Gianetti v. Siglinger
Gianetti v. Siglinger
Opinion of the Court
Opinion
This appeal
The record reveals the following relevant facts and procedural history. On December 30, 1995, Allison Sig-linger was involved in an automobile accident. As a result of this accident, the plaintiff, a plastic surgeon, provided services to Allison twice: at the emergency room of Bridgeport Hospital on the day of the accident; and during an office visit on January 9, 1996.
At the time that treatment was rendered, both the Siglingers and the plaintiff had a relationship with Physicians Health Services of Connecticut, Inc. (Physicians Health), a health maintenance organization.
The plaintiffs relationship with Physicians Health is more complicated. From 1977 through 1998, the plaintiff was a provider of Physicians Health services as a member of the Greater Bridgeport Individual Practice Association, Inc. (practice association), or its predecessors.
The parameters of this arrangement were a matter of some contention between the plaintiff and the practice association up to and during the time that the plaintiff provided services to Allison Siglinger. Specifically, on more than one occasion, the plaintiff had billed Physicians Health subscribers directly for certain services that he had provided to them. The plaintiff subsequently sought payment through litigation. See, e.g., Gianetti v. Fischetti, Superior Court, judicial district of Fairfield at Bridgeport, Docket No. CV-98-0352010S (February 3, 2000), aff'd, 64 Conn. App. 902, 777 A.2d 213 (2001); Gianetti v. Mulroney, Superior Court, judicial district of Fairfield at Bridgeport, Docket No. CV-91-0290495S (July 10, 1995). In a September 6, 1991 letter, the practice association informed the plaintiff that the board of directors had determined that the plaintiff had a pattern of not fulfilling his contractual obligations to the prac
It is undisputed that the plaintiff did not inform the Siglingers at the time of treatment that he might claim compensation directly from them for his services, nor did he inform them of his disagreements with Physicians Health and other subscribers regarding compensation beyond that paid by Physicians Health. Indeed, the plaintiff submitted a request for payment to Physicians Health for the services that he performed for Allison Siglinger and received $1888.80 in July, 1996. The plaintiff requested a reconsideration of the amount paid to him, and by December, 1996, Physicians Health had adjusted his compensation for the care of Allison to $1980.80. The plaintiff has since filed an action against Physicians Health in small claims court, alleging “[ijncorrect payment of medical services rendered” and seeking an additional $481.60 in compensation.
During this time frame, Glenn Siglinger, on behalf of Allison Siglinger, brought a personal injury action arising out of the automobile accident and Young acted as his attorney. In an effort to obtain records from the plaintiff pertaining to the treatment of Allison, Young sent the plaintiff a document entitled “authorization for record request and irrevocable lien.”
The plaintiff then filed the present action, seeking recovery from the Siglingers under the theories of breach of contract, quantum meruit and unjust enrichment, and from Young under an unjust enrichment theory. The Siglingers filed an answer denying the allegations and alleging the following six special defenses: breach of contract; waiver; satisfaction; negligent provision of services; duress; and violation of General Statutes § 20-7L
During a three day hearing, the trial court accepted evidence and heard testimony from the plaintiff, Young, Glenn Siglinger, and Michael Lee. Lee was a founding member of Physicians Health and, at various times, served as the chairman and vice chairman of the practice association. He testified regarding the operation of Physicians Health and the practice association, as well as the relationship of those organizations with the plaintiff.
The trial court rendered judgment in favor of the defendants on the complaint. The trial court also rendered judgment for the defendants on their counterclaims for CUTPA violations. In so holding, the trial court determined that the 1992 agreement between the
On appeal, the plaintiff raises fourteen issues.
The judgment is affirmed.
The plaintiff appealed from the judgment of the trial court to the Appellate Court, and we transferred the appeal to this court pursuant to General Statutes § 51-199 (c) and Practice Book § 65-1.
General Statutes § 42-110b provides in relevant part: “(a) No person shall engage in unfair methods of competition and unfair or deceptive acts or practices in the conduct of any trade or commerce. . . .
“(d) It is the intention of the legislature that this chapter be remedial and be so construed.”
“Beginning in the late 1960’s, insurers and others developed new models for health-care delivery, including [health maintenance organizations]. . . . The defining feature of [a health maintenance organization] is receipt of a fixed fee for each patient enrolled under the terms of a contract to provide specified health care if needed. The [health maintenance organization] thus assumes the financial risk of providing the benefits promised: if a participant never gets sick, the [health maintenance organization] keeps the money regardless, and if a participant becomes expensively ill, the [health maintenance organization] is responsible for the treatment agreed upon even if its cost exceeds the participant’s premiums.” (Citation omitted.) Pegram v. Herdrich, 530 U.S. 211, 218-19, 120 S. Ct. 2143, 147 L. Ed. 2d 164 (2000).
