| North Shore Univ. Hosp. Clinical Practice Plan v Liepper |
| 2008 NY Slip Op 50039(U) [18 Misc 3d 129(A)] |
| Decided on January 2, 2008 |
| Appellate Term, Second Department |
| Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431. |
| This opinion is uncorrected and will not be published in the printed Official Reports. |
Appeals from an order of the District Court of Nassau County, First District (Anthony
William Paradiso, J.), entered October 23, 2006, and from a judgment of the same court, entered
October 25, 2006. The order granted plaintiff's motion for summary judgment. The judgment,
entered upon the October 23, 2006 order, awarded plaintiff the principal sum of $11,198.41.
Appeal from order dismissed.
Judgment reversed without costs, order granting plaintiff's motion for summary
judgment vacated and plaintiff's motion for summary judgment denied.
At the outset, we note that the appeal from the order entered October 23, 2006 is
dismissed since the right of direct appeal therefrom terminated with entry of the judgment
(Matter of Aho, 39 NY2d 241, 248 [1976]). The issues raised on the appeal from the
order are brought up for review on the appeal from the judgment.
Plaintiff brought the instant action to recover the principal balance of $11,198.41
claimed to be due for medical services rendered to defendant, and sought summary judgment for
same. Although defendant's medical insurance carrier had reimbursed plaintiff for a portion of
the services rendered, the carrier denied full reimbursement, claiming that defendant had reached
the maximum limit of her policy. Defendant opposed plaintiff's summary judgment motion
based, inter alia, upon an alleged representation by plaintiff's physician that, with the exception
of certain specified out-of-pocket expenses paid for by defendant, he would look solely to
plaintiff's insurer for reimbursement.
[*2]
It is well settled that a medical provider is entitled to
recover for professional services rendered, if not under express contract, then under an implied
agreement to pay their reasonable value (see 83A NY Jur 2d, Physicians, Surgeons, and
Other Healers § 201). The medical provider's compensation is often paid by insurance, and
insurers sometimes limit the fees which can be charged to their subscribers (see 83A NY
Jur 2d, Physicians, Surgeons, and Other Healers § 204).
Although it is undisputed that plaintiff rendered medical services to defendant and
that defendant failed to pay plaintiff its outstanding bill for services, defendant raised a triable
issue of fact as to whether there was an oral agreement pursuant to which plaintiff's physician,
with the authority to bind plaintiff, agreed to limit the fee to the amount covered by insurance,
with the exception of the sum of $1,910 paid for by defendant. Accordingly, plaintiff's motion for
summary judgment should have been denied.
We pass on no other issues.
Rudolph, P.J., McCabe and Tanenbaum, JJ., concur.
Decision Date: January 2, 2008