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Wright v. Hooker

Court of Appeals of Texas, Twelfth District, Tyler

December 13, 2017

KEITH WRIGHT AND BELINDA MELANCON SOUTHERN, APPELLANTS
v.
JOHNNA C. HOOKER, MARY SANFORD, BRANDY MIRELES AND RYAN BREWER, APPELLEES

         Appeal from the 217th District Court of Angelina County, Texas (Tr.Ct. No. CV-00624-15-10)

          Panel consisted of Worthen, C.J., Hoyle, J., and Neeley, J.

          MEMORANDUM OPINION

          James T. Worthen, Chief Justice

         Keith Wright, city manager for the City of Lufkin, and Belinda Melancon Southern, director of finance for the City of Lufkin, in their official capacities, appeal the trial court's order granting summary judgment for Johnna Hooker, Mary Sanford, Brandy Mireles, and Ryan Brewer. Appellants raise five issues on appeal. We reverse and remand in part, and reverse and render in part.

         Background

         Appellees were individually involved in separate motor vehicle accidents alleged to have been caused by the negligence of a third party. Each Appellee was transported to the hospital and treated by the City of Lufkin emergency medical services (EMS) following the accidents. Thereafter, EMS filed medical services liens, pursuant to Chapter 55 of the property code, against each Appellee's causes of action resulting from their respective motor vehicle accidents.

         Appellees later sued Appellants, seeking a declaratory judgment that EMS did not timely bill Appellees' respective health insurance policies and was therefore limited in its recovery to the amount Appellees would have owed had EMS timely billed Appellees' health insurance carriers pursuant to Chapter 146 of the Texas Civil Practice and Remedies Code. Appellees also sought a declaratory judgment that EMS's liens were invalid under section 55.004(g)(3) of the property code. Appellees sought an injunction requiring EMS to withdraw the liens, cease collection efforts, and cease filing liens in violation of Chapter 146 of the Texas Civil Practice and Remedies Code and Chapter 55 of the Texas Property Code.

         Southern, as director of finance, handles the billing for EMS. She testified at a deposition regarding EMS's billing practices. She explained that when EMS transports a patient who was injured in a motor vehicle accident, the billing personnel (biller) obtains an accident report from the police department to determine the at fault party's motor vehicle insurance information. The biller then contacts the motor vehicle insurance company to determine if an injury claim has been filed on the policy. If an injury claim has been filed, the biller submits EMS's bill to the at fault party's motor vehicle insurance carrier for payment. If a claim is not filed within several days of the accident, the biller submits the charges to the patient's health insurance carrier, if the patient has an active health insurance policy.

         Southern testified that when an injury claim is filed and the bill is submitted to the motor vehicle insurer, the biller monitors the account and maintains contact with the insurance adjuster until the claim is paid. If, during pendency of the claim, the biller believes the injury claim will be unsuccessful, the biller withdraws the bill from the motor vehicle insurer and submits the bill to the patient's health insurance provider. If the patient hires an attorney to pursue a motor vehicle accident claim, EMS typically files a lien against the patient's cause(s) of action.

         Southern explained that EMS has a contract with Medicare and Medicaid, but not with any private health insurance carriers. Because EMS does not contract with private health insurance carriers, if EMS submits the bill to a private health insurance carrier, it does not know prior to receiving the carrier's response if or what percentage of the total charges the carrier will pay. If EMS submits a bill to a private health insurer or a motor vehicle insurer and receives partial payment, EMS bills the patient for any remaining balance. Southern testified that EMS did not bill any of the Appellees' health insurance policies, and that EMS filed a release of Sanford's lien.

         During the pendency of the litigation, Appellees filed a traditional motion for summary judgment. Appellants filed a written response asking the trial court to deny Appellees' motion, and requesting the court grant summary judgment in their favor.[1] The trial court granted summary judgment in favor of Appellees and entered a judgment finding that Appellants violated Chapter 55 of the property code by filing liens against Appellees' causes of action "even though Defendants were entitled to bill Plaintiffs' medical insurance." The judgment further enjoined Appellants from continuing the practice of filing EMS liens against patients who have "coverage under a private medical indemnity plan or program from which Lufkin EMS is entitled to recover payment for services under an assignment of benefits or similar right." This appeal followed.

         Summary Judgment

         Appellants present four issues challenging the trial court's summary judgment rulings.[2]They contend that: (1) the trial court erred in its interpretation of section 55.004(g)(3) of the property code because EMS has no recourse against a health insurance provider with which it does not have a contract; (2) Appellees' did not demonstrate that they had coverage under a private medical indemnity plan to which EMS had been given an assignment of benefits or other similar right; (3) Hooker did not execute an assignment of benefits; and (4) Sanford's claims are moot because EMS released her lien prior to filing suit. Appellants urge this Court to reverse the trial court's judgment and enter a take nothing judgment in Appellants' favor.

         Appellees in turn, argue that the trial court correctly granted their summary judgment motion because section 55.004(g)(3) should be interpreted to mean that EMS is not entitled to file liens for services if EMS has a right to be paid by a patient's private insurance carrier. They further argue that EMS's lien as to Hooker's causes of action is invalid because it "filed a lien for $1, 202.00 against Ms. Hooker despite the statute explicitly limited the maximum charge covered under the lien to $1, 000." Appellees urge this Court to affirm the trial court's order granting summary judgment.

         Standard of Review

         Declaratory judgments rendered by summary judgment are reviewed under the same standards that govern summary judgments generally. Drake Interiors, L.L.C. v. Thomas, 433 S.W.3d 841, 846 (Tex. App.-Houston [14th Dist.] 2014, pet. denied). We review a summary judgment de novo. Id.; see also Valence Operating Co. v. Dorsett, 164 S.W.3d 656, 661 (Tex. 2005). We take as true all evidence favorable to the non-movant, and indulge every reasonable inference in the non-movant's favor. Joe v. Two Thirty Nine Joint Venture, 145 S.W.3d 150, 157 (Tex. 2004); Grynberg v. Grey Wolf Drilling Co., L.P., 296 S.W.3d 132, 135 (Tex. App.- Houston [14th Dist.] 2009, no pet.).

         Summary judgment for a defendant is appropriate only when he negates at least one element of each plaintiff's theories of recovery, or pleads and conclusively proves each element of an affirmative defense. Sci. Spectrum, Inc. v. Martinez, 941 S.W.2d 910, 911 (Tex. 1997). Evidence is conclusive only if reasonable people could not differ in their conclusions. City of Keller v. Wilson, 168 S.W.3d 802, 816 (Tex. 2005). When, as here, both sides move for summary judgment, each bears the burden of establishing that it is entitled to judgment as a matter of law ...


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