Not in Westchester County?
September 17, 2019Cart

Business

by Westchester County Business Journal
by WCBJ

Judge: Mom’s insurance card no guarantee of hospital payment

Westchester Medical Center has been left holding a bill for medical services provided to a woman who submitted her mother’s insurance card for payment.

The Valhalla hospital claims that the insurance card amounted to a promise of payment.

But Westchester Supreme Court Justice Terry Jane Ruderman ruled on Jan. 29 that because the bill lacked the mother’s signature, “the claimed promise is unenforceable.”

Fanette Ceus was treated at the hospital in 2015 and presented the Aetna insurance card of her mother, Antoinette Ceus, of Elmsford. The card, according to court records, listed Fanette and three other children as beneficiaries.

Fanette also signed a patient consent form that stated she was covered by the health plan.

Aetna declined to pay for the services, for reasons not explained in the lawsuit. Then the hospital’s parent company, Westchester County Health Care Corp., sued Antoinette for $12,810.

She denied any knowledge of the medical incident and claimed that it wasn’t until she received a copy of a hospital form that she knew her daughter was the patient.

Her daughter was an adult at the time of the medical services, she said in an affidavit.

“I did not accompany her to the hospital, nor did I make a promise to pay for her medical service. She does not reside with my husband and me.”

Her attorney, Jeffrey I. Klein, moved for summary judgment, contending that the mother cannot be held liable for services for her adult daughter for which she did not promise to pay.

That motion, argued the hospital’s attorney, Michael J. Florio, is “inappropriate and distasteful.”

He said the hospital has been left holding the bill for the mother’s “mistaken, false or fraudulent claims.” The mother “goes on to state,” he said, “that she is not responsible for her daughter’s behavior.”

Florio cited federal law that allows a child to stay on the parents’ health insurance plan until age 26.

The mother could sue her daughter or Aetna, he said, “if she believes this will help clear her of responsibility.”

The crux of the hospital’s case, Ruderman said, is that the use of the insurance card was a commitment by the mother “to answer for a debt incurred by those individuals listed on the insurance card.”

But even when a parent requests medical services for a child, she said, the parent is not necessarily liable for the cost of those services. In this case, the mother neither requested the services nor promised to pay.

As to covering children up to age 26 on the parents’ insurance, the federal mandate does not include a requirement to pay for medical expenses that are not covered by the insurance after the child reaches age 21.

A guarantee to answer for the debt of another person, Ruderman stated, must be in writing and signed by the person who is to be charged. The insertion of a name on a bill as guarantor, without a signature, “is unenforceable.”

Ruderman granted the motion for summary judgment and dismissed the hospital’s case.

Westchester Medical Center has won a partial victory against Antoinette. Five months after her daughter’s incident, Antoinette was treated at the hospital.

The hospital tried to bill Aetna but the claim was rejected because Antoinette was no longer covered by the plan. Then the hospital billed Empire Blue Cross/Blue Shield. That claim was rejected because it was submitted more than 180 days after the date of service.

The hospital sued Antoinette for $4,188.

The hospital claimed that she presented the wrong insurance information. She said she presented the correct card and is not responsible for the hospital’s failure to submit the claim in time.

This time, Ruderman denied Ceus’ motion for summary judgment.

Whether Antoinette’s story is credible or the hospital erred, she said in a Nov. 5 decision, is a triable issue.