Opinion
KNLCV156023749S
03-29-2016
William W. Backus Hospital v. Paul Belisle
UNPUBLISHED OPINION
RULING ON MOTIONS FOR SUMMARY JUDGMENT FILED BY THE PLAINTIFF
Robert F. Vacchelli, Judge.
These consolidated cases are actions by the plaintiff, William W. Backus Hospital, seeking to collect unpaid balances on hospital bills from the defendants, who were patients at the hospital. The plaintiff moves for summary judgment in each case. For the following reasons, the court finds that the material facts are in dispute. Therefore, the motions must be denied.
I
The law governing summary judgment is well-settled. As our Appellate Court has summarized:
Practice Book § [17-49] requires that judgment shall be rendered forthwith if the pleadings, affidavits and any other proof submitted show that there is no genuine issue as to any material fact and that the moving party is entitled to judgment as a matter of law. A material fact is a fact that will make a difference in the result of the case . . . The facts at issue are those alleged in the pleadings. (Citation omitted; internal quotation marks omitted.) Gohel v. Allstate Ins. Co., 61 Conn.App. 806, 809, 768 A.2d 950 (2001).
In seeking summary judgment, it is the movant who has the burden of showing the nonexistence of any issue of fact. The courts are in entire agreement that the moving party for summary judgment has the burden of showing the absence of any genuine issue as to all the material facts, which, under applicable principles of substantive law, entitle him to a judgment as a matter of law. The courts hold the movant to a strict standard. To satisfy his burden the movant must make a showing that it is quite clear what the truth is, and that excludes any real doubt as to the existence of any genuine issue of material fact . . . As the burden of proof is on the movant, the evidence must be viewed in the light most favorable to the opponent. (Citations omitted; internal quotation marks omitted.) Allstate Ins. Co. v. Barron, 269 Conn. 394, 405, 848 A.2d 1165 (2004).
It is frequently stated in Connecticut's case law that, pursuant to Practice Book § § 17-45 and 17-46, a party opposing a summary judgment motion " must provide an evidentiary foundation to demonstrate the existence of a genuine issue of material fact." Harvey v. Boehringer Ingelheim Corp., 52 Conn.App. 1, 4, 724 A.2d 1143 (1999). As noted by the trial court in this case, typically " [d]emonstrating a genuine issue requires a showing of evidentiary facts or substantial evidence outside the pleadings from which material facts alleged in the pleadings can be warrantably inferred." (Internal quotation marks omitted.) New Milford Savings Bank v. Roina, 38 Conn.App. 240, 244, 659 A.2d 1226, cert. denied, 235 Conn. 915, 665 A.2d 609 (1995). Moreover, " [t]o establish the existence of a material fact, it is not enough for the party opposing summary judgment merely to assert the existence of a disputed issue . . . Such assertions are insufficient regardless of whether they are contained in a complaint or a brief . . . Further, unadmitted allegations in the pleadings do not constitute proof of the existence of a genuine issue as to any material fact." (Citations omitted; internal quotation marks omitted.) Id., 244-45.Rockwell v. Quintner, 96 Conn.App. 221, 227-29, 899 A.2d 738, cert. denied, 280 Conn. 917, 908 A.2d 538 (2006).
The Practice Book further mandates that " [a]ny adverse party shall at least five days before the date the motion is to be considered on short calendar file opposing affidavits and other available documentary evidence. Affidavits, and other documentary proof not already part of the file, shall be filed and served as are pleadings." Practice Book § 17-45. " Supporting and opposing affidavits shall be made on personal knowledge, shall set forth such facts as would be admissible in evidence, and shall show affirmatively that the affiant is competent to testify to the matters stated therein. Sworn or certified copies of all papers or parts thereof referred to in an affidavit shall be attached thereto." Practice Book § 17-46.
II
In each of the above titled cases, the plaintiff alleges, inter alia, that the defendants were admitted to the plaintiff hospital for treatment as patients therein, and that the plaintiff furnished hospitalization and ancillary services and goods to said defendants until defendants were discharged. It further alleges that each patient guaranteed payment of the plaintiff's " regular charges."
The plaintiff alleges that the defendants' employers were duly billed for payment under the defendants' self-funded plans of insurance (" plans"). Thereafter, the plans audited the bills and arbitrarily disallowed a certain percentage as in excess of the plans' " allowable claim limit." The unpaid balances are as follows: Paul Belisle--$7, 409.16; Clay Fields--$5, 578.25; Amy Bloom--$9, 270.46; Charles St. James--$3, 653.15.
Key to each claim is the plaintiff's contention that it must collect these charges, and the defendants must pay, because the plaintiff is required, by state statute, to post its charges on a public schedule called a " pricemaster" with the Office of Health Care Access division of the state Department of Public Heath (" OHCA" or " office"), pursuant to General Statutes § 19a-681. It further argues that it cannot excuse the defendants' unpaid balances because of General Statutes § 19a-646(b) which provides, in pertinent part' that " no hospital shall provide a discount or different rate of reimbursement from the filed rates or charges to any payer except as provided in this section" or risk penalties prescribed in § 19a-681. Section 19a-646(c) further states that " any payer may directly negotiate with a hospital for a different rate or method of reimbursement, or both; provided . . . the (written) discount agreement . . . is on file at the hospital." The plaintiff argues that none of the defendants, nor their employers or plan administrators negotiated a discount agreement with the plaintiff, nor did they arrange for any written agreement for a different rate or method of reimbursement of plaintiff's published charges filed with the OHCA. Therefore, the pricemaster rates are mandatory, plaintiff argues. Plaintiff further argues that the defendants guaranteed payment of its regular charges; accordingly, they must pay the remaining portion of the charges. Finally, plaintiff further argues that it has demanded payment, but the defendants have neglected and refused to pay.
