APPEAL FROM THE CIRCUIT COURT COOK COUNTY.
The opinion of the court was delivered by: Justice Cousins
Nos. 93 CH 5193 93 CH 5194 93 CH 5195 Cons.
THE HONORABLE AARON JAFFE, JUDGE PRESIDING.
delivered the opinion of the court:
This is an appeal and cross-appeal from consolidated declaratory judgment actions filed by the plaintiff-appellant, Christ Hospital & Medical Center (Christ Hospital), against defendant-appellee, the Illinois Comprehensive Health Insurance Plan (ICHIP). ICHIP contended that Christ Hospital should have refunded $431,899.56 that ICHIP had paid for services rendered to a patient, Brian Noti, whom ICHIP considered no longer eligible for ICHIP coverage under the Illinois Comprehensive Health Insurance Plan Act (215 ILCS 105/1 et seq. (West 1996) (formerly Ill. Rev. Stat. 1989, ch. 73, par. 1301 et seq.)) (the Act). ICHIP argued that Brian Noti was no longer eligible for ICHIP coverage because section 7(e)(2) of the Act (Ill. Rev. Stat. ch. 1989, ch. 73, par. 1307(e)(2) et seq., provided that a person was ineligible for ICHIP coverage if that person was a recipient of medical assistance. ICHIP contended that Brian Noti was a recipient of medical assistance from the Illinois Department of Public Aid (the Department). When Christ Hospital denied that any refund was due, ICHIP deducted the disputed amount from amounts due the hospital for services rendered to other patients who were covered by ICHIP. Christ Hospital then attempted to recover $239,743.34 of the amount set off by ICHIP.
Christ Hospital now appeals from a February 21, 1997, order in which the trial court granted ICHIP's motion for summary judgment and, inter alia, ordered ICHIP to pay Christ Hospital $239,753.34, the amount owed for services rendered to other patients but also ordered Christ Hospital to pay ICHIP $167,269.54, the amount to be refunded to ICHIP for services rendered to Brian Noti. ICHIP cross-appeals from a December 2, 1994, order in which the trial court granted Christ Hospital's motion for summary judgment and held that "receipt of medical assistance" as used in section 7(e)(2) of the Act (Ill. Rev. Stat. 1989, ch. 73, par. 1307(e)(2) means payment of medical assistance benefits.
Jerome Noti's son, Brian, suffered from severe medical problems. Jerome insured Brian as a dependent under a group health insurance plan issued by Central Life Insurance Company (Central Life) to his employer. The Central Life policy contained a lifetime maximum benefit for any one insured individual of $1 million. Brian was born on June 7, 1988, and developed congestive heart failure shortly after birth. He was hospitalized at Christ Hospital for most of his life. He reached the lifetime maximum benefit under the Central Life policy on or about October 1, 1989.
In anticipation of Brian reaching his lifetime maximum benefit under the Central Life policy, Jerome applied for insurance coverage for Brian from ICHIP on June 1, 1989. ICHIP issued a policy on June 28, 1989, that provided Brian with health insurance with a lifetime maximum benefit of $500,000.
Christ Hospital provided medical services to Brian from October 1, 1989, to May 28, 1990. Christ Hospital billed the Notis $563,671.34 for these services. ICHIP paid Christ Hospital $441,889.56 for services rendered from October 1, 1989, to February 11, 1990. Central Life paid $111,261.78 of the bill.
On January 23, 1990, Jerome applied to the Department for medical assistance for Brian. The Department application queried whether the applicant had received any medical services during the three months prior to the date of the application. Jerome checked "yes" and listed the months of October, November and December 1989. The Department application queried whether the applicant wanted the Department to evaluate eligibility for these bills. Jerome checked "yes" and again listed the months of October, November and December 1989. The Department approved Brian for medical assistance on March 8, 1990, but made his approval retroactive to October 1, 1989.
Thereafter, ICHIP determined that, under the eligibility provision of the Act, section 7(e)(2) (Ill. Rev. Stat. 1989, ch. 73, par. 1307(e)(2)), Brian's eligibility for medical assistance from the Department disqualified him from ICHIP coverage. Section 7(e)(2) provides that a person shall not be eligible for coverage under ICHIP if he or she is a recipient of medical assistance. ICHIP further contended that Brian's policy terminated on October 1, 1989, the date upon which Brian was eligible for medical assistance with the Department. ICHIP sought a refund from Christ Hospital for the $441,899.56 that it had paid the hospital for services rendered to Brian after October 1, 1989, and instructed Christ Hospital to bill the Department for any services provided to Brian after October 1, 1989. Christ Hospital billed the Department for services rendered to Brian from March 1, 1990, to May 28, 1990, and the Department made payments to the hospital for those services. When Christ Hospital did not bill the Department for the services rendered to Brian from October 1989 to March 1990, ICHIP refused to pay Christ Hospital for services rendered to three other ICHIP insureds, Steven McCawley, Gene McPherson and Roger Safranek.
On June 8, 1993, Christ Hospital filed three actions for declaratory and other relief against ICHIP. The hospital sought to recover the sums owed by ICHIP for services provided to Steven McCawley, Gene McPherson and Roger Safranek and alleged that ICHIP withheld these sums in order to offset what ICHIP claimed was an overpayment for services rendered to Brian Noti. The trial court granted a motion by Christ Hospital to consolidate the actions. The circuit court also granted a motion by Christ Hospital to non-suit the complaint seeking recovery from ICHIP for services provided to Roger Safranek.
On August 23, 1994, Christ Hospital filed a motion for summary judgment on a major issue and argued that Brian Noti's eligibility for medical assistance did not disqualify him from ICHIP coverage under section 7(e)(2) of the Act in effect at the time in 1989, because the Act predicated eligibility upon actual receipt of medical assistance benefits. In response, ICHIP argued that Brian's eligibility for ICHIP coverage ended when he became eligible for medical assistance on October 1, 1989. On December 2, 1994, the trial court ...