UNITED STATES DISTRICT COURT
`FOR THE EASTERN DISTRICT OF NORTH CAROLINA
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`CLASS ACTION COMPLAINT
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`Plaintiff,
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`GEORGE CANSLER, on his own behalf,
`and on behalf of a class of those similarly
`situated,
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` v.
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`UNIVERSITY HEALTH SYSTEMS OF
`EASTERN CAROLINA, INC., EAST
`CAROLINA HEALTH-CHOWAN, INC.,
`HALIFAX REGIONAL MEDICAL
`CENTER, INC., ROANOKE VALLEY
`HEALTH SERVICES, INC., PITT
`COUNTY MEMORIAL HOSPITAL,
`INC., DUPLIN GENERAL HOSPITAL,
`INC., EAST CAROLINA HEALTH-
`BEAUFORT, INC., EAST CAROLINA
`HEALTH-BERTIE, INC., EAST
`CAROLINA HEALTH-HERITAGE,
`INC., THE OUTER BANKS HOSPITAL,
`INC., VIDANT MEDICAL GROUP
`AFFILIATES, LLC, VIDANT MEDICAL
`GROUP, LLC, VIDANT INTEGRATED
`CARE, LLC, and FIRSTPOINT
`COLLECTION RESOURCES, INC.,
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`Defendants.
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`i
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`Case 4:22-cv-00014-FL Document 1 Filed 02/18/22 Page 1 of 31
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`TABLE OF CONTENTS
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`I. NATURE OF THE ACTION ................................................................................................. 1
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`II. THE PARTIES ........................................................................................................................ 2
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`A. Plaintiff. ................................................................................................................................... 2
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`B. Defendants............................................................................................................................... 2
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`III. JURISDICTION AND VENUE ........................................................................................... 5
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`IV. FACTUAL BACKGROUND .............................................................................................. 6
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`A. How Prices of Medical Services Are Set for Patients with Commercial Insurance. ........ 6
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`B. Background on Vidant, its Unreasonable Prices, and its Refusal to Disclose Prices. ...... 9
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`C. Background on Defendants’ Unlawful Means of Attempting to Collect Debts. ............ 12
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`D. Facts Regarding Plaintiff and his Experience with Defendants’ Unlawful Conduct. .... 13
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`E. Mr. Cansler Receives Care from Vidant Chowan Hospital. ............................................ 13
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`F. Mr. Cansler receives bills with unreasonable prices to which he did not assent.. .......... 15
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`V. CLASS ALLEGATIONS. ................................................................................................... 20
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`VI. CLAIMS FOR RELIEF ...................................................................................................... 22
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`Count One (UDTPA) .................................................................................................................. 22
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`Count Two (Declaratory Relief) ................................................................................................ 24
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`Count Three (FDCPA) ............................................................................................................... 26
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`Count Four (NCCAA) ................................................................................................................ 27
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`JURY DEMAND ......................................................................................................................... 28
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`PRAYER FOR RELIEF............................................................................................................. 28
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`Plaintiff, George Cansler, through counsel, acting on his own behalf and on behalf of a
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`putative class of those similarly situated, brings this action for violations of the North Carolina
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`Unfair and Deceptive Trade Practices Act (“UDTPA”), N.C.G.S. § 75-1 et seq., the Declaratory
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`Judgment Act, 28 U.S.C. § 2201(a) et seq., the Fair Debt Collection Practices Act (“FDCPA”), 15
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`U.S.C. § 1692 et seq., and the North Carolina Collection Agency Act (“NCCAA”), N.C.G.S. § 58-
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`70 et seq., against Defendants University Health Systems of Eastern Carolina, Inc., East Carolina
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`Health-Chowan, Inc., Halifax Regional Medical Center, Inc., Roanoke Valley Health Services,
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`Inc., Pitt County Memorial Hospital, Inc. Duplin General Hospital, Inc., East Carolina Health-
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`Beaufort, Inc., East Carolina Health-Bertie, Inc., East Carolina Health-Heritage, Inc., The Outer
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`Banks Hospital, Inc., Vidant Medical Group Affiliates, LLC, Vidant Medical Group, LLC, Vidant
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`Integrated Care, LLC (collectively, “Vidant”), and FirstPoint Collection Resources, Inc.
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`(“FirstPoint”), and states as follows based on personal knowledge, investigation of counsel, and
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`information and belief:
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`I. NATURE OF THE ACTION
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`1.
