[Cite as King v. ProMedica Health Sys., Inc., 129 Ohio St.3d 596, 2011-Ohio-4200.] 

KING, APPELLEE, v. PROMEDICA HEALTH SYSTEM, INC., ET AL., APPELLANTS. 

[Cite as King v. ProMedica Health Sys., Inc., 

129 Ohio St.3d 596, 2011-Ohio-4200.] 

Insurance—R.C. 1751.60—Automobile-insurance medical benefits—Coordination 

of multiple health-care-insurance payors. 

(No. 2010-1236—Submitted May 25, 2011—Decided August 30, 2011.) 

APPEAL from the Court of Appeals for Lucas County, No. L-09-1282, 

2010-Ohio-2578. 

__________________ 

MCGEE BROWN, J. 

{¶ 1} Appellants, ProMedica Health System, Inc., and the Toledo 

Hospital, appeal from a decision of the Sixth District Court of Appeals finding 

that pursuant to R.C. 1751.60(A), appellants were statutorily prohibited from 

billing Virginia King’s motor-vehicle insurer, Safeco Insurance Company of 

Illinois, for the medical treatment rendered to her at the Toledo Hospital. 

{¶ 2} We are asked to decide whether R.C. 1751.60(A) prohibits a 

provider from seeking payment for medical treatment rendered to an insured 

injured in an automobile accident from the insured’s automobile-insurance 

medical benefits. R.C. 1751.60(A) states that every provider that contracts with a 

health-insuring corporation to provide health-care services to an insured shall seek 

payment solely from the corporation. Separately, we also are asked to decide 

whether R.C. 1751.60(A) conflicts with Ohio’s law regarding the coordination of 

insurance benefits. We hold that R.C. 1751.60(A) applies only when a healthcare provider seeks payment from an insured. We also hold, therefore, that R.C. 

1751.60(A) does not conflict with Ohio’s law on the coordination of insurance 

benefits. The coordination of multiple health-care-insurance payors is covered 
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under R.C. 3902.11 et seq. and the rules promulgated pursuant to those statutes. 

Accordingly, we reverse the judgment of the Sixth District Court of Appeals. 

Background 

{¶ 3} Appellee, Virginia King, was injured in an automobile accident on 

December 1, 2007, and was treated for her injuries at the Toledo Hospital. King 

informed the hospital admitting staff that she was covered by Aetna Health, Inc. 

and provided her health-insurance information to them. It is undisputed that 

appellants billed King’s automobile insurer, Safeco Insurance Company of 

Illinois, for the services rendered. 

{¶ 4} In her complaint, King alleged personal damages and sought a 

class-action suit pursuant to Civ.R. 23 on behalf of all enrollees or subscribers1

treated within the ProMedica Health System who were covered by a healthinsuring corporation. King raised four causes of action: breach of contract, 

violation of public policy, violation of various sections of R.C. Chapter 1345 (the 

Consumer Sales Practices Act), and conversion. Each of these causes of action is 

based on the claim that the appellants violated R.C. 1751.60(A) by billing the 

automobile insurer instead of the health-insuring corporation. Appellants filed a 

motion to dismiss King’s complaint for failure to state a claim upon which relief 

may be granted, pursuant to Civ.R. 12(B)(6). 

{¶ 5} The trial court granted appellants’ motion to dismiss. The court 

noted that King had not alleged that appellants sought compensation directly from 

her, the insured. The trial court found that King’s claims, which were all based on 

a violation of R.C. 1751.60(A), failed. 

{¶ 6} King appealed, and the Sixth District Court of Appeals reversed. 

King v. ProMedica Health Sys., Inc., 6th Dist. No. L-09-1282, 2010-Ohio-2578. 

The court held that health-care providers that execute preferred-provider 

 

1. For purposes of this opinion, we will refer to an “enrollee” and “subscriber” as an “insured.” 
January Term, 2011 

3

agreements with health-insuring corporations can bill only the health-insuring 

corporation subject to the agreement for covered services furnished to their 

insured and cannot bill any other potential payors. Id. at ¶ 13. Appellants 

appealed the decision to this court. We granted discretionary jurisdiction to 

review appellants’ second proposition of law. 126 Ohio St.3d 1597, 2010-Ohio4928, 935 N.E.2d 44. 

