Vallare v. Ville Platte Med. Ctr., LLC

• Decision Date: 22 February 2017
• Docket Number: 16–863,16–953
• Citation: 214 So.3d 45
• Parties: Gloria VALLARE, individually and on behalf of all others similarly situated v. VILLE PLATTE MEDICAL CENTER, LLC, and Louisiana Health Service and Indemnity Co, d/b/a Blue Cross Blue Shield of Louisiana
• Court: Court of Appeal of Louisiana — District of US

214 So.3d 45

Gloria VALLARE, individually and on behalf of all others similarly situated

v.VILLE PLATTE MEDICAL CENTER, LLC, and Louisiana Health Service and Indemnity Co, d/b/a Blue Cross Blue Shield of Louisiana

16–863

16–953

Court of Appeal of Louisiana, Third Circuit.

February 22, 2017

Charles A. O'Brien, III, Alison N. Pham, Attorneys at Law, P.O. Box 98029, Baton Rouge, LA 70898–9029, (225) 295–2454, COUNSEL FOR DEFENDANT–APPLICANT: Louisiana Health Service and Indemnity Co., d/b/a Blue Cross and Blue Shield of Louisiana

Kurt S. Blankenship, Robert I. Baudouin, Amanda B. Bensabat, Blue Williams, L.L.P., 3421 North Causeway Blvd, Ninth Floor, Metairie, LA 70002, (504) 830–4938, COUNSEL FOR DEFENDANT–APPLICANT: Ville Platte Medical Center, LLC

Scott R. Bickford, Lawrence J. Centola, III, Jason Z. Landry, Martzell & Bickford, 338 Lafayette St., New Orleans, LA 70130, (504) 581–9065, COUNSEL FOR PLAINTIFF–RESPONDENT: Gloria Vallare

J. Lee Hoffoss, Jr., Claude P. Devall, Donald W. McKnight, Hoffoss Devall, LLC, 517 West College Street, Lake Charles, LA 70605, (337) 433–2053, COUNSEL FOR PLAINTIFF–RESPONDENT: Gloria Vallare

J. Clemille Simon, Simon Law Offices, P.O. Box 52242, Lafayette, LA 70505, (337) 232–2000, COUNSEL FOR PLAINTIFF–RESPONDENT: Gloria Vallare

Derrick G. Earles, Laborde Earles, LLC, P.O. Box 1559, Marksville, LA 71351, (318) 777–7777, COUNSEL FOR PLAINTIFF–RESPONDENT: Gloria Vallare

Court composed of Elizabeth A. Pickett, Shannon J. Gremillion, and D. Kent Savoie, Judges.

PICKETT, Judge.

The relator-defendant, Louisiana Health Service & Indemnity Company, d/b/a Blue Cross and Blue Shield of Louisiana (BCBS), seeks supervisory writs in our docket number 16–863 from the judgment of the trial court which overruled its exception of prescription.

The relator-defendant, Ville Platte Medical Center, LLC (VPMC), seeks supervisory writs in our docket number 16–953 from the judgment of the trial court which overruled its exception of prescription and denied its motion for summary judgment.

We have consolidated these writs for the purpose of issuing this opinion.

STATEMENT OF THE CASE

The facts and procedural history of these cases were explained in a prior appeal in this matter, Vallare v. Ville Platte Medical Center, LLC , 14-261, pp. 1-2 (La.App. 3 Cir. 11/5/14), 151 So.3d 984, 985, writ denied , 15-121 (La. 8/28/15), 176 So.3d 401 :

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. 22:1874(8) provided by Eunice Community Medical Center/Acadian Medical Center and all persons since April 1, 2010[,] who received "covered health care services" as defined by La.R.S. 22:1874(8) from VILLE PLATTE MEDICAL CENTER and its predecessors ("VPMC ["] ); and at the time of the covered health care services had "Health Insurance Coverage" as defined by La. R.S. 22:1874(18) ; and from whom VPMC attempted to recover any amount in excess of the "contracted reimbursement rate" as defined by La. R.S. 22:1874(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 liability insurance carrier and/or any third party, from January 1, 2004[,] through June 18, 2013.

VPMC appealed the class certification. The trial court's ruling certifying the class was affirmed on appeal, but the class definition was amended to delete the subclasses. Vallare , 151 So.3d 984.

