Commercial Law World - Issue 4, 2017 - 23

TIMOTHY WAN

for summary judgment, holding that "The fact that
Gentissi may be entitled to obtain reimbursement from
another source does not relieve him to pay for the
services rendered to him in the first instance." In North
Shore University Hospital at Manhasset v. Bernstein, Index
Number 15067-10 decision of the Honorable Andrea
Phoenix, dated January 5, 2011, the Court granted
Plaintiff's motion for summary judgment, holding
that where the "patients do not deny that service was
provided, the belief that there is insurance coverage
does not relieve the patient from liability." In North
Shore University Hospital at Manhasset v. Juan, Index
Number 25022-05, decision of the Honorable Randy Sue
Marber, dated June 16, 2006, the Court held that "The
issue of third party coverage is distinct from patient's
obligation to pay the Plaintiff. If the Plaintiff and patient
are the only parties to a contract, patient is not absolved
of liability by seeking indemnification from a third
party... Therefore, whether patient would be indemnified
through his motor vehicle or other insurance company
has no relevance to Plaintiff's claim against patient."
In the District Court of Suffolk County, the case
trend is similar. In North Shore University Hospital at
Manhasset v. Morris, Index Number SMC 10261-05,
decision of the Honorable G. Ann Spelman, dated May
5, 2006, the Court held that "Assuming, arguendo, that
the patient did have medical insurance in effect on the
date in question, such coverage would not constitute a
valid defense to the action at bar, since the fact that the
services may have been covered by insurance does not
relieve the patient of his responsibility for the payment
of same." In Southside Hospital v. Smith, Index Number
SMC 11872-05, decision of the Honorable G. Ann
Spelman, dated July 11, 2006, the Court held that "the
possibility that the patient's treatment may be covered
by insurance does not relate to the merits of the main
action, and is legally insufficient as a defense..."
This is also true in the Civil Court of Queens County.
In Long Island Jewish Medical Center v. Samuels, Index
Number 50801-03, decision of the Honorable Kevin J.
Kerrigan, dated November 10, 2004, this Court held that
patient "has failed to articulate a meritorious defense;
he merely states that his wife had full medical coverage
at the time of the hospital service." In Long Island
Jewish Medical Center v. Kaur, Index Number 128513-10,
decision of the Honorable Leslie J. Purificacion, dated
October 5, 2012, this Court granted summary judgment
where "patient's only defense that the sum due plaintiff
was covered by insurance is insufficient to raise a triable
issue of fact. Patient submits no evidence to demonstrate
that insurance paid plaintiff for the services rendered."

Additionally, on March 31, 2004, the Supreme Court
of Queens County, by the Honorable Orin R. Kitzes,
in Long Island Jewish Medical Center v. Weisenberg,
Index Number 3488-03, granted Summary Judgment
for the Plaintiff, holding that "Motion by Plaintiff for
summary judgment is granted . Cross motion by patient
for summary judgment and attorney's fees is denied.
Plaintiff rendered medical care and treatment to patient
and payment has not been made. Patient does not deny
the claim by plaintiff but asserts that his insurance
carrier... is responsible for payment." Moreover, on
January 13, 2005, the Supreme Court of Queens County,
by the Honorable Arnold N. Price, in Long Island Jewish
Medical Center v. Keeney, Index Number 7025-04, denied
an application by Patient to vacate a default judgment,
holding that "patients' conclusory averment that they
believed that their insurance company was paying the
hospital bill does not obviate their obligation of payment
for services rendered."
Fundamentally, insurance coverage is not a defense
because there is no contractual privity between Medical
provider and Patient's insurance carrier. The sole
contract that exists is between the Patient, and their own
insurance carrier.

Medical provider is neither a
party to that contract, nor has
contractual privity with either
party, under said contract.
Medical provider is merely a
third-party beneficiary.
Parenthetically, it should be noted that this does not
affect any plenary action brought by a patient against a
third-party, for indemnification, in any way.

"The Amount Is Too High!"
Another myth is an attack that an "amount is
too high". Or, more articulately asserted, "the billed
amount is unreasonable." Presuming that the medical
provider has an affidavit from their patient accounts
department, asserting that the charges are reasonable,
the balance shifts to the patient, who would need to
provide some sort of expert opinion or expert witness
to refute that. Absent the expert to contradict, the
allegation that attempts to dispute the charge itself,
is wholly without merit.
CLLA.ORG

23


http://www.CLLA.ORG

Table of Contents for the Digital Edition of Commercial Law World - Issue 4, 2017

Contents
Commercial Law World - Issue 4, 2017 - Cover1
Commercial Law World - Issue 4, 2017 - Cover2
Commercial Law World - Issue 4, 2017 - Contents
Commercial Law World - Issue 4, 2017 - 2
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Commercial Law World - Issue 4, 2017 - 4
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Commercial Law World - Issue 4, 2017 - 28
Commercial Law World - Issue 4, 2017 - Cover3
Commercial Law World - Issue 4, 2017 - Cover4
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