Analysis

{¶ 7} We are asked to determine the applicability of R.C. 1751.60(A). 

Appellants argue that the sole purpose of R.C. 1751.60(A) is to protect an insured 

patient from being billed for medical services when the health-care provider has 

contracted with the patient’s health-insuring corporation to provide services to the 

corporation’s insured. Appellants contend that the Sixth District misapplied R.C. 

1751.60(A) when that court concluded that the statute prohibited appellants from 

seeking compensation from Safeco, which provided medical benefits as King’s 

automobile insurer. We agree. 

{¶ 8} R.C. 1751.60(A) states, “Except as provided for in divisions (E) 

and (F) of this section, every provider or health care facility that contracts with a 

health insuring corporation to provide health care services to the health insuring 

corporation’s enrollees or subscribers shall seek compensation for covered 

services solely from the health insuring corporation and not, under any 

circumstances, from the enrollees or subscribers, except for approved copayments 

and deductibles.” 

{¶ 9} By its express terms, R.C. 1751.60(A) governs providers or healthcare facilities, health-insuring corporations, and a health-insuring corporation’s 

insured. The statute is applicable only when there is a contract between a 

provider and a health-insuring corporation, and the provider seeks compensation 

for services rendered. The legislature expressed its intent that the provider must 
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seek compensation solely from the health-insuring corporation and not from the 

insured. 

{¶ 10} It is undisputed that appellants never sought compensation from 

King. But King argues that her Safeco medical-benefit payments are an asset that 

belongs to her and that by seeking medical-benefit payments available under the 

automobile policy, appellants essentially sought compensation from her. King’s 

argument is unpersuasive. Under R.C. 1751.01(G), “ ‘[c]ompensation’ means 

remuneration for the provision of health care services, determined on other than a 

fee-for-service or discounted-fee-for-service basis.” Compensation by Safeco did 

not equate to compensation by King: by making the payment, Safeco fulfilled its 

contractual obligation to King to cover her medical costs in the event of an 

accident. When appellants received payment, they received it from Safeco. 

Because King was not asked to make any payment for the services she received, 

appellants did not violate R.C. 1751.60(A). 

{¶ 11} King also argues that appellants violated R.C. 1751.60(A) because 

they sought compensation from Safeco and not Aetna. King contends that the 

statutory language “shall seek compensation for covered services solely from the 

health insuring corporation and not, under any circumstances, from the enrollees 

or subscribers” means that all providers that contract with a health-insuring 

corporation relinquish their ability to seek compensation from any other parties 

and can collect payment from only the health-insuring corporation. The Sixth 

District agreed, finding that providers that execute preferred-provider agreements 

with health-insuring corporations can bill only the health-insuring corporation 

subject to the agreement for services furnished to an insured to the exclusion of 

any and all other potential payors. The Sixth District’s reasoning relied on its 

construction of the word “solely,” defining it to mean “to the exclusion of others.” 

2010-Ohio-2578, at ¶ 12. This interpretation, however, cannot be reconciled with 

the statute. 
January Term, 2011 

5

{¶ 12} R.C. 1751.60(A) has limited application. The statute addresses the 

contract between a provider and a health-insuring corporation. No other entities 

are mentioned in the statute. The statutory language allowing a provider to 

recover “solely from the health insuring corporation and not, under any 

circumstances, from the enrollees or subscribers” relates only to this contractual 

relationship. Here, the term “solely” does not have the meaning given to it by the 

Sixth District. Reading the word in this manner would impermissibly render the 

phrase “and not, under any circumstances, from the enrollees or subscribers” 

superfluous. Rather, the word “solely” is part of a phrase that defines the context 

of the statute; it means, in this context, to the exclusion of a health-insuring 

corporation’s insured. This reading gives full meaning to every word of the 

statute. Read in context, the statute’s language allowing a provider to seek 

compensation from the health-insuring corporation and not the insured is limited 

to the situation in which a health-care services contract is in place between a 

provider and a health-insuring corporation. Therefore, we hold that R.C. 

