Full Opinion

FOR IMMEDIATE NEWS RELEASE NEWS RELEASE #051 FROM: CLERK OF SUPREME COURT OF LOUISIANA The Opinions handed down on the 30th day of October, 2026 are as follows: PER CURIAM: 2026-CC-00274 DENNIS GIBSON, INDIVIDUALLY & ON BEHALF OF ALL OTHERS SIMILARLY SITUATED VS. NATIONAL HEALTHCARE OF LEESVILLE, INC. D/B/A BYRD REGIONAL HOSPITAL (Parish of Vernon) REVERSED. SEE PER CURIAM. Hughes, J., dissents and assigns reasons. SUPREME COURT OF LOUISIANA No. 2026-CC-00274 DENNIS GIBSON, INDIVIDUALLY & ON BEHALF OF ALL OTHERS SIMILARLY SITUATED VS. NATIONAL HEALTHCARE OF LEESVILLE, INC. D/B/A BYRD REGIONAL HOSPITAL On Supervisory Writ to the 30th Judicial District Court, Parish of Vernon PER CURIAM We are presented with the issue of whether the district court erred in denying summary judgment on the question of whether a hospital is contractually obligated to seek payment for medical bills from plaintiff’s health insurer before filing a lien against plaintiff. For the reasons that follow, we conclude the district court erred in denying summary judgment. UNDERLYING FACTS AND PROCEDURAL HISTORY The procedural facts of this lawsuit, which has been pending for over a decade, are complex. For purposes of the issue currently before us, the following facts are relevant: In 2016, plaintiff, Dennis Gibson, filed a putative class action filed suit against National Healthcare of Leesville, Inc. d/b/a Byrd Regional Hospital (“Byrd”). Plaintiff alleged that after he received emergency medical treatment, Byrd improperly obtained a lien against him for the undiscounted bill rate without first seeking to collect from his health insurer. Plaintiff alleged several causes of action, including claims under the Balance Billing Act, La. R.S. 22:1874, et seq. and breach of contract claims. Byrd filed a motion for summary judgment as to plaintiff’s contractual claims, which relied on an assignment executed by plaintiff at the time of treatment. Citing the language of the assignment, Byrd argued it did not have a contractual obligation to file a claim with plaintiff’s insurer before filing its lien against plaintiff. The district court denied Byrd’s motion. Byrd sought review of the denial of summary judgment, along with other rulings.1 The court of appeal affirmed the denial of summary judgment. Gibson v. Nat’l Healthcare of Leesville, Inc., 2021- 0369 (La. App. 3 Cir. 3/15/23), 371 So.3d 53, writ denied, 2023-0778 (La. 10/31/23), 372 So.3d 336 (“Gibson I”). On remand, plaintiff’s Balance Billing Act claims were dismissed, leaving only the contractual claims pending.2 Byrd then re-urged its motion for summary judgment as to the contractual claims. The district court denied Byrd’s motion for summary judgment. Byrd sought supervisory relief, which the court of appeal denied. Upon Byrd’s application to this court, we granted certiorari to review the matter in more detail.3 DISCUSSION As discussed earlier, plaintiff’s suit against Byrd primarily alleged violations of the Balance Billing Act (“Act”), La. R.S. 22:1871, et seq., which prohibits a contracted healthcare provider from collecting or attempting to collect amounts from an insured patient in excess of the contracted reimbursement rate.4 Although 1 The writ application was consolidated with an appeal involving a class certification ruling on the Balance Billing Act claims. 2 Following this court’s opinion in DePhillips v. Hosp. Serv. Dist. No. 1 of Tangipahoa Parish, 2019-01496 (La. 7/9/20), 340 So.3d 817, which held Balance Billing Act claims are subject to a one-year prescriptive period, Byrd filed an exception of prescription. The district court dismissed these claims as prescribed. 3 We initially ordered written briefing pursuant to the provisions of La. Code Civ. P. art. 966(H). After reviewing the briefs, we elected to bring up the full record and schedule the matter for oral argument. 4 We note that noncovered services are never subject to the Act. La. R.S. 22:1872(23) defines “noncovered health care services” as “services, items, supplies, or drugs for the diagnosis, prevention, treatment, cure, or relief of a health condition, illness, injury, or disease that are neither covered under the terms of health insurance coverage nor required by law to be covered, or care (continued…) 2 plaintiff’s statutory claims under the Act have now been dismissed as prescribed, plaintiff argues Byrd assumed a contractual duty to submit bills to his health insurer prior to attempting to collect these bills from plaintiff directly. In DePhillips v. Hosp. Serv. Dist. No. 1 of Tangipahoa Parish, 2019-01496 (La. 7/9/20), 340 So.3d 817, 822, we held that claims under the Act were tort claims subject to a one-year prescriptive period. Although the plaintiffs in DePhillips also advanced implied and quasi-contract theories of recovery, we rejected those arguments because the plaintiff could not produce evidence of a specific contract. Id. at 825. However, DePhillips implied that such a contractual claim might exist if a party could “prove either the agreement to any provision not to balance bill or any breach” of