Gianetti v. Rutkin
The prohibitions in Connecticut General Statutes §20-7f on balance billing, a practice by which healthcare providers seek to recover from the patient the difference between the self-determined value of the provider's services and the amount provided for in the contract between the provider and the patient's health insurer, do not extend to healthcare providers that are "out-of-network." David Rutkin, insured by Physician Health Services, a managed health care plan, was treated at St. Vincent's Medical Center emergency room, an in-network provider. Rutkin was treated by Charles Gianetti, a plastic surgeon, who testified that he did not then inform Rutkin he was not an in-network provider. During follow-up office visits, Rutkin signed a form acknowledging he was "…responsible for the payment of all fees regardless of insurance…" Gianetti billed Rutkin $8945 directly and commenced this action alleging breach of contract and quantum meruit against Rutkin and alleged that Rukin's wife, Elizabeth Rutkin, was jointly liable for the outstanding medical bills under C.G.S. §46b-37(b). The court rendered judgment for the plaintiff on all counts awarding $320 on the breach of contract count regarding the office visits and $8625 for the emergency room treatment under the doctrine of quantum meruit. The defendants appealed claiming, first, that the application of quantum meruit was inequitable because Rutkin assumed the health care providers at the hospital would be contractually related with his insurer. The Appellate Court affirmed the judgment. The trial court reasonably concluded that a reasonable person in Rutkin's circumstances ought to have known that medical services ordinarily are not provided gratuitously and that he would be expected to pay for the services, either personally or through his insurance, depending on the network status of the treating providers. The trial court also did not err by holding that C.G.S. §20-7f (b) prohibits balance billing patients only for services rendered by in-network providers. Gianetti's direct billing of Rutkin was permissible under C.G.S. §20-7f (b). The statute's prohibitions apply only to health care providers in contractual relationships with the patient's insurance carrier. Further, C.G.S. §20-7f (b) prohibits balance billing for medical services "covered under a managed care plan." Here, neither party submitted the bill for payment by Rutkins' insurer. Without showing that part of the services were covered by insurance, the defendants' could not seek the protection of C.G.S. §20-7f(b).