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`This action concerns unfair and deceptive billing and collection practices engaged
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`in by Vidant and FirstPoint. Defendants grossly overcharged Mr. Cansler without having any
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`enforceable agreement with him to pay Vidant’s inflated prices. Defendants then utilized
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`aggressive, manipulative, and illegal collection practices in an attempt to coerce him to pay an
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`unreasonable amount to which he had never agreed. Indeed, Vidant had a policy of not disclosing
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`to patients like Mr. Cansler the prices of Vidant’s services. This was despite the fact that Vidant
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`was aware that many patients, like Mr. Cansler, would have to bear the vast majority of that
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`expense after the services were provided. Mr. Cansler’s experience is typical of insured patients
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`Case 4:22-cv-00014-FL Document 1 Filed 02/18/22 Page 3 of 31
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`1
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`who receive care at Vidant facilities. He therefore sues for damages and declaratory relief both
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`for himself and a class of those similarly situated.
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`II. THE PARTIES
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`A. Plaintiff.
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`2.
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`Plaintiff George Cansler is a resident of Edenton, North Carolina, Chowan County.
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`B. Defendants.
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`3.
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`Defendant University Health Systems of Eastern Carolina, Inc. d/b/a Vidant Health,
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`is a North Carolina nonprofit corporation. Its principal place of business is located at 800 W.H.
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`Smith Boulevard, Greenville, NC 27834, Pitt County. It may be served with process through its
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`registered agent at P.O. Box 6028, Greenville, NC 27835.
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`4.
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`Vidant Health is a not-for-profit, 1,447-bed hospital system that serves more than
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`1.4 million people in 29 counties in Eastern North Carolina. The system is made up of nine
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`hospitals and more than 12,000 employees. Its estimated revenue for the year 2017 was
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`$1,693,152,000. It is one of the largest health systems in the State. It is sophisticated as an
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`organization and has far greater resources than an individual consumer. “Vidant Health” appears
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`on the bills Mr. Cansler received. On information and belief, in the past Vidant Health has made
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`collection claims in consumer bankruptcies regarding medical bills. On information and belief,
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`Vidant Health primarily controlled and directed the billing practices alleged herein.
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`5.
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`Defendant East Carolina Health-Chowan, Inc., d/b/a Vidant Chowan Hospital, is a
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`North Carolina nonprofit corporation. Its principal place of business is located at 800 W.H. Smith
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`Boulevard, Greenville, NC 27834. It may be served with process through its registered agent
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`Michael Waldrum at P.O. Box 6028, Greenville, NC 27835. As described below, the Plaintiff’s
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`relevant service occurred at Vidant Chowan Hospital.
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`6.
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`Defendant Halifax Regional Medical Center, Inc., operating under the name Vidant
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`North Hospital, is a North Carolina nonprofit corporation. Its principal place of business is located
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`at 800 W.H. Smith Boulevard, Greenville, NC 27834. It may be served with process through its
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`registered agent Michael Waldrum at P.O. Box 6028, Greenville, NC 27835.
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`7.
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`Defendant Roanoke Valley Health Services, Inc., operating under the name Vidant
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`North Hospital, is a North Carolina nonprofit corporation. Its principal place of business is located
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`at 2100 Stantonsburg Road, Greenville, NC 27834. It may be served with process through its
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`registered agent Michael Waldrum at 800 W.H. Smith Boulevard, Greenville, NC 27834.
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`8.
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`Defendant Pitt County Memorial Hospital, Inc., operating under the name Vidant
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`Medical Center, is a North Carolina nonprofit corporation. Its principal place of business is located
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`at 800 W.H. Smith Boulevard, Greenville, NC 27834. It may be served with process through its
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`registered agent Michael Waldrum at P.O. Box 6028, Greenville, NC 27835.
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`9.
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`Defendant Duplin General Hospital, Inc., operating under the name Vidant Duplin
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`Hospital, is a North Carolina nonprofit corporation. Its principal place of business is located at 800
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`W.H. Smith Boulevard, Greenville, NC 27834. It may be served with process through its registered
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`agent Michael Waldrum at P.O. Box 6028, Greenville, NC 27835.
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`10.
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`Defendant East Carolina Health-Beaufort, Inc., operating under the name Vidant
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`Beaufort Hospital, is a North Carolina nonprofit corporation. Its principal place of business is
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`located at 800 W.H. Smith Boulevard, Greenville, NC 27834. It may be served with process
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`through its registered agent Michael Waldrum at P.O. Box 6028, Greenville, NC 27835.