The practice association was an organization that credentialed and selected physicians to provide services to Physicians Health subscribers. Its members were the exclusive providers of such covered services to Physicians Health subscribers in the greater Bridgeport area.
In 1977, the plaintiff signed a participating physician agreement that provided he would bill the health plan his usual charges for services rendered to subscribers and the amount of compensation to be paid by the health plan would be determined by the association’s board of trustees. This agreement further provided that “at no time shall [the plaintiff] seek compensation from [subscribers] for such services except for the nominal co-payments . . . .” The agreement was for a one year term with automatic renewal absent termination by either party with a ninety day notice.
In 1988, the practice association revised the arrangement to comply with federal laws and regulations. The new compensation clause provided that the “ ‘[p]hysician shall look only to [the practice association] for compensation for [c]overed [s]ervices and in no event, including, but not limited to non-payment by the [practice association, Physicians Health or practice association] insolvency, or breach of this [ajgreement, shall [p]hysician bill, charge, collect a deposit from, seek compensation, remuneration or reimbursement from, or have any recourse against [subscribers], other than [Physicians Health] acting on their behalf for services provided pursuant to [the agreement between the practice association and the physician].’ ”
The arrangement also was revised in 1992 when the plaintiff signed a physician agreement providing, inter alia, more detailed compensation provisions for payment by Physicians Health. The agreement again was effective for a period of one year and continued in effect unless terminated by either party on ninety days notice. The plaintiff never filed a notice of termination.
This document, dated January 9, 1996, and signed by Glenn Siglinger as the father and guardian of Allison Siglinger, provided in relevant part: ‘'Permission is hereby granted to my attorneys ... to obtain copies of my records, bills, and all information pertaining to the same.” It further provided
General Statutes § 20-7f (b) provides: “It shall be an unfair trade practice in violation of [CUTPA] for any health care provider to request payment from an enrollee, other than a copayment or deductible, for medical services covered under a managed care plan.”
General Statutes § 38a-193 (c) provides: “(1) Every contract between a health care center and a participating provider of health care services shall be in writing and shall set forth that in the event the health care center fails to pay for health care services as set forth in the contract, the subscriber or enrollee shall not be liable to the provider for any sums owed by the health care center. (2) In the event that the participating provider contract has not been reduced to writing as required by this subsection or that the contract fails to contain the required prohibition, the participating provider shall not collect or attempt to collect from the subscriber or enrollee sums owed by the health care center. (3) No participating provider, or agent, trustee or assignee thereof, may: (A) Maintain any action at law against a subscriber or enrollee to collect sums owed by the health care center; or (B) request payment from a subscriber or enrollee for such sums. For purposes of this subdivision ‘request payment’ includes, but is not limited to, submitting a bill for services not actually owed or submitting for such services an invoice or other communication detailing the cost of the services that is not clearly marked with the phrase ‘THIS IS NOT A BILL’.”
Specifically, the plaintiff contends that the trial court improperly: (1) overruled his objection to the introduction of his agreement with the practice association because there was no privity of contract between the defendants and the practice association; (2) concluded that the defendants had not waived any rights under the contract between the plaintiff and the practice association by providing the plaintiff with the document entitled “authorization for record request and irrevocable lien”; (3) relied on two trial court decisions, Gianetti v. Fischetti, supra, Superior Court, Docket No. CV-980352010S, and Gianetti v. Mulroney, supra, Superior Court, Docket No. CV-91-0290495S; (4) concluded that the plaintiff had violated CUTPA “both in instituting the present action and continuing to maintain the present action”; (5) concluded that § 20-7f (b) was applicable although it was “not in effect” at the time the plaintiffs claims arose; (6) concluded that Young’s CUTPA counterclaim was not precluded by the statute of limitations; (7) failed to consider other trial court decisions in which the plaintiff had been awarded money from other Physicians Health subscribers; (8) failed to consider a trial court decision “involving [Physicians Health] patients where [the plaintiff] was not a party and the court ruled that [the plaintiff] should receive payment in addition to the [Physicians Health] payment”; (9) ordered its memorandum of decision to be distributed to all defendants and “place[d] a copy in the file of all pending cases where [the plaintiff also is acting as] a pro se plaintiff, irrespective of whether those cases involved issues similar to this matter”; (10) awarded attorney’s fees to the defendants; (11) awarded punitive damages to the defendants; (12) failed to find that the defendants’ submission to an insurance company of the plaintiffs statement, which they
Reference
- Full Case Name
- CHARLES D. GIANETTI v. GLENN SIGLINGER
- Cited By
- 3 cases
- Status
- Published