the agreement by the health care provider. Id. The assignment executed by plaintiff in the instant case provides: I [patient] hereby assign and authorize payment directly to the Facility, and to any facility-based physician, all insurance benefits, sick benefits, injury benefits due because of liability of a third party, or proceeds of all claims resulting from the liability of a third party, payable by any party, organization, et cetera, to or for the patient unless the account for this Facility, outpatient visit or series of outpatient visits is paid in full upon discharge or upon completion of the outpatient series. If eligible for Medicare, I request Medicare services and benefits. I further agree that this assignment will not be withdrawn or voided at any time until the account is paid in full. I understand that I am responsible for any charges not covered by my insurance company. I understand that I am obligated to pay the account of the Facility in accordance with the regular rates and terms of the Facility…. In its original motion for summary judgment, Byrd asserted that plaintiff could not cite any language in the assignment which placed an obligation on Byrd to not balance bill plaintiff. In affirming the district court’s denial of summary services or products excluded from the provisions of this Subpart pursuant to an advance written agreement by the enrollee or insured concerning specific payment terms when authorized by an agreement with the provider.” 3 judgment, the court of appeal in Gibson I rejected Byrd’s argument, explaining, “we cannot conclude on summary judgment that Byrd is under no contractual obligation to file a claim with Mr. Gibson’s medical insurer before, or instead of, filing a medical lien against the patient.” Id. at 61. The court speculated that Byrd’s argument could lead to unjust treatment of patients, reasoning “[t]he consequence of saying a hospital’s contract obligates the patient to pay the bill but does not obligate the hospital to first bill the patient’s insurer could lead to unjust priority treatment of patients whose services stem from accidental injuries for whom someone other than the patient is responsible.” Id. According to the Gibson I court, the Act does not intend for hospitals to obtain payment at a non-discounted rate by filing a medical lien instead of billing the patient’s health insurer at the discounted rate. Id. One judge dissented from the majority’s holding in Gibson I. The dissenting judge found nothing in the assignment requires Byrd to recoup plaintiff’s medical expenses from his health insurer before filing a medical lien: Mr. Gibson argues the Assignment’s requirement that he pay “any charges not paid by my insurance company” implies Byrd is entitled only to collect those payments made pursuant to its agreements with BCBSLA. I do not agree. This argument relies upon Byrd’s contracts with BCBSLA to create a contractual obligation in favor of Mr. Gibson. Those contracts limit what Byrd can collect from a BCBSLA insured only if it files a claim for payment of the insured’s medical expenses. Byrd did not do so here. Mr. Gibson further argues the Assignment and Byrd’s contractual agreements with BCBSLA imply Byrd limited its right to collect his medical expenses from BCBSLA alone. Section 1 of the Assignment identifies different sources for Byrd’s collection of medical expenses: “all insurance benefits, sick benefits, injury benefits due because of liability of a third-party, or proceeds of all claims resulting from the liability of a third party” and directly from the patient. This provision does not mandate the circumstances under which any of these methods of collection must be used. For these reasons, I do not find a genuine issue of material fact exists as to whether Byrd is limited to accepting Mr. Gibson’s health insurance in payment for his medical expenses. 4 Lastly, Mr. Gibson’s argues the Assignment’s provision that the patient will pay his account “in accordance with the regular rates and terms of the Facility” is ambiguous when considered in conjunction with Byrd’s contracts with BCBSLA. Again, the Assignment does not require Byrd to recoup Mr. Gibson’s medical expenses from BCBSLA, and it did not do so. Therefore, I conclude no genuine issue of material fact exists as to whether this phrase is ambiguous. [emphasis added] About a year after Gibson I was rendered, a different circuit addressed a similar issue in Bowden v. Ruston La. Hosp. Co., LLC, 55,525 (La. App. 2 Cir. 5/8/24), 388 So.3d 480. In Bowden, the plaintiff filed a class action suit against Northern Louisiana Medical Center, alleging the hospital unlawfully billed plaintiff directly for medical bills arising out of a vehicle accident instead of first proceeding against his health insurer. Id. at 482. The hospital filed a motion for summary judgment, arguing that the plaintiff failed to produce evidence in support of his breach of contract claim. Id. The plaintiff opposed the motion. In support, the plaintiff relied on the same uniform assignment language at issue in this case, providing “I