Jessica Bennett and Thuy N. Gasser v. ACS Primary Case Physicians-Southeast, P.C.

According to Jessica Bennett's Class Action Complaint, on December 16, 2018, Provider's medical professionals treated Bennett in the emergency room at Mary Black Memorial Hospital in Spartanburg for injuries Bennett suffered in a car accident. Bennett was covered under a health insurance policy issued by Insurer through her employer. Insurer and Provider had previously entered into an Individual Preferred Provider Agreement allowing Provider the benefits of becoming a "Network Provider" and requiring Provider to file claims for covered services with Insurer and to accept negotiated rates for covered services. Nonetheless, instead of filing a claim with Insurer for services rendered to Bennett, Provider billed Bennett directly for $1,050.00, applying rates that were higher than the rates negotiated with Insurer.



Similarly, according to Thuy Gasser's Class Action Complaint, in December 2019, Provider's medical professionals treated Gasser in the emergency room at Grand Strand Regional Medical Center in Myrtle Beach for injuries Gasser suffered in a car accident. Gasser was covered under a health insurance policy issued by Insurer through an individual health insurance exchange. Insurer and Provider had previously entered into an Individual Health Insurance Exchange ("HIX") Preferred Provider Agreement allowing Provider the benefits of becoming a "HIX Network Provider" and requiring Provider to file claims for covered services with Insurer and to accept negotiated rates for covered services.[1] Nonetheless, instead of filing a claim with Insurer for services rendered to Gasser, Provider billed Gasser directly for $1,622.00, applying rates that were higher than the rates negotiated with Insurer.



On March 17, 2020, Bennett filed one of the two class actions underlying these consolidated appeals, asserting claims for breach of contract (based on each putative class member's status as a third-party beneficiary of the Provider Agreement),[2] unjust enrichment, and "Equity." On May 21, 2020, Gasser filed the second class action, asserting claims for breach of contract/third-party beneficiary and unjust enrichment. After both actions were removed to federal court and subsequently remanded to the circuit court, Provider filed its respective motions to compel arbitration and stay or dismiss Insureds' claims. In its supporting briefs, Provider asserted that Insureds were bound by the respective arbitration provisions in the Provider Agreements because their assertion of third-party beneficiary status estopped them from avoiding those provisions.



The circuit court denied the respective motions, concluding that Insureds were "completely unaware that the [Provider Agreements] existed when [they] received [their] medical treatment." Subsequently, the circuit court denied Provider's motion for reconsideration in Bennett's class action.[3] These appeals followed.



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Bennett v. ACS Primary Care Physicians-Southeast P.C., 6089, Appellate Case 2021-001342 (S.C. App. Sep 18, 2024)