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Lopez v. Morley

October 22, 2004

SERVANDO LOPEZ, PLAINTIFF AND PETITIONER-APPELLEE AND CROSS-APPELLANT,
v.
MAUREEN JANE MORLEY, DEFENDANT
(PROVENA MERCY CENTER, RESPONDENT-APPELLANT AND CROSS-APPELLEE).



Appeal from the Circuit Court of Kane County. No. 02-LK-518. Honorable F. Keith Brown, Judge, Presiding.

The opinion of the court was delivered by: Justice Kapala

PUBLISHED

Respondent-appellant and cross-appellee, Provena Mercy Center (Provena), appeals from the judgment of the circuit court of Kane County granting the motion by plaintiff and petitioner-appellee and cross-appellant, Servando Lopez, to extinguish Provena's lien under the Hospital Lien Act (Act) (770 ILCS 35/1 (West 2002)). Plaintiff cross-appeals from the trial court's denial of his motion for Supreme Court Rule 137 (155 Ill. 2d R. 137) sanctions. We affirm.

I. BACKGROUND

Plaintiff received medical treatment from Provena for injuries suffered on December 23, 2001, during an automobile accident with defendant, Maureen Jane Morley. Provena charged plaintiff $33,753.27 for this treatment. Plaintiff does not dispute that the charges were reasonable and customary. Provena took a hospital lien for the full amount of the charges. 770 ILCS 35/1 (West 2002).

Plaintiff had health insurance coverage that was administered by United Health Care (United). United had a contract with Provena, in which Provena agreed to accept less than the reasonable and customary value of services rendered to certain insured persons, including plaintiff. Under the terms of their contract, the amount paid by United would be considered full payment for the services rendered to the insured, and Provena would not seek recovery for any additional amounts from the insured. United paid Provena $4,900 as full payment for the services rendered to plaintiff.

Plaintiff subsequently filed suit against defendant for his injuries. The parties settled the matter for $120,000. During the settlement negotiations plaintiff represented that his medical bills from Provena amounted to $33,753.27. Also, during the pendency of the suit, plaintiff contacted Provena about the balance of his bill.

Provena informed plaintiff's attorney on at least two occasions that plaintiff had a zero balance with Provena. Plaintiff then filed a petition to adjudicate Provena's hospital lien. Plaintiff's position was that Provena did not have a lien because it had accepted $4,900 as full payment from United and, therefore, Provena was not owed any further money. Plaintiff cited our decision in N.C. v. A.W., 305 Ill. App. 3d 773 (1999), that he claimed was conclusive. Provena responded that although it could not recover any further amounts from plaintiff directly, it still held a valid lien for the difference between what was charged and what was paid by United. Provena admitted that the authority cited by plaintiff supported plaintiff's contentions but Provena also argued that we should overrule our previous ruling and allow Provena to recover on the lien. Plaintiff also moved for Rule 137 sanctions against Provena for contending that it had a right to recover on the lien despite controlling precedent. The trial court extinguished Provena's lien and denied plaintiff's motion for sanctions.

Provena filed a timely appeal and plaintiff filed a timely cross-appeal. On appeal, the Illinois

Trial Lawyers Association (ITLA) filed a motion for leave to file an amicus curiae brief in support of plaintiff, which we granted.

II. DISCUSSION

Provena contends that our holding in N.C. violates public policy and the language of section 1 of the Act (770 ILCS 35/1 (West 2002)) and, therefore, should be overturned. Provena contends that we should follow the reasoning enunciated by the Fourth District in Rogalla v. Christie Clinic, P.C., 341 Ill. App. 3d 410 (2003). Plaintiff and the ITLA in its amicus curiae brief argue that our decision in N.C. was sound and should be upheld.

In N.C. the plaintiff was injured as result of an automobile accident with the defendant. The plaintiff was treated at Northern Illinois Medical Center (NIMC). NIMC's bill totaled $22,551. The plaintiff was insured by Great West Life & Annuity Insurance Co. (Great West) through a preferred provider organization (PPO) plan. This PPO plan was affiliated with One Health Plan of Illinois, Inc. (One Health).

One Health had contracted with NIMC to provide bulk business to NIMC in return for NIMC receiving a reduced rate as full payment for its services. This contractual savings was passed on to Great West through its contract with One Health. One Health's contract with NIMC also provided that, except for deductibles, coinsurance, copayments, and charges for non-approved and non-covered services, a One Health member was not liable for any amount over what was paid by the insurer. As a result, Great West paid NIMC only $4,200 as full ...


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