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`11.
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`Defendant East Carolina Health-Bertie, Inc., operating under the name Vidant
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`Bertie Hospital, is a North Carolina nonprofit corporation. Its principal place of business is located
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`at 800 W.H. Smith Boulevard, Greenville, NC 27834. It may be served with process through its
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`registered agent Michael Waldrum at P.O. Box 6028, Greenville, NC 27835.
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`12.
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`Defendant East Carolina Health-Heritage, Inc., operating under the name Vidant
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`Edgecombe Hospital, is a North Carolina nonprofit corporation. Its principal place of business is
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`located at 800 W.H. Smith Boulevard, Greenville, NC 27834. It may be served with process
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`through its registered agent Michael Waldrum at P.O. Box 6028, Greenville, NC 27835.
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`13.
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`Defendant The Outer Banks Hospital, Inc., is a North Carolina nonprofit
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`corporation. Its principal place of business is located at 4800 South Croatan Highway, Nags Head,
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`NC 27959. It may be served with process through its registered agent Michael Waldrum at P.O.
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`Box 6028, Greenville, NC 27835.
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`14.
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`Defendant Vidant Medical Group Affiliates, LLC, is a North Carolina limited
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`liability company. Its sole member is Vidant Medical Group, LLC, a North Carolina limited
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`liability company. Vidant Medical Group Affiliates, LLC’s principal office is located at 800 W.H.
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`Smith Boulevard, Greenville, NC 27834. It may be served with process through its registered
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`agent, Michael R. Waldrum, at P.O. Box 6028, Greenville, NC 27835.
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`15.
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`Defendant Vidant Medical Group, LLC, is a North Carolina limited liability
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`company. Its sole member is Defendant University Health Systems of Eastern Carolina, Inc. Its
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`principal office is located at 2100 Stantonsburg Road, Greenville, NC 27834. It may be served
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`with process through its registered agent, Michael R. Waldrum, at P.O. Box 6028, Greenville, NC
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`27835. On information and belief, in the past Vidant Medical Group, LLC has made collection
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`claims in consumer bankruptcies regarding medical bills.
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`16.
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`Defendant Vidant Integrated Care, LLC, is a North Carolina limited liability
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`company. Its sole member is Defendant University Health Systems of Eastern Carolina, Inc. Its
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`principal office is located at 800 W.H. Smith Boulevard, Greenville, NC 27834. It may be served
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`with process through its registered agent, Michael R. Waldrum, at P.O. Box 6028, Greenville, NC
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`27835.
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`17.
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`On information and belief, during the pertinent times, Vidant Medical Group
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`Affiliates, LLC, Vidant Medical Group, LLC and Vidant Integrated Care, LLC participated with
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`Vidant Health and the Vidant hospitals in effectuating the billing practices alleged herein and are
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`each jointly and severally liable due to their direct active involvement in the subject practices.
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`18.
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`Defendant FirstPoint is a North Carolina corporation. Its principal place of business
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`is located at 225 Commerce Pl., Greensboro, NC 27401. It may be served with process through its
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`registered agent Anthony Robertson at 225 Commerce Pl., Greensboro, NC 27401. It holds a
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`collection agency license under N.C.G.S. § 58-70-1 and is a “debt collector” under the FDCPA,
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`15 U.S.C. §1692a(6) and a “collection agency” under N.C.G.S. §§ 58-70-15 and 58-70-90(1).
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`III. JURISDICTION AND VENUE
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`19.
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`This Court has subject matter jurisdiction over Plaintiff’s federal claim under the
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`FDCPA pursuant to 28 U.S.C. § 1331, because the claim arises under federal law. The Court has
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`supplemental jurisdiction over any state law claims pursuant to 28 U.S.C. § 1367, because they
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`arise out of the same transactions or occurrences.
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`20.
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`In addition, the Class Action Fairness Act, or CAFA, 28 U.S.C. § 1332(d),
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`establishes subject matter jurisdiction, in that the putative class meets CAFA jurisdictional
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`requirements of minimal diversity, because some class members live in Virginia; there are 100 or
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`more putative class members, and more than $5 million in controversy.
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`21.
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`Venue is proper in this district pursuant to 28 U.S.C. § 1391(b) and (c) and 18
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`U.S.C. § 1965, because Vidant transacts business in, is found in, or has agents in this judicial
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`district, and because some of the actions giving rise to this complaint took place within this district.
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`22.
