On August 30, 2011, the Ohio Supreme Court held that healthcare providers may seek payment from an individual’s automobile insurer for healthcare claims where the individual also has health insurance. King v. ProMedica Health Sys., Inc., Slip Opinion No. 2011-Ohio-4200. The plaintiff in the case, Virginia King, had been involved in an automobile accident and was treated at Toledo Hospital, which is part of ProMedica Health System. King informed the hospital that she had health insurance, but the hospital billed King’s automobile insurer for her medical claims.
King sought a class action lawsuit on a variety of claims, with each related to the interpretation of O.R.C. Section 1751.60(A). This section provides, in part, that "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." Originally dismissed by the trial court, the appellate court reversed, holding that providers who have entered into agreements with health insuring corporations may only bill the health insuring corporation for treatment of a member of the health insuring corporation.
The Ohio Supreme Court reversed, finding that ProMedica did not violate O.R.C. Section 1751.60(A) because ProMedica did not seek payment from King, the subscriber, for her healthcare costs, but rather from her automobile insurer. Additionally, the court did not believe the term "solely," as used in the statute, precluded recovery from the automobile insurer. Rather, the court found that the proper construction of the statute is that as among the provider, the member and the health insuring corporation, the provider must seek payment from the health insuring corporation, as opposed to the member, for payments other than co-payment or deductibles. Because the automobile insurer is not part of that contractual triangle, the provider is not precluded by statute from seeking payment from the automobile insurer.