Medical Charges Presumed Reasonable and Challenges Must Be Substantiated

March 7, 2013 in Medical and Healthcare by Brad Council

On February 11, 2013, in the Court of Appeals of Ohio, Third Appellate District, Hardin County, judgment was affirmed in Riverside Methodist Hospital, Plaintiff-Appellee, (“Riverside”) v. Stephanie S. Phillips, Defendant-Appellant, (“Phillips”) Case No. 6-12-14 finding that summary judgment for Riverside was appropriate even without the medical bill being introduced into evidence and the Defendant’s claims of unreasonable charges were unsupported.

On September 2, 2011, Riverside filed a collection action against Phillips.  For privacy reasons, Riverside did not attach an itemization of the charges to the complaint but stated to the court that it would provide at the court’s request.  In response, Phillips filed an answer disputing that the medical and hospital charges were reasonable or necessary.  Riverside subsequently filed a motion for summary judgment contending that there was no issue of fact that Riverside rendered the medical and hospital services to Phillips and that her account was due and owing. In her memorandum contra to Riverside’s motion, Phillips stated that there was an issue of fact as to whether her insurance provider was responsible for the charges and whether the charges were reasonable and necessary.  The only evidence she submitted addressed the issue of liability for payment (Phillips or Aetna), not reasonableness of the charges. Despite the memorandum, the court granted Riverside’s motion for summary judgment.

Phillips then filed an appeal stating that the trial court erred in granting the judgment because there was an issue of fact as to the reasonableness and necessity of Riverside’s charges.  She claims that Riverside failed to provide an itemization when in fact, in its complaint, Riverside offered to provide an itemization. Riverside contended that simply because the trial court did not request a copy of the itemization does not mitigate the fact that the bill itself is sufficient evidence for reasonableness. In addition, in discovery, Phillips admitted she received a copy of the bill.

Even though the reasonable value of medical services is a question of fact, “[a] medical provider may be entitled to a presumption that its customary fees are reasonable.” St. Vincent Med. Ctr. v. Sader, 100 Ohio App.3d 379, 383 (6th

Dist.1995). In personal-injury actions, the Supreme Court of Ohio has said that“[b]oth the original medical bill rendered and the amount accepted as full payment are admissible to prove the reasonableness and necessity of charges rendered for medical and hospital care.” Robinson v. Bates, 112 Ohio St.3d 17, 2006-Ohio Case No. 6-12-14, 6263, ¶ 17

While Riverside did not submit the medical bill into evidence, Riverside presented other evidence by way of its employees’ affidavits to corroborate the amount of the charges contained in the bill sent to Phillips.  The court further found that despite her arguments on appeal, Phillips admitted that she did not compare the charges contained in Riverside’s bill to those of other hospitals nor did she demonstrate that Riverside customarily engaged in a practice of accepting an amount less than the one originally billed. Phillips’ general assertions without evidence tying that practice to the facts and circumstances of the case were insufficient to create a genuine issue of material fact to avoid summary judgment.

Therefore, the Court of Appeals affirmed the judgment of the trial court.

 

The full text of the opinion may be found at:

http://www.sconet.state.oh.us/rod/docs/pdf/3/2013/2013-ohio-423.pdf

 

Many thanks to Kim Goldwasser for her contributions to this article.  Kim is a paralegal with Slovin & Associates Co., L.P.A.