Searching over 5,500,000 cases.


searching
Buy This Entire Record For $7.95

Download the entire decision to receive the complete text, official citation,
docket number, dissents and concurrences, and footnotes for this case.

Learn more about what you receive with purchase of this case.

UH Rainbow Babies & Children's Hospital v. Caresource

Court of Appeals of Ohio, Eighth District, Cuyahoga

July 19, 2018

UH RAINBOW BABIES & CHILDREN'S HOSPITAL PLAINTIFF-APPELLEE
v.
CARESOURCE [Appeal By United Healthcare Insurance Company] DEFENDANT-APPELLEE

          Civil Appeal from the Cuyahoga County Court of Common Pleas Case No. CV-16-867735

          ATTORNEYS FOR APPELLANT Brent S. Silverman Robert A. West Ciano & Goldwasser, L.L.P. Donald T. Campbell Aalook K. Sharma

          ATTORNEYS FOR APPELLEE FOR UNIVERSITY HOSPITALS RAINBOW BABIES & CHILDREN'S HOSPITAL John F. Garswood Daniel W. DreyfussFOR CARESOURCE Katrina M. English CareSource Matthew C. O'Connell Sutter O'Connell Co.

          BEFORE: Keough, J., E.A. Gallagher, A.J., and Boyle, J.

          JOURNAL ENTRY AND OPINION

          KATHLEEN ANN KEOUGH, J.

         {¶1} Third-party defendant-appellant, UnitedHealthcare Insurance Company ("United") appeals from the trial court's decision denying its motion to stay the proceedings, compel arbitration, and dismiss with prejudice. For the reasons that follow, we affirm.

         {¶2} In February 2014, mother-insured gave birth to multiple children at Rainbow Babies & Children's Hospital, a medical facility operated by University Hospitals ("UH"). At the time of the births, mother had employer-sponsored health insurance provided by United. It is undisputed that United provided medical coverage from the children's birth until at least February 28, 2014. On March 1, 2014, mother enrolled in Caresource, a Medicaid-managed care plan, that continued to provide medical coverage to the children until they were discharged from UH in April 2014.

         {¶3} UH billed both United and Caresource for services rendered to the children. Caresource initially paid the claim for one of the children, but denied the other claim. However, about a month later, Caresource reversed the payment and denied both claims until it could verify coverage through mother's coordination of benefits.

         {¶4} In August 2016, UH filed a breach of contract action against Caresource for failure to pay the medical bills of its insured. UH did not bring an action against United. Caresource filed its answer, denying liability and asserting that United is the sole responsible party for the payment of the medical bills.

         {¶5} In March 2017, without objection, the trial court granted Caresource leave to file a third-party complaint and a counterclaim against UH. Count 1 of the third-party complaint sought indemnification and contribution against United. Count 2 requested declaratory relief against United and UH, requesting that the trial court declare that United is the primary insurer and responsible party to UH, and that Caresource is the secondary insurer and not responsible for the medical bills.[1]

         {¶6} In response, United admitted that a justiciable controversy existed but asserted that Caresource is liable for the payments to UH. Accordingly, United raised as an affirmative defense that the trial court lacked jurisdiction over the declaratory judgment action, claiming that the matter was subject to arbitration because United's Facility Participation Agreement ("FPA") with UH contains an arbitration provision that requires the parties to arbitrate "any and all disputes" covered under the FPA. Subsequently, pursuant to R.C. 2701.01, United moved to stay the proceedings, compel arbitration, and dismiss the case with prejudice. United maintained that because Caresource was seeking the benefit of United paying UH's claims, it was subject to the arbitration agreement between United and UH.

         {¶7} Caresource opposed the motion to compel, contending that the action is not subject to arbitration because (1) Caresource is not a party or signatory to the FPA containing the arbitration provision; (2) there is no dispute between United and UH; rather the dispute is between United and Caresource, and (3) the controlling contract is mother-insured's certificate of coverage ("COC") issued by United. In support, Caresource attached to its brief in opposition mother's health insurance policy, which is titled, "UnitedHealthcare Insurance Company; UnitedHealthcare Choice Plus; Certificate of Coverage, Riders, Amendments, and Notices for [mother's employer]." The lengthy document identifies the eligible individuals under the policy, when coverage begins, and when that coverage ends. Caresource maintained that these provisions determine whether the children were covered by United or Caresource during the disputed time period. Caresource noted that the document does not contain an arbitration clause.

         {¶8} Following a hearing, the trial court denied United's motion to compel, finding:

The court is not persuaded that equity demands defendant Caresource be compelled to arbitrate as a nonsignatory to the agreement. In the case law cited by third party defendant United, it is clear that the nonsignatory parties in those cases benefitted from the contract that contained the arbitration clause. In the case before the court, Caresource has not benefitted in ...

Buy This Entire Record For $7.95

Download the entire decision to receive the complete text, official citation,
docket number, dissents and concurrences, and footnotes for this case.

Learn more about what you receive with purchase of this case.