man we're ready to proceed with the first case automobile accident and transported to hospital in westchester she when she arrived at the hospital she received the services of the apple the professional radiology inc refer to three out throughout the br as p r i which i will do in this argument when she received those services she received them as an insurer of united healthcare united healthcare contracted with p r i p r i was and in that work preferred provider and when p r i rendered those services they render them to united health care's insured upon presenting evidence that she insured barbara jackson at that time and from that moment had no why ability for the for the bill that generated by professional radiology they had no why ability she had no why ability for that bill under the all the state collection from miss jackson seventeen fifty one sixty b which states on equivocally that once she presented that evidence of insurance that there after she had no why ability for the bill and seventeen fifty one dot thirteen c two which states that that protection survives even in the event that the insurer becomes insolvent and even in the event and in the event that the insurer does not pay  professional radiology attempts to evade those protections by erg uing throughout the brief that the statutes were merely a balance billing statute in other words the argument of the apple levy is that so long  professional radiology did not bill united health care the health insurer it was not prohibited from billing mr jackson if p r i build united healthcare then the applebee's argument is that they could not build mr jackson for the balance between their full bill and the bill paid by not health care they argue that they had the right to elect which one contract is that reliance place and i realize that that they're going to tell me but you say that's not true throw what is the language that you looked at as how can't do that i'm sorry that is absolutely not true and that's not true because the language which i have stated to the court is by force of law in ohio included in the contract so it is not only the all the higher you it is contractual language that is mandated to be in the contract happily makes an argument and the argument that they make is that that was all turned around by the pro medica case which is the seminal case from the iowa supreme court in regard to seven hundred fifty one and on page japanese brief they state that the holding of the court in king was that the statute does not apply unless the health provider bills the health insurer that would get you to where they want to go absolutely and that would be fatal to our case absolutely however they state that the court so held at paragraph twelve of its  paragraph twelve indicates that it's not at all what the court held what the court held was as the statute only applies when a health provider bills a health insuring corporations insured namely so the the holding that stating is is incorrect there is nothing in ohio all that would give them the right to do what they did at that there's nothing in ohio all that would permit them to directly bill her ramasamy morial case where the bill was sent directly to a nationwide to tortfeasor is insurance company which for some mysterious reason paid a debt that she didn't know and the nationwide did no none of that occurred in this case this is a case of direct billing every bill went directly to mr jackson every but every every bill contained a statement the cio the debt her debt was in arrears there's no mention of any third party this is a direct billing case this was what the statute was intended for and when they did that they did that in contravention of state and federal and this was all about three dollars and ninety seventh well your honor nationally i know where the court is on that the initial bill was eight hundred and some dollars and then after they collected that from her they came back at the end and said you still owe three dollars and forty nine cents that was in that they're the age of collect i mean that billing in a deal tell me about that yes ma'am that they were hired by p r i to collect the debt from mrs when they were unsuccessful and doing so themselves c c c is a debt collector they claim to be nothing else and the water is that they sent were debt collection letters rather about a debt that she didn't but if they're relying on information from the healthcare provider that says we're owed eight hundred fifty eight with a sixty or whatever we wrote this person had paid collected why would any additional knowledge be attributed to them or your art two things number one we don't know what they knew and what they did not know because we have an undeveloped record we have we don't not know what's in their file and we do not know what the commission was but it it is it is at least probable that they had to enquire in regard to where did this debt from and it could be if we have a chance to develop the record that c c c was it was provided the information that united healthcare existed and was told collected from m and if that doesn't work we'll go we'll go to the health insurer don't know that that's what but but you know we're standing in the dark because the case was dismissed ok and i know you're almost out of habit i need to ask you one other question there is a second case please actually i agree with your honor and out of an abundance of caution we contacted the clerk because there were separate arguments that were scheduled in those cases and we you know we told the court that these were related cases on that and the court may decide not to have separate arguments on the because they do spring from the same operative newport's laugher of fact and they do involve the same statutes in the same yes your honor i'm out a little so but yes it's mr frank use here in cincinnati and he's on this case and i'm on that case thank you thank you and in the business solutions we respectfully submit that the trial court properly granted the twenty six motion for either of two separate reasons one the trial court properly recognized that the statute in question or c seven hundred fifty one point correct so the situation to answer your question your honor it would exist when there was a contract in place and the provider sent a bill or attempted to collect from the health insurance corporation that probably the clearest guidance from the state of ohio on this issue comes from the ohio department of insurance regulatory guideline so in the context of the supreme court's king decision which notes that the statute is of limited application the guidance from the hard part of insurance states that several things one there's no private cause of