Dennis Gibson.

          David 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.

          Court composed of Sylvia R. Cooks, Billy Howard Ezell, and Candyce G. Perret, Judges.

          BILLY HOWARD EZELL, JUDGE.

         This 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 court's decision.

         FACTS

         Dennis 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.

         Linda 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.

         Michael 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.

         In Mr. 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.

         On July 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.

         After 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):

         All persons currently and/or formerly residing in the State of Louisiana during the ...


Buy This Entire Record For $7.95

Download the entire decision to receive the complete text, official citation,
docket number, dissents and concurrences, and footnotes for this case.

Learn more about what you receive with purchase of this case.