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`The Court has personal jurisdiction over the Defendants.
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`IV. FACTUAL BACKGROUND
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`23.
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`Vidant and FirstPoint have operated a system that saddles patients with
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`astonishingly high medical bills. Vidant knows that the prices it charges patients for medical
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`services are unreasonably high. Indeed, when patients ask Vidant representatives about the cost
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`of care before they receive a service, Vidant has had a policy of refusing to tell patients the price
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`it plans to charge. Thus, Vidant made it impossible for patients to make an informed financial
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`decision about their care, and patients could not—and did not—willingly consent to pay Vidant’s
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`unreasonable, undisclosed prices.
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`24.
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`After patients received care, Vidant compounded the financial harm patients
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`suffered by harassing them to pay these excessive fees, including by sending their bills to FirstPoint
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`and implicitly threatening their credit score.
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`25.
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`In this way, and as described more fully below, Defendants have used and continue
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`to use an unfair, deceptive scheme designed to extract undisclosed and unreasonably high prices
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`from patients.
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`A. How Prices of Medical Services Are Set for Patients with Commercial Insurance.
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`26. With respect to patients with commercial insurance (as opposed to government
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`insurance such as Medicare or Medicaid), the market for hospital services is different to other
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`markets because the person consuming the hospital services, the patient, does not negotiate—and
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`in many cases, such as here, cannot even know beforehand—the costs of the medical services they
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`are consuming.
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`27.
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`Instead, commercial health plans, such as Blue Cross Blue Shield of North Carolina
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`(“Blue Cross”), purchase medical services for the benefit of their insured members, the consumers.
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`Commercial health plans negotiate with hospitals for the price the plans will pay for medical
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`services, known as the “allowed amount,” before services are consumed by members.
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`28.
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`Commercial health plans do not negotiate with hospitals on a service-by-service
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`basis; rather, they negotiate with hospitals for bundles of services that the health plan will offer to
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`members as “in-network” benefits. If the health plan and hospital reach a deal for a bundle of
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`services (for instance, all acute inpatient hospital services), the hospital will be considered in-
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`network for every service in that bundle. This means that for any service in that bundle, if a
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`commercial health plan’s member receives that service from the hospital, the health plan will pay
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`the hospital some share of the allowed amount those two parties negotiated for that service.
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`29.
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`Under most commercial health plans, the patient will then be responsible for paying
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`the share of the allowed amount that the insurance company did not pay. For insured patients with
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`so-called “high deductible” plans, such as Mr. Cansler, the patient bears responsibility for paying
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`the vast majority of the allowed amount for a particular procedure (e.g., 80%), until the deductible
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`is met. Thus, for the first several thousand dollars of medical treatment a patient receives each
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`year, the patient pays a significant majority of that cost.
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`30.
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`Because of the ever-rising costs of health care, many group and individual private
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`insurance plans have high deductibles or other mechanisms that place a significant payment
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`obligation on the consumer.
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`31.
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`Healthcare consumers are in a unique posture to be exploited by a revenue-minded
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`hospital system because they generally do not know nor consent to the costs prior to the service.
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`Rather, they reasonably assume that the hospital system will have the integrity to use reasonable
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`prices.
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`32.
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`Consumers are unaware that their treating doctors, as well, generally have no
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`knowledge of the prices being charged by the hospitals for their services nor do they have any
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`control over what those prices should be. Rather, such functions are carried out by an entirely
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`separate billing and administrative component of the system.
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`33.
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`Each hospital keeps its own “chargemaster,” a list of all of the hospital’s billable
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`items and the corresponding charges. These charges are set by the hospital and are not the
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`reasonable amounts consumers would expect to be charged.
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`34.
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`Patients are in general not privy to the allowed amounts their insurer has negotiated
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`with hospitals for various services. These bundled prices are a function of the artificial
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`chargemaster prices and are not disclosed to patients. At no point do patients agree to specific
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`prices for specific procedures. Thus, despite the fact that the patient is the one consuming the
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`services and will often bear a significant amount of the financial responsibility for the services
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`they consume, a patient like Mr. Cansler does not know before they consume a service how much
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`it will cost them. Compounding matters, at all times relevant to this litigation, Vidant followed a
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`corporate a policy of not disclosing the allowed amount of its services to patients even if they
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`asked.
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`35.
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`In the absence of an agreement between the patient and the hospital as to a particular
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`service’s price, the hospital is not entitled to the full chargemaster for that service, because the
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`chargemaster is much higher than the reasonable cost of the service.