On remand, BCBS filed an exception of prescription while VPMC filed an exception of prescription and a motion for summary judgment. Both exceptions of prescription were overruled, and the motion for summary judgment was denied following a hearing on September 22, 2016. A written judgment was signed on October 5, 2016. BCBS and VPMC are now before this court seeking supervisory review of the trial court's rulings.

SUPERVISORY RELIEF

"A court of appeal has plenary power to exercise supervisory jurisdiction over trial courts and may do so at any time, according to the discretion of the court." Herlitz Const. Co., Inc. v. Hotel Investors of New Iberia, Inc. , 396 So.2d 878, 878 (La.1981). "In cases in which a peremptory exception has been overruled by the trial court, the appellate court appropriately exercises its supervisory jurisdiction when the trial court's ruling is arguably incorrect, a reversal will terminate the litigation, and there is no dispute of fact to be resolved." Charlet v. Legislature of State of Louisiana , 97-0212 (La.App. 1 Cir. 6/29/98), 713 So.2d 1199, 1202, writs denied , 98–2023, 98-2026 (La. 11/13/98), 730 So.2d 934 (citing Herlitz , 396 So.2d 878 ). In such instances, judicial efficiency and fundamental fairness to the litigants dictate that the merits of the application for supervisory writs should be decided in an attempt to avoid the waste of time and expense of a possibly useless future trial on the merits. Herlitz , 396 So.2d 878. "The supervisory jurisdiction of this court may also be ‘exercised to reverse a trial court's denial of a motion for summary judgment and to enter summary judgment in favor of the mover.’ " Csaszar v. National Cas. Co. , 14-1273, p. 3 (La.App. 3 Cir. 11/4/15), 177 So.3d 807, 809, writ denied , 15-2221 (La. 1/25/16), 185 So.3d 752 (quoting Richard v. Swiber , 98-1515, p. 4 (La.App. 1 Cir. 9/24/99), 760 So.2d 355, 358.)

ON THE MERITS

VPMC's Exception of Prescription

VPMC argues, first, that Vallare vaguely alleges the existence of a contract between her and BCBS, and there is no contract between Vallare and VPMC. Further, VPMC contends that "the mere existence of a contract between the parties does not indicate that an action is contractual in nature." Carriere v. Jackson Hewitt Tax Service Inc. , 750 F.Supp.2d 694, 705 (E.D. La. 11/3/10). "Even when a contract exists, unless a specific contract provision is breached, Louisiana treats the action as tort." Richard v. Wal–Mart Stores, Inc. , 559 F.3d 341, 345 (5th Cir. 2009) (citing Trinity Universal Ins. Co. v. Horton , 33,157 (La.App. 2 Cir. 4/5/00), 756 So.2d 637 ).

A central question in this litigation is whether VPMC and BCBS engaged in a prohibited practice called balance billing, as defined by La.R.S. 22:1874. The supreme court in Emigh v. W. Calcasieu Cameron Hosp. , 13-2985, p. 3 (La. 7/1/14), 145 So.3d 369, 371, explained that the "practice of rejecting insurance and collecting or attempting to collect full charges is referred to as ‘balance billing’ and is prohibited by [La.R.S. 22:1874 ]."

VPMC refers to a recent case, Stewart v. Ruston Louisiana Hospital Company, LLC , 2016 WL 1715192 (W.D. La. 2016), involving similar facts wherein the court found that the plaintiffs' claims, related to alleged violations of the Balance Billing Act, sounded in tort. The hospital in Stewart treated an insured minor for injuries sustained in an automobile accident. The hospital filed a medical provider's lien to recoup the amount owed for the services provided and never billed the minor or her parents nor pursued collection of the amount owed. The minor and her parents filed suit as a class action approximately two years after services were rendered for violations of the Balance Billing Act and the Member Provider Agreement. The plaintiffs sought recovery of payments wrongfully made to the hospital, loss of profit damages, damages for emotional distress, mental anguish, and injunctive relief. The hospital subsequently filed a motion for summary judgment, arguing that the plaintiffs' cause of action was delictual in nature and subject to a one-year prescriptive period. Further, the hospital urged that the plaintiffs' claims had prescribed because they were filed more than one year past the date the plaintiffs knew of the violation.

In reaching its...