1751.60(A) applies only when a provider seeks payment from a health-insuring 

corporation’s insured with which the provider has entered into a contract. 

{¶ 13} King’s argument that appellants were not entitled to seek the 

medical-benefit payments is appropriately covered under R.C. 3902.11 et seq. and 

the rules promulgated pursuant to those statutes. Ohio’s coordination-of-benefits 

laws apply when a provider seeks compensation from multiple insurers who are 

obligated to pay for health-care services rendered to an insured. R.C. 1751.60(A) 

concerns only a health-care provider’s ability to seek compensation from a healthinsuring corporation’s insured, where the health-insuring corporation has a 

contract with the provider, and therefore does not apply to coordination of 

benefits and does not conflict with R.C. 3902.11. 

{¶ 14} Appellants did not seek compensation from King. Thus, King fails 

to show that appellants violated R.C. 1751.60(A). 
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Conclusion 

{¶ 15} Because King failed to show that appellants sought compensation 

from her, she failed to establish a violation of R.C. 1751.60(A). Accordingly, we 

reverse the court of appeals and reinstate the trial court’s order dismissing King’s 

complaint pursuant to Civ.R. 12(B)(6). 

Judgment reversed. 

O’CONNOR, C.J., and LUNDBERG STRATTON, O’DONNELL, LANZINGER,

and CUPP, JJ., concur. 

PFEIFER, J., dissents. 

__________________

PFEIFER, J., dissenting. 

{¶ 16} R.C. 1751.60(A) provides, “[E]very provider or health care facility 

that contracts with a health insuring corporation to provide health care services to 

the health insuring corporation’s enrollees or subscribers shall seek compensation 

for covered services solely from the health insuring corporation and not, under 

any circumstances, from the enrollees or subscribers, except for approved 

copayments and deductibles.” 

{¶ 17} “Solely” in R.C. 1751.60(A) means solely. It does not mean 

“unless you can get paid closer to your top rate through an injured patient’s 

automobile-insurance policy.” Applying the usual meaning to the word “solely” 

does not, as the majority states, render the phrase “and not, under any 

circumstances, from the enrollees or subscribers” superfluous. This is because of 

still another phrase, “except for approved copayments and deductibles.” Read as 

a whole, R.C. 1751.60(A) requires providers that have contracted with a healthinsurance corporation to seek payment from only the health-insurance 

corporation, except for copayments and deductibles, which may be billed to 

enrollees or subscribers. 
January Term, 2011 

7

{¶ 18} When a patient’s other insurance is not dissipated through direct 

billing by health-care providers, the patient can use that other insurance to pay 

copayments, deductibles, or for treatment options excluded from the healthinsurance corporation’s coverage. An automobile-insurance policy that includes 

medical coverage is an asset of the patient—when a provider seeks compensation 

from that policy, it seeks compensation from the patient in violation of R.C. 

1751.60(A). 

_________________ 

Murray & Murray Co., L.P.A., John T. Murray, Leslie O. Murray, and 

Michael J. Stewart; and Mickel & Huffman and John L. Huffman, for appellees. 

Jones Day, Patrick F. McCartan, Marc L. Swartzbaugh, Douglas R. 

Cole, and Alexis J. Zouhary; and Marshall & Melhorn, L.L.C., Marshall A. 

Bennett Jr., and Jennifer J. Dawson, for appellants. 

Anspach Meeks Ellenberger, L.L.P., Garrick O. White, and Richard F. 

Ellenberger; and Barry F. Hudgin, urging reversal for amici curiae Mercy Health 

Partners and Catholic Healthcare Partners. 

Bricker & Eckler, L.L.P., Anne Marie Sferra, and Bridget Purdue 

Riddell, urging reversal for amici curiae Ohio Hospital Association, Ohio State 

Medical Association, Ohio Osteopathic Association, and Ohio Association of 

Health Plans. 

Arthur, O’Neil, Mertz, Michel & Brown Co., L.P.A., Daniel R. Michel, 

and Jennifer N. Brown, urging affirmance for amicus curiae Ohio Association for 

Justice. 

______________________