The Indiana Court of Appeals reversed summary judgment for a doctor in his attempt to collect an unpaid medical bill, finding the trial court erred when it struck the affidavit of an expert witness designated by the defendant.
In Marianne Jackson v. Thomas Trancik, M.D., No. 29A02-1012-CC-1391, Marianne Jackson went to Dr. Thomas Trancik for two office visits and shoulder surgery, which consisted of four separate procedures performed during one surgery. The bill was $11,147; Jackson paid a $20 co-pay and the doctor received nearly $6,000 as payment from Jackson’s insurer. He later filed suit against Jackson to recover the remaining $5,252.
Jackson wanted to introduce an affidavit by Christine Lewis, owner of MedReview Solutions, a firm specializing in reviewing medical bills. Lewis believed that three of the four surgical procedures weren’t billed correctly and that resulted in the doctor overcharging Jackson by more than $3,700. Her affidavit was struck after Trancik argued that Lewis wasn’t an expert qualified to render such an opinion and that her opinion wasn’t shown to be reliable or based on personal knowledge.
Lewis’ curriculum vitae shows she reviews medical bills for a living and she is also a certified public accountant and has completed a training program with Medical Billing Advocates of America. Based on her experience and training, she is qualified to render an expert opinion on the correctness of Trancik’s billing, wrote Chief Judge Margret Robb.
“Lewis is not second-guessing Dr. Trancik’s decision to perform the surgery that he did, nor is she opining about the quality of his work or its utility measured in medical terms. Rather, Lewis is opining that given the services that were performed, a different amount should have been billed according to methodology that reflects commonly accepted pricing and reimbursement methods. A trier of fact may consider Lewis’s lack of medical training when evaluating the weight to be given to her opinion, but that does not make her opinion inadmissible,” she wrote.
The judges also found that Lewis’ affidavit establishes a genuine factual issue as to what amount Jackson may owe, so summary judgment for Trancik was an error. They remanded for further proceedings.