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`36.
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`One measure of the reasonable price for a service is the rate that Medicare pays,
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`because Medicare ties the prices it pays for a given service to the cost of providing that service
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`plus a small profit margin. For most services, the chargemaster price for a service is many times
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`higher than what a hospital would receive for that service from Medicare.
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`37.
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`For example, the 2018 Medicare rate for the CT scan that Mr. Cansler received
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`(discussed in more detail below) was $302.60. However, Vidant’s chargemaster for that same
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`service was $4,000, more than 13 times higher. And the allowed amount for that CT scan under
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`Mr. Cansler’s plan was $3,576, more than 11 times the Medicare rate.
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`38.
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`This huge disparity between the Medicare rate and the price Vidant charges
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`individuals like Mr. Cansler is not limited to CT scans. For many other common procedures,
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`Vidant charges patients more than 10 times the rate that Medicare would pay for that identical
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`service.
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`39.
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`Vidant patients never assent to health care providers’ chargemasters, nor would
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`they if they had a meaningful choice.
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`40.
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`Neither Vidant’s chargemasters nor the allowed amounts they negotiate with
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`commercial health plans are reasonable rates for the relevant services.
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`41.
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`Under North Carolina law, where there is no contract specifying the rate to be
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`charged for treatment, a hospital is entitled only to the reasonable value of the service it provides.
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`B. Background on Vidant, its Unreasonable Prices, and its Refusal to Disclose Prices.
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`42.
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`University Health Systems of Eastern Carolina, Inc. was created in 1997. In 2011,
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`it changed its “doing business as” name to Vidant Health.
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`43.
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`Vidant Health controls and operates nine hospitals in Eastern North Carolina. Each
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`hospital is its own corporation, with Vidant Health’s CEO, Waldrum, acting as the registered agent
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`for all of them.
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`44.
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`The Vidant system is centrally controlled and Vidant Health issues corporate
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`policies addressing financial management that each of the hospital corporations is expected to
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`follow.
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`45.
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`Each of the Vidant hospitals keeps its own chargemaster. Each of the Vidant
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`hospitals’ chargemaster and allowed amount rates for CT scans grossly exceed any reasonable
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`value of the service. Vidant hospitals charge similarly inflated chargemasters and allowed
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`amounts for many other common procedures and services.
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`46. Medicare reimbursement prices are often used as benchmarks, representing a fair
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`amount for the procedure.
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`47.
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`The Medicare reimbursement price for a CT scan, abdominal and pelvis, CPT code
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`74176, in North Carolina in 2018 was $302.60 and in 2021 was $315.
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`48.
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`During the pertinent times, Vidant hospitals charged patients well in excess of that
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`price for the same CT scan procedure. The 2021 chargemaster prices were:
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`• Vidant Chowan Hospital: $4,000,
`• Vidant Medical Center: $4,996,
`• Vidant Edgecombe Hospital: $4,720,
`• The Outer Banks Hospital: $4,200,
`• Vidant Duplin Hospital: $3,785,
`• Vidant North Hospital: $2,713.20,
`• Vidant Beaufort Hospital: $2,533,
`• Vidant Bertie Hospital: $1,785, and
`• Vidant Roanoke Hospital: $1,727.
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`49.
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`Vidant’s business practices have sought to harass patients into paying their
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`excessive prices. During the pertinent times, Vidant set unreasonable prices, deliberately did not
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`disclose its prices to patients like Mr. Cansler prior to treatment, sought to bill the patients for the
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`excessive prices after the fact and, when patients were unable or unwilling to pay the inflated
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`prices, sought to coerce them into payment by threatening their credit score and engaging in
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`collection efforts.
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`50.
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`As of 2018, Vidant refused to disclose its costs to patients prior to treatment, even
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`if they asked. Vidant claimed that the Emergency Medical Treatment and Labor Act
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`(“EMTALA”), 42 U.S.C. § 1395dd, prohibited it from informing patients of the costs of care, and,
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`while knowing that patients would not be disclosed the costs until after the care, set egregiously
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`high costs for the care.
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`51.
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`EMTALA has never prohibited hospitals from disclosing chargemasters or allowed
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`amounts to patients. EMTALA requires that hospital emergency departments provide a medical
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`screening examination to any person who comes to the emergency department and requests an
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`examination. EMTALA prevents the hospital from refusing to examine or treat a patient based on
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`their insurance status, ability to pay, national origin, race, