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DENNIS GIBSON, INDIVIDUALLY AND ON BEHALF OF ALL OTHERS SIMILARLY SITUATED v. NATIONAL HEALTHCARE OF LEESVILLE, INC. D/B/A BYRD REGIONAL HOSPITAL
I respectfully dissent from the majority's decision to affirm the trial court's denial of the motion for summary judgment and motion to decertify the class action filed by National Healthcare of Leesville, Inc. d/b/a Byrd Regional Hospital's (Byrd). Byrd filed a motion for summary judgment asking that this matter be dismissed because it is prescribed. In order to determine whether a one-year or ten-year prescriptive period applies, we must look at the underlying facts. For the following reasons, I dissent and would grant Byrd's motions and dismiss Mr. Gibson's claims against Byrd and decertify the class action.
Balance Billing Act Claims
Mr. Gibson argues Byrd contractually assumed an obligation not to balance bill his medical expenses, citing “I understand that I am responsible for any charges not covered by my insurance company[,]” which appears in the Assignment. He further argues the Assignment is ambiguous because it provides: “I understand that I am obligated to pay the account of the Facility in accordance with the regular rates and terms of the Facility.” To prove these claims, Mr. Gibson seeks to link the Assignment to BCBSLA's agreements with Byrd. However, nothing in the Assignment links it to BCBSLA's agreements, and the MPA specifically provides that it does not inure to the benefit of third parties.
Byrd asserts nothing in the Assignment links it to the BBA, Mr. Gibson's health insurance coverage with BCBSLA, BCBSLA's Member Provider Agreement (“MPA”) that it executed, or BCBSLA's Policy and Procedure Manual, which “sets forth the policies and procedures to be followed by the [healthcare] provider when providing health care services to BCBSLA members and submitting claims to BCBSLA” 1 and concludes nothing obligates it to pursue payment only from BCBSLA. Byrd further argues Mr. Gibson attempts to create ambiguity where none exists when he seeks to link the terms of the MPA and/or the Policy and Procedure Manual to the Assignment because neither document is referenced in the Assignment. Byrd also points out Mr. Gibson has admitted BCBSLA insureds are not parties to the MPA and the MPA precludes third-party beneficiary status for BCBSLA insureds.2
In interpreting contracts, we are guided by the general rules contained in articles 2045-2057 of the Louisiana Civil Code. The interpretation of a contract is the determination of the common intent of the parties with courts giving the contractual words their generally prevailing meaning unless the words have acquired a technical meaning. La.Civ.Code arts. 2045, 2047; see e.g., Louisiana Ins. Guar. Ass'n v. Interstate Fire & Casualty Co., 93-911 (La.1994), 630 So.2d 759, 763. When the words of a contract are clear and explicit and lead to no absurd consequences, no further interpretation may be made in search of the intent of the parties. La. Civ.Code art. 2046.
Campbell v. Melton, 01-2578, p. 6 (La. 5/14/02), 817 So.2d 69, 74-75.
Additionally, “the rules of construction do not authorize a perversion of the words or the exercise of inventive powers to create an ambiguity where none exists or the making of a new contract when the terms express with sufficient clearness the parties’ intent.” Peterson v. Schimek, 98-1712, p. 5 (La. 3/2/99), 729 So.2d 1024, 1029. Although one party may create a dispute about what a contract provision means, that alone does not render the provision ambiguous. Campbell, 817 So.2d 69.
The first section of the Assignment addresses Byrd's recoupment of the medical expenses Mr. Gibson incurred after being injured. It authorized Byrd to collect “all insurance benefits, sick benefits, injury benefits due because of liability of a third-party, or proceeds of all claims resulting from the liability of a third party, payable by any party, organization, et cetera.” As written, this provision does not require or imply that Byrd must collect benefits from any of the identified sources in any particular order. The two statements cited by Mr. Gibson obligate him to pay “any charges not covered by my insurance company” and to pay those charges “in accordance with the regular rates and terms of the Facility.” Neither statement obligates Byrd to do or not do anything with respect to Mr. Gibson.
Mr. Gibson contends the Assignment is invalid because it assigns a personal right which is prohibited by La.Civ.Code art. 2642. Pursuant to La.Civ.Code art. 2034, “Nullity of a provision does not render the whole contract null unless, from the nature of the provision or the intention of the parties, it can be presumed that the contract would not have been made without the null provision.” Mr. Gibson made no such showing.
Byrd collected Mr. Gibson's medical expense pursuant to La.R.S. 9:4752, which grants a limited medical privilege to health care providers and hospitals for their reasonable charges or fees collected from third parties. Mr. Gibson urges this practice violates the conclusion reached in Rabun v. St. Francis Medical Center, Inc., 50,849 (La.App. 2 Cir. 8/10/16), 206 So.3d 323. There the court relied upon agreements between the defendant hospital and the plaintiff's insurer without identifying a specific contractual provision to conclude the plaintiff's “medical expenses could not exceed the contracted rate provided in her member provider agreement.” Id. at 328. Following DePhillips v. Hospital Service District No. 1 of Tangipahoa Parish, 19- 1496 (La. 7/9/20), 340 So.3d 817, and Wightman v. Ameritas Life Insurance Co., 22-264 (La. 10/21/22), __ So.3d __, this conclusion is required only if Byrd violated its contract with Mr. Gibson.
Mr. Gibson argues the Assignment's requirement that he pay “any charges not paid by my insurance company” implies Byrd is entitled only to collect those payments made pursuant to its agreements with BCBSLA. I do not agree. This argument relies upon Byrd's contracts with BCBSLA to create a contractual obligation in favor of Mr. Gibson. Those contracts limit what Byrd can collect from a BCBSLA insured only if it files a claim for payment of the insured's medical expenses. Byrd did not do so here.
