Mounce ex rel. Situated v. CHSPSC, LLC
| Decision Date | 29 September 2017 |
| Docket Number | CASE NO. 5:15-CV-05197 |
| Parties | JESSICA MOUNCE, Individually and on Behalf of All Others Similarly Situated PLAINTIFF v. CHSPSC, LLC; NORTHWEST ARKANSAS HOSPITALS, LLC d/b/a NORTHWEST MEDICAL CENTER; and PROFESSIONAL ACCOUNT SERVICES, INC. DEFENDANTS |
| Court | U.S. District Court — Western District of Arkansas |
Currently before the Court are Defendants CHSPSC, LLC ("CHSPSC"), Northwest Arkansas Hospitals, LLC ("the Hospital"), and Professional Account Services, Inc.'s ("PASI") Motion for Summary Judgment (Doc. 44), and Plaintiff Jessica Mounce's Motion for Class Certification (Doc. 42).1 The Court held a hearing on both Motions on November 3, 2016, at which time the parties presented oral argument to the Court.
Defendants argue in their Motion for Summary Judgment that Ms. Mounce's individual claims must be dismissed because she voluntarily paid the hospital bill at issue in the case, and in doing so, gave up the right to file any lawsuit concerning the lien. Defendants also argue that Ms. Mounce's substantive claims for violations of the ArkansasDeceptive Trade Practices Act ("ADTPA"), Ark. Code Ann. § 4-88-101 et seq., common-law tortious interference with business expectancy/contract, and unjust enrichment should be dismissed on the merits. Defendants point out that if summary judgment is granted and the Court dismisses Ms. Mounce from the lawsuit, her Motion for Class Certification will become moot, as she is the only named plaintiff in the case and the only person identified as having an interest in serving as class representative.
In response to the Motion for Summary Judgment, Ms. Mounce concedes that she directed her attorney to negotiate with PASI, the billing agent of the Hospital, for a reduction in the hospital bill associated with the lien that had been filed against her unliquidated tort claim; however, she argues that her payment to PASI was not voluntary and therefore should not preclude her from bringing this lawsuit. She further contends that her substantive claims have merit and that she is a proper representative of a class of more than 850 individuals who are similarly situated. In her Motion for Class Certification brought pursuant to Federal Rule of Civil Procedure 23, she explains why she believes the Court should certify a class of former patients of the Hospital, such as herself, who had what she characterizes as improper or illegal liens asserted against their third-party tort claims. Defendants respond that a class action would not be an efficient and effective mechanism for resolving these patients' claims—if indeed the claims have merit—and that, in any event, Ms. Mounce would not be an appropriate class representative.
Below, the Court will set forth the background facts at issue in the case, and then it will take up Defendants' Motion for Summary Judgment, followed by Ms. Mounce's Motion for Class Certification. For the reasons explained herein, the Motion for SummaryJudgment (Doc. 44) is DENIED, and the Motion for Class Certification (Doc. 42) is GRANTED.
Jessica Mounce, individually and on behalf of an Arkansas class of persons similarly situated, filed a lawsuit (Doc. 3) in Washington County Circuit Court on June 3, 2015, alleging violations of the ADTPA and claims for tortious interference, unjust enrichment, and injunctive relief against the Hospital where she sought treatment for injuries, and against two other companies affiliated with the Hospital.2 The case was removed to this Court by Defendants on August 18, 2015, and an Amended Complaint (Doc. 39) was filed on February 10, 2016. The Amended Complaint omits a separate cause of action for injunctive relief, but is otherwise substantially similar to the original Complaint.
The circumstances leading up to the filing of this case began when Ms. Mounce was injured in an automobile accident on November 27, 2013. She was not at fault. The driver who caused the accident was insured by Horace Mann Insurance ("Horace Mann"), and Ms. Mounce engaged an attorney named Jeff Slaton to assist her in pursuing a tort claim against the driver. Ms. Mounce did not seek medical attention immediately after the accident. Instead, she waited until November 30, 2013, to visit the emergency room at Northwest Medical Center in Springdale, Arkansas. During intake, she handed her health insurance card to a Hospital employee.