action under seventeen five one point six zero into the statute only applies to situations where there is and i guess united as to wrecked for business reasons providers will choose to accept frequently discounted payment from the health insurance corporation because there's guaranteed payment they know they have a solid revenue source and they'll make the determination to seek payment from that health insurance corporation where the statute says you've agreed to take a discounted amount you don't that you can't think come back to the patient and say the value of the services we provided worth a thousand dollars of every provider of health care every provider or health care facility that contracts with the health insurance health insurance corporation to provide services shall seek compensation for coverage services slowly from the health insurance corporation and not under any circumstances from the enrollee or the subscriber earth except for approved co payments and deductibles that  clear and it seems to align with mr ewing argument how do you get the case you just made the judge style or from the reading of that language or the statute certainly says what it says right  looked looking at the totality of the ohio with the wording on this issue including the khaybar decision from the higher court of appeals which explicitly says that a health care provider is not required to submit claim to the health insurance corporation even if they have a contract with it and they're not required to submit a claim to that in any their work there's a contract by united for payment of fifty percent of your clients can just go straight to the patient one hundred percent of this bill and we don't care what united we would reason we would respect that it's a business decision for the provider to make there is not there's not a single ohio case that we're aware of that is ever held this sat suit applies to correct there's no doubt that what clearly could not happen is my client submit a claim to u h c gets paid and then asks for the difference from mr jackson that would be a clear violation of seventy five one point six zero that's the balance billing situation the hard part of insurance says the statute is designed to guard against but that's not alleged to have happened here but can't can business practices of course and dealing of that really it just made the wording of the statute no no but we would we would say that the trial court correctly recognized that the interpretation of that statute under ohio law is to limit the situation to balance billing circumstances the tr noted the supreme court explicitly says that seven hundred five one point six zero has a limited purpose and therefore we respectfully submit the trial court properly determined that the statute would not apply to anything other than balance billing well excuse me go ahead that that's not a balance no that they billed her in full they built her for the fall of that was that was her that was her total bill or bill correct had they had they submitted a claim receipt partial payment from insurance company and then attempted to bill her for anything other a viable claim none of the eight causes of action in their complaint would be viable regardless of whether the statute applies or doesn't apply there still is no viable claim in under an overview we respect we submit that the dismissal is still appropriate and i'll go through these alleged question i was going to say does your client do this in all situations where people have gone in for professional services and say we're not going to do with this help ensure we want you to pay one hundred percent on the dollar that you could do that that what you're saying i think that the way we interpret the ohio guidance on this issue that a provider would would have the ability to make that business decision if they wanted to now they do frequently may choose not to do that they may prefer to pursue the path of guaranteed payment from insurance company in terms of whether my client does or doesn't i don't have knowledge and i can't submit there's anything in the record that would indicate whether it does or doesn't and i wouldn't again this case was decided on the pleadings so we don't yet have any factually developed information for the average person on the street to say are you going to the hospital yes but i've got insurance and that will take care of it and that's not true in your case it just is that there's just rubber on the dash now it's not that she doesn't have insurance now but he may have to pay the whole thing out of his own and then he have to go against united of course you because this a rose out of a tort situation she would have the ability to then recover whatever she paid to the hospital she could then recover that amount from the tortfeasor so she's not all three going to be out of pocket in that doesn't wind this case with king and because those courts recognize that when the provider is seeking payment in a tort certain circumstance where the money is often repaid by the tortfeasor that they've held that's not a violation of seven hundred five one point six zero so the patient here ultimately would not be financially harmed because the tortfeasor will often still be responsible for satisfying the medical obligation of the injured person could be the auto accident they could be responsible they still have medical and cos that's that's correct that's right and i would again i would wreck though there would be no other pocket in that case that is correct and i would submit under those circumstances the provider may make the business determination to simply seek payment from the health insurance corporation and in take the guaranteed payment available but apart from the torrid aspect of it the relationship of the injured person and the health insurance carrier for her the situation where you build directly you would expect that that person then would the give that go to our insurance carrier and say do something about it or certainly a circumstance could happen certainly for sure that's right if it didn't happen it would make the insurance kind of a waste of time and i suppose that's that's a possible circumstance and it's the amount of time if if there are other questions judge guy good morning please the court david benjamin shaver for controlled credit we've talked a lot this morning about ohio revised code section seven hundred fifty one sixty in its application i think the language of the statute shows clearly that it does not apply to control of credit we are neither controlled credit is neither a provider nor a health care facility under the language that's used in the statute and how those terms are defined in the revised code i think