On June 7, 2022 the New Jersey Appellate Division affirmed the lower court’s ruling in Bergen Anesthesia Group v. Arshynova, dismissing Bergen Anesthesia Group’s (the “Plaintiff”) collection claim for out-of-network anesthesia services provided in connection with Ms. Arshynova’s (the “Defendant”) caesarean section birth.
Prior to her scheduled hospital admission, Defendant was assured by the hospital’s staff that all costs of her treatment would be covered by her insurance policy with no additional charges. Despite those assurances, approximately 10 hours after she was admitted to the hospital, she was informed she needed a caesarean section and thus the out-of-network Plaintiff, having an arrangement with the hospital to provide anesthesia services in such an event, would serve as her anesthesiologist. At no time did Defendant sign any documents or otherwise enter into any agreements agreeing to be financially responsible for the additional charges whether or not paid by insurance.
Despite this, Plaintiff issued a bill for $1,485.43 to Defendant for the balance remaining after her insurance paid the claim as an out-of-network service. Defendant refused to pay and the Plaintiff subsequently filed a claim to collect on the bill. Defendant responded with a counterclaim for malpractice, which was subsequently dismissed.
In its oral decision, the court found for Defendant, finding her testimony that the hospital agreed “to accept [her] insurance and that everything would be covered... including the anesthesia services” to be credible and thus finding that “[t]here was no agreement that [she] entered into that’s been proved to show that she was to pay over and above that which [her insurance company] determined to be the proper charges...” Furthermore, the court took note of the fact that the Plaintiff accepted the insurance company’s payment and “there was no agreement that [the Plaintiff] [w]ould balance... bill [the Defendant] for these services.”
On appeal, Plaintiff additionally took another position outside of the breach of contract claim, and put forth an argument based on theories of unjust enrichment and quantum meruit, but the court declined to overturn the trial court’s determination. As a result of these determinations, the Appellate Division ultimately affirmed the trial court’s ruling that Plaintiff failed to prove it had a valid contract with the Defendant and dismissed the Plaintiff’s claim accordingly.
This decision takes on a different tact in deciding controversies surrounding out-of-network billing and highlights the importance of providers having a clear agreement with patients to receive and assume financial responsibility for out-of-network charges, and, more importantly, to comply with the No Surprises Act and New Jersey’s Out-of-Network Consumer Protection, Transparency, Cost-Containment, and Accountability Act so that they are properly compensated.