Mr. Gibson further argues the Assignment and Byrd's contractual agreements with BCBSLA imply Byrd limited its right to collect his medical expenses from BCBSLA alone. Section 1 of the Assignment identifies different sources for Byrd's collection of medical expenses: “all insurance benefits, sick benefits, injury benefits due because of liability of a third-party, or proceeds of all claims resulting from the liability of a third party” and directly from the patient. This provision does not mandate the circumstances under which any of these methods of collection must be used. For these reasons, I do not find a genuine issue of material fact exists as to whether Byrd is limited to accepting Mr. Gibson's health insurance in payment for his medical expenses.
Lastly, Mr. Gibson's argues the Assignment's provision that the patient will pay his account “in accordance with the regular rates and terms of the Facility” is ambiguous when considered in conjunction with Byrd's contracts with BCBSLA. Again, the Assignment does not require Byrd to recoup Mr. Gibson's medical expenses from BCBSLA, and it did not do so. Therefore, I conclude no genuine issue of material fact exists as to whether this phrase is ambiguous.
In my opinion, Mr. Gibson has not proved Byrd's Assignment obligated it not to balance bill his medical expenses. Accordingly, I would grant Byrd's motion for summary judgment, and dismiss with prejudice Mr. Gibson's claims against it.
Mr. Gibson asserts the class action need not be decertified, citing La.Code Civ.P. art. 596(A) which provides, in pertinent part: “Liberative prescription on the claims arising out of the transactions or occurrences described in a petition brought on behalf of a class is suspended on the filing of the petition as to all members of the class as defined or described therein.”
In Leet v. Hospital Service District No. 1 of East Baton Rouge Parish, 20-745, (La.App. 1 Cir. 2/25/21), 322 So.3d 274, writ denied, 21-445 (La. 6/22/21), 318 So.3d 31, fn. 12, the court recognized that a class representative's class action no longer exists if he is no longer a member of the defined class. The prescriptive period provided in La.Code Civ.P. art. 596(A) is suspended only if a class action proceeding was timely filed against the defendant. Quinn v. Louisiana Citizens Prop. Ins. Corp., 12-152 (La. 11/2/12), 118 So.3d 1011. See also Ansardi v. Louisiana Citizens Prop. Ins. Corp., 11-1717, 12-166 (La.App. 4 Cir. 3/1/13),111 So.3d 460, writs denied, 13-697, 13-698 (La. 5/17/13), 118 So.3d 380, where the court held that unless the class-action lawsuit upon which the insured plaintiff relied for the suspension or interruption of the prescriptive period was timely filed, the class-action did not suspend or interrupt the prescriptive period for his action against the state's insurer of last resort.
Mr. Gibson cites the cases of Gunderson v. F.A. Richard & Assoc., 10-61 (La.App. 3 Cir. 6/2/10), 40 So.3d 418, and Sosna v. Iowa, 419 U.S. 393, 95 S.Ct. 553 (1975), as support for his argument that the class should not be decertified in regard for the due process interests of the unnamed putative class members who relied upon the filing of the class action. In Gunderson, 40 So.3d 418, this court refused to decertify a class action when no class representatives remained before the court because they had all been enjoined by a federal court from pursuing their claims. In reaching this conclusion, the court looked to Sosna, 419 U.S. 393, 95 S.Ct. 553, where the Supreme Court held that even where a controversy is no longer “alive” as to the named plaintiff in a class action, a class action, once certified, may acquire a legal status separate from the interest asserted by the named plaintiff. For a class action to acquire its own legal status, “A litigant must be a member of the class which he or she seeks to represent at the time the class action is certified by the district court.” Id., 419 U.S. at 403, 95 S.Ct. at 559.
Byrd argues Mr. Gibson was not a member of the class he sought to represent when he filed suit or when the action was certified because his claim had prescribed before he filed suit. Accordingly, the class action herein never attained its own legal status, and prescription was not suspended as provided by La.Code Civ.P. art. 596(A).
The majority notes the supreme court did not pronounce when prescription begins to run on a BBA claim. As discussed above, I do not believe Mr. Gibson has shown a genuine issue of material fact exists as to whether Byrd contractually assumed an express or implied obligation to forgo balance billing. Therefore, his claim that Byrd had an obligation not to balance bill him for medical expenses is statutory in nature and subject to a one-year prescriptive period. DePhillips v. Hosp. Serv. Dist. No. 1 of Tangipahoa Par., 19-1496 (La. 7/9/20), 340 So.3d 817, and Wightman v. Ameritas Life Ins. Corp., 22-364 (La. 10/21/22), 351 So.3d 690. Mr. Gibson had one year to assert his claim against Byrd. Based on his pleadings, he knew in December 2011 that Byrd did not collect its medical expenses from BCBSLA. Therefore, based on the allegations of his petition, Mr. Gibson's claim had prescribed when he filed suit in 2016, and he had the burden of proving it had not prescribed. Kinnett v. Kinnett, 20-1134 (La. 10/10/21), 332 So.3d 1149.
For these reasons, I agree with Byrd that the class action never attained its own legal status and prescription was not suspended. Accordingly, I would grant the motion for summary judgment and decertify the class action.
1. The Director, Provider Relations and Communications of BCBSLA, made this statement in an affidavit filed in opposition to the exception of prescription.
2. The MPA states, in pertinent part: “This Agreement is not a third party contract and is not intended to confer any benefits nor legally enforceable right to any third party.” Mr. Gibson made this admission in opposition to Byrd's motion to order arbitration.
PICKETT, Chief Judge, dissents and assigns reasons.
Response sent, thank you
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Docket No: 21-369
Decided: March 15, 2022
Court: Court of Appeal of Louisiana, Third Circuit.
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