the supreme court's decision in king the pro medica also confirms that the statute does not apply to control credit you have a supreme court i think states pretty clearly in in the king the king opinion that the statute applies to only those entities or persons that might be mentioned within the taxed including providers health care facilities health insurance corporations well how do you respond with the evening comment that the see with basically acting  way that but he basic if that we need to know what they knew and when they knew it and whether they were acting in full knowledge that they couldn't do what they were trying to do so how do you respond i don't believe that it's necessarily in the record but  c has no such knowledge of debt collection is a is a is a volume business they receive lots of accounts from lots of different clients and that information comes in they rely on that information they're entitled to do so i think it's been the position of this circuit for a long time since one thousand nine hundred two in the smith v trans world decision that a debt collector is entitled to rely on the information that it receives and it is under no duty to conduct an independent investigation of the account prior to attempting to collect it and that's what happened here they got information from p r i they sent an initial letter on believe was may the fourth twenty fifteen about a week later they spoke to ms jackson she advised that she was represented by counsel and that counsel then negotiated the the balance of the bill for less than what she owed and she she settled that account so i'm not sure how ms jackson believes that c c c could have violated these various consumer statutes she claims to have been misled and deceived when she was represented by counsel and none of these issues were raised with c c c patients we turn it over to you and you go get it from the patient therefore your state i think professional radiology council has addressed that issue but i'm not sure that the answer to that question is to control credit matters you know they are entitled to rely on the information they're clearly not subject to the statute themselves so you know i'm not sure what control credit is supposed to do in this situation they receive these accounts the information is transmitted to it and it relies on that information and goes you know goes forth and has clearly says that there is no duty to investigate that account prior to attempting to collect it i think doing so would be would certainly raise the cost of everything you know again it's a volume business they receive lots of accounts and they rely on the information that they receive from their clients and i think i'd like to also i'd like to echo the point that professional radiology council made which is the facts in the record support the conclusion of the district court with respect to  whether this court agrees with the district reasoning or not the conclusion is correct and judgment on the pleadings as to controlled credit was appropriate there are no facts in the record to support any of the claims that m jackson has made against control of credit control credit did not breach any contracts third party any direct contracts as i mentioned before it did not deceive her or mislead or in any way in fact again i was represented by counsel during counsel's communications with control credit who negotiated the we negotiated the thousand and sixty six to eight hundred fifty two dollars i believe i was ultimately paid and that was the end of controlled credits involvement with this whole situation i don't see any facts that would support claims for fraud or unjust enrichment or conversion and as we argued to the district court you know we've kind of been sitting here thinking what are we doing in this case this is an argument about how an account is building controlled credit has no involvement whatsoever in billing decisions or determining whether or not an account is appropriately billed to an insured or the insureds insurance company and i see that my time is up if there are no more questions from from your honour's we respectfully request that the court from the district court judge control credit thank you very much will try to do some of this as much as i can just found that on that last point that by definition a collection agency the target of all of their collections are the person for whom t collection agencies to make an end run around the hospital going directly against the person who got the service and you know your arm you know our theory is that while seventeen fifty one does not apply it's no different than the statute of limitations may not apply to control credit but a statute of limitations does apply to the debt and this court has held and other courts have held that the pursuit of a time barred debt is a because it is a debt that cannot be legally collected this cannot be legal angle that collection agency can never seek payment from somebody who th incurred as a result of treatment in a hospital not at all your honor in fact if the patient was uninsured or if p r i was an out of network provider and therefore there was no insurance play and you didn't have the protection of these statutes then c c c could certainly go after the patient for the money the reason why they can't in this case is because the law immunized barbara jackson from having any responsibility for the bill ok but the second talked about providers or health care facilities neither of which applies to see she sees that i'm not sure still how you just not following you there i apologize maybe i'm not make it clear to the court the debt never existed it is not whether seven hundred fifty one applies to people to p r i it's that there was no debt there was never a debt to be collected under ohio law it has nothing to do with c c c they went to collect a debt that was a vote no different than had it been time are no different than had been a request for words or seeking compensation from a health insurer so it absolutely within the of the of the total ban balance billing has begun but there is a total ba was a bill to her med pay insure safety and she claimed that the safeco was taking money from her but the court held that that's a third party you didn't get the bill it didn't come out of your pocket but the best chief justice o'connor states there is no disagreement that this lady does not have to get into her pocket to pay this bill that can be verified on the publicly so so by implication here say that you're absolutely absolutely i think that's it i think my time's up i think that we're hearing let me thank the parties for your argument the matter is submitted and the court will issue its opinion in due course