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IF A HEALTHCARE PROVIDER ATTEMPTS TO “BALANCE BILL” FOR CHARGES WRITTEN OFF, WHEN MUST THE PATIENT FILE SUIT TO STOP THE COLLECTION EFFORT?

The patient must file his suit within one (1) year of a healthcare provider’s effort to collect the amount above the health insurance agreed reimbursement rate.  See Louisiana Supreme Court opinion of DePhillips v. Hospital Service District No. 1 of Tangipahoa Parish. (See www.lasc.org/Opinions/2020/19-1496.C.OPN.pdf)

Earnest Williams was injured in an accident on February 11, 2011.  He was treated in the emergency room of North Oaks Hospital (“North Oaks”).  Mr. Williams had health insurance with Blue Cross and Blue Shield of Louisiana (“BCBS”).

North Oaks and BCBS had a contract in which North Oaks agreed to accept a discounted reimbursement rate for the services provided to BCBS members, like Mr. Williams.  These contracts are sometimes called Member Provider Agreements.

North Oaks filed a claim with BCBS.  BCBS paid North Oaks the agreed, discounted reimbursement amount.  Later, North Oaks tried to collect from Mr. Williams its full, undiscounted charges.  North Oaks did this by filing a medical lien against Mr. Williams’ accident claims.

Mr. Williams filed suit against North Oaks.  He claimed North Oaks’ collection efforts violated its Member Provider Agreement with BCBS.  Mr. Williams also claimed North Oaks’ collection efforts violated Louisiana’s Health Care Consumer Billing and Disclosure Protection Action, La R.S. 22:1871, et seq. (“Balance Billing Act”).  The Act prohibits a healthcare provider from attempting to collect from a health insurance enrollee or insured any amount in excess of the contracted reimbursement rate for the healthcare services.

In response to the lawsuit, North Oaks argued Mr. Williams filed his suit untimely.  One of the main arguments by North Oaks was Mr. Williams’ claim under the Balance Billing Act must be brought within one year of when the collection effort started.

In a divided 4-3 decision, the Louisiana Supreme Court sided with North Oaks.  The majority of the Supreme Court said enrollees or insureds must bring their claim against the healthcare provider who may violate the Balance Billing Act within one year of the collection efforts.

If you have questions about any claims or your legal rights, call Frederick Law Firm at (337) 269-5143, where we will discuss your case and explain your rights. At Frederick Law Firm, you get the Frederick Fee Guarantee, and we strive to be Fast Fair and Focused on your needs.

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