understand that I am responsible for any charges not covered by my insurance company” and “I understand that I am obligated to pay the account of the Facility in accordance with the regular rates and terms of the Facility.” Id. at 485. The Bowden court expressly declined to follow Gibson I, reasoning that the contractual language does not state that the hospital has any obligation to seek payment from the plaintiff’s health insurance. Id. The conflict in the circuits between Gibson I and Bowden prompted us to examine this issue in more detail in order to clarify the law. While DePhillips left the door open to the possibility of a contractual balance billing obligation separate and apart from statutory claims under the Act, our opinion made it very clear that such an obligation cannot be implied but must arise from a specific and express provision of the contract. We rejected any attempt to create a general good faith 5 contractual obligation on the part of health care providers to not balance bill, explaining that “[t]o do so would convert many, if not all, delictual actions into contract claims where the tortfeasor and victim have an underlying contractual relationship—a position that would defeat a court’s obligation to look to the source of the duty itself.” DePhillips, 340 So.3d at 825. The arguments advanced by plaintiff in the current matter as well as the finding of the court of appeal in Gibson I are contrary to the views we expressed in DePhillips. A plain reading of the assignment provides that plaintiff agreed he was “responsible for any charges not covered by my insurance company” and was obligated to pay the account of the Facility in accordance with “the regular rates and terms of the Facility….” This language clearly establishes plaintiff’s obligations as the patient to pay for the medical treatment he received at Byrd. It does not impose any obligation to seek payment from plaintiff’s health insurance. When the words of an insurance contract are clear and explicit and lead to no absurd consequences, no further interpretation may be made in search of the parties’ intent and courts must enforce the contract as written. See LSA–C.C. art. 2046; Sims v. Mulhearn Funeral Home, Inc., 2007-0054 (La. 5/22/07), 956 So.2d 583, 589. We further reject plaintiff’s attempt to rely on extrinsic evidence to establish an ambiguity in the agreement. Plaintiff asserts that Byrd’s corporate representative admitted in deposition that the assignment provided insured patients with a reasonable expectation that Byrd would submit claims for payment to their respective health insurers, which would then pay the medical bills under the contractual discounted rates. The representative agreed it was reasonable for patients presenting insurance information to the hospital to presume the “regular rates and terms” referenced in the assignment would be controlled by those insurance agreements. 6 The meaning and intent of the parties to a written instrument is ordinarily determined from the instrument’s four corners, and extrinsic evidence is inadmissible either to explain or to contradict the instrument’s terms. Olympia Minerals, LLC v. HS Res., Inc., 2013-2637 (La. 10/15/14), 171 So.3d 878, 887. As we have discussed, the language of the agreement clearly and unambiguously establishes the parties’ intent to place no obligation on Byrd to submit a claim to the patient’s insurer prior to seeking to recover from the patient directly.5 In conclusion, we find Byrd has established it is entitled to judgment as a matter of law dismissing plaintiff’s contractual claims. The district court erred in finding otherwise, and the judgment of the district court must be reversed.6 DECREE For the reasons assigned, the judgment of the district court is reversed, and summary judgment is granted, dismissing with prejudice the remaining claims of plaintiff, Dennis Gibson, individually and on behalf of all others similarly situated, against National Healthcare of Leesville, Inc. d/b/a Byrd Regional Hospital plaintiff’s contractual claims against National Healthcare of Leesville, Inc. d/b/a Byrd Regional Hospital. 5 For similar reasons, we reject plaintiff’s suggestion he may have quasi-contractual claims for payment of a thing not due or detrimental reliance. 6 In addition, we overrule the opinion of the court of appeal in Gibson I insofar as it holds summary judgment under these facts was not appropriate. 7 SUPREME COURT OF LOUISIANA No. 2026-CC-00274 DENNIS GIBSON, INDIVIDUALLY & ON BEHALF OF ALL OTHERS SIMILARLY SITUATED VS. NATIONAL HEALTHCARE OF LEESVILLE, INC. D/B/A BYRD REGIONAL HOSPITAL On Supervisory Writ to the 30th Judicial District Court, Parish of Vernon Hughes, J., dissents. This is not a balance billing case. There is a contract between the patient and the hospital. The contract provides that the patient is “responsible for any charges not covered by my insurance company.” If hospitals find this language inconvenient they should remove it from the assignment form. This court does it for them. I respectfully dissent and would affirm the lower courts.