Ms. Mounce's health insurance at the time was provided through the George's Inc. Medical Plan ("the George's Plan" or "the Plan"), an ERISA-based employer benefit plan that assumes responsibility for paying the health care services incurred by its members. See Doc. 51-3, Dep. of Benjamin Butler, p. 6. The George's Plan contracted with Arkansas Blue Cross and Blue Shield ("Blue Cross") as the Plan's Claims Administrator. According to the Plan, employees and their dependents participate in a Preferred Provider Organization ("PPO"), in which participating medical service providers agree to accept PPO allowances and charge persons who are covered under the Plan certain reduced rates for services. (Doc. 51-1, p. 46).
Ms. Mounce, as a person covered under the Plan, was also considered a "member" of Blue Cross's True Blue PPO Network Agreement ("the Provider Agreement") (Doc. 50-23, pp. 2-3) (defining a "member" as "any person who satisfies the eligibility requirements and financial obligations to qualify for coverage of health care services under a Health Plan, including but not limited to . . . any . . . health benefit plan, whose sponsor or claims administrator has entered into any PPO Network access agreement with [Blue Cross] . . . ."; and specifying that hospitals who enter into Blue Cross's Provider Agreement "agree to provide Covered Services to Members"). Blue Cross, as Claims Administrator of the George's Plan, negotiated the Provider Agreement with the Hospital. Id. at 2. The Provider Agreement sets forth a discounted payment schedule for medical services rendered to Blue Cross's members. See id. at 21 (). Further, Blue Cross's corporate representative confirmed in a deposition that Blue Cross considered Ms. Mounce to be a member, and would have processed and paid the Hospital's bill for her medical treatment from November of 2013, had the bill beensubmitted by the deadline established in the Provider Agreement. See Doc. 55-8, Dep. of Benjamin Butler, pp. 2-3.
Ms. Mounce testified that after she gave her health insurance card to the Hospital employee who was performing intake, the employee asked whether her injuries had resulted from a car accident, and Ms. Mounce confirmed that they had. See Doc. 44-1, Dep. of Jessica Mounce, p. 14. The employee then asked Ms. Mounce who was at fault in the accident and whether the other driver had insurance, and the employee recorded the information Ms. Mounce provided. Id. At some point, Ms. Mounce was presented with a form called "Conditions of Admission and Consent to Medical Treatment" ("Admission Form") (Doc. 42-14), which all patients must read and sign. The first paragraph of the Admission Form states the following:
I hereby assign and authorize payment directly to the Facility, and to any facility-based physician, 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, to or for the patient unless the account for this Facility, outpatient visit or series of outpatient visits is paid in full upon discharge or upon completion of the outpatient series. If eligible for Medicare, I request Medicare services and benefits. I further agree that this assignment will not be withdrawn or voided at any time until the account is paid in full. I understand that I am responsible for any charges not covered by my insurance company.
According to Ms. Mounce, she was told by someone at the Hospital that her bill would be submitted to her health insurer, Blue Cross, for direct payment. See Doc. 44-1, p. 21. She believed this would be the case. Id. at 20, 25. She also signed the Admission Form, as evidenced by her recollection that she "sign[ed] a paper that sa[id] that they're going to submit the claim [to insurance]." Id. at 26. To Ms. Mounce, the Admission Form"clearly indicated" to her that she "would only be responsible for charges not covered by her insurance company." (Doc. 49, pp. 20-21). She came to this conclusion after reading the last sentence of the first paragraph of the Admission Form, which states: "I understand that I am responsible for any charges not covered by my insurance company." (Doc. 42-14, p. 3 (emphasis added)).3
The parties agree that the Hospital never submitted Ms. Mounce's bill to Blue Cross for payment. Instead, the Hospital followed a special billing policy used in auto accident cases, which the Hospital's Assistant Chief Financial Officer, Susan Parker, explained in her deposition. Ms. Parker testified that in non-auto accident cases, it is the policy of the Hospital to obtain the health insurance information of the patient and then have PASI bill the patient's health insurance company. (Doc. 50-24, Dep. of Susan Parker, p. 9). However, in auto accident cases where it is suspected that the patient's injuries were caused by another party, the Hospital's policy is to allow PASI to determine whether to seek payment from a different source than health insurance. Id. at 10. See also PASI's Standard Patient Accounting User's Manual (Doc. 42-11, p. 6 (explaining patientregistration and billing procedures to be followed when a patient advises "there is automobile insurance or liability involved")).
Defendants believe that, under the Hospital's Provider Agreement with Blue Cross, as well as under its provider agreements...
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