Articles Posted in Healthcare

On February 20, 2018, the U.S. Supreme Court in CNH Industrial v. Reese rejected the Sixth Circuit’s approach to interpreting collective bargaining agreements (“CBA”), instead affirming that courts must interpret such agreements in accordance with ordinary principles of contract law.  The Court held the only reasonable interpretation of the CBA was that post-retirement health care benefits offered under the CBA did not vest for life but rather expired when the CBA expired.

In 1998, CNH agreed to a CBA that provided health care benefits to certain employees who retired under the company’s pension plan. The CBA specified that all other coverages outside of health care benefits, such as life insurance, ceased upon retirement. It also contained a clause stating that the agreement would expire in May 2004 and that the CBA “dispose[d] of any and all bargaining issues, whether or not presented during negotiations.”

When the CBA expired in 2004, a group of CNH retirees and spouses sued CNH, seeking a declaration that their health care benefits vested for life and an injunction to prevent CNH from revoking them. After the district court granted summary judgment to the retirees, CNH appealed. Relying on principles of contract interpretation established in an earlier Sixth Circuit decision, known as Yard-Man inferences, the Sixth Circuit affirmed the district court’s decision. The Sixth Circuit concluded that, since the CBA was silent on whether health care benefits vested for life, and since it tied health care benefits to pension eligibility, the CBA was ambiguous as a matter of law. Because it was ambiguous, the Sixth Circuit held, extrinsic evidence could be considered in interpreting the CBA. Upon considering extrinsic evidence, the Sixth Circuit ruled that the evidence supported lifetime vesting.

In the recent case of Parkview Hospital, Inc. v. Frost, which is now before the Indiana Supreme Court, the issue of the reasonableness of hospital charges in the context of a contested hospital lien is addressed and may pose some issues with a hospital’s chargemaster. Frost was seriously injured in a motorcycle collision and was uninsured and incurred $625,117.66 in charges from the hospital which subsequently filed a statutory hospital lien under IC 32-33-4 et. seq.  No financial responsibility agreement was signed until after Frost left the hospital.  As authorized under the statute, Frost argued against the lien alleging that Parkview’s charges were unreasonable because they were greater than the amounts the hospital accepts from patients with private health insurance or government healthcare programs.  Parkview sought the determination of the trial court that, as a matter of law, their default medical expense rates were reasonable.  The Court of Appeals, in affirming the trial court, held that the trial court “correctly found that Frost should be allowed to discover [this] evidence” and that it was admissible under the Hospital Lien Act in determining the reasonableness of the charges.  The Indiana Supreme Court accepted transfer and oral argument was heard on September 1, 2016.

Depending on the outcome from the Indiana Supreme Court, hospitals might expect more disputes over the reasonableness of charges in uninsured situations.

James A. L. Buddenbaum has practiced law for more than 25 years with Parr Richey representing municipalities and businesses in utility, healthcare and general business sectors in both regulatory and transactional matters. Jim also has extensive experience in representing businesses in making large property damage and similar insurance claims.