General Statutes § 19a-681 provides, in pertinent part, as follows:
In support of its motion for summary judgment, the plaintiff has filed affidavits from its patient accounts supervisor stating that she has reviewed the itemized bills issued for each defendant and that the itemized charges are in accordance with the Hospital's regular charges filed with the OHCA covering the dates of the defendants' hospitalizations. The affiant further stated that none of the defendants, nor any payer on their behalf, had a written agreement with the plaintiff for a discount or different rate or method of reimbursement from the hospital's regular rates on file with the OHCA. It is undisputed that, on their respective admission dates, each defendant executed a " Guarantee of Payment" form wherein they guaranteed payment of " the hospital's regular charges for this period of hospitalization." In that form, each defendant acknowledged that he or she would be " financially responsible to the hospital . . . for charges not covered by" available insurance. It is also undisputed that none of the defendants nor their insurance plans had negotiated an agreement with the plaintiff for a discounted rate, that the defendants received treatment and services at the hospital, that their insurance plans were billed, and that their plans only paid a portion of the charges.
Defendants filed answers to the respective complaints with special defenses alleging equitable estoppel, unjust enrichment, unconscionable action; duress; violation of the Connecticut Unfair Trade Practices Act; lack of material terms; fraud; accord and satisfaction and contending that plaintiff is limited to a quantum meruit remedy, if any.
Defendants argued that summary judgment should be denied because material facts are in dispute. They contend, in sum, that the guarantee of payment form that they were required to sign is not an express contract to pay pricemaster rates or the unreasonable prices demanded in this case; that the contract is an unenforceable adhesion contract, that the prices charged are excessive and that it would be unconscionable to force them to pay the full amount. They further contend that plaintiff has failed to prove what goods and services were actually provided, and that it has failed to prove that its charges were equal to the charges listed on the pricemaster.
In support of their objections, defendants filed an affidavit by Mr. St. James in the St. James case attesting to the fact that he went to the hospital under stressful circumstances, he was never told that he would be required to pay pricemaster rates, that he had no opportunity to negotiate rates, and that he believed that they had to sign the guarantee or he would not be treated. He was required to pay a $500.00 co-pay at the time of admission, and he was under the impression that $500.00 was all he would be required to pay. They also filed an affidavit of their counsel supplying the court with various financial records of the plaintiff purporting to show that, during the relevant time period, the hospital only collected about 42 per cent of its billings and yet maintained a 14.1 per cent profit margin, arguably demonstrating that it would be grossly unfair to make the defendants pay the full bill when hardly anyone else does so, and that to require them to pay the full rate would be unconscionable. They additionally submit transcripts of the depositions of two hospital business office staff demonstrating an array of conflicting facts which cast doubt on the accuracy of the plaintiff's factual assertion that the rates on the bill matched the rates on the paymaster. The court observes that no affidavits, exhibits or objections were filed by the defendants in the Belisle, Fields or Bloom cases in response to the plaintiff's motion for summary judgment filed in those cases; but, at oral argument, the parties agreed that since all of the cases involved the same issues and were consolidated for simultaneous action, all would be considered together and the court's decision would be applicable to all four cases.
Plaintiff argues that none of defendants' defenses are viable because they lack evidentiary foundation and because the plaintiff's pricemaster rates " control a payer's liability" in accordance with General Statutes § 19a-646(b) and the Supreme Court's decision in Caraballo v. Electric Boat Corp., 315 Conn. 704, 110 A.3d 321 (2015).
Of critical importance to resolution of the issues would be evidence of the itemized bills for services rendered and the pricemaster in effect for the time in question. The court observes that neither party has supplied the court with either item. The absence of this critical information, and the presence of the other conflicting evidence supporting the defendants' defenses, demonstrates to the court that, at least at this early stage of the case, the plaintiff has not yet accomplished its burden to demonstrate that there are no material facts in issue. Mott v. Wal-Mart Stores East, LP, 139 Conn.App. 618, 626-27, 57 A.3d 391 (2012). Viewing the evidence in the light most favorable to the opponents, as the court must do in such a motion for summary judgment, Ramirez v. Health Net of Northeast, Inc., 285 Conn. 1, 11, 938 A.2d 576 (2008), the court cannot find that the plaintiff is entitled to judgment as requested as a matter of law. " In ruling on a motion for summary judgment, the court's function is not to decide issues of material fact, but, rather, to determine whether any such issues exist." (Citation omitted.) Nolan v. Borkowski, 206 Conn. 495, 500, 538 A.2d 1031 (1988). Such factual issues exist in this case with respect to grounds for summary judgment advanced by the plaintiff. Therefore, the plaintiff's motions are denied.
Having determined that the plaintiff's motions for summary judgment cannot be granted, it is unnecessary, at this time, to resolve the issue of whether General Statutes § 19a-646(b) and the Supreme Court's decision in Caraballo v. Electric Boat Corp., supra, per se preclude any and all defenses to a hospital bill.
III
For all of the foregoing reasons, the court finds that the material facts are in dispute and that, therefore, the plaintiff's motions for summary judgment should be denied.
(a) . . . (2) " pricemaster" means a detailed schedule of hospital charges. (b) Each hospital shall file with the office its current pricemaster which shall include each charge in its detailed schedule of charges. (c) Upon the request of the Department of Public Health or a patient, a hospital shall provide to the department or the patient a detailed patient bill. If the billing detail by line item on a detailed patient bill does not agree with the detailed schedule of charges on file with the office for the date of service specified on the bill, the hospital shall be subject to a civil penalty of five hundred dollars per occurrence payable to the state not later than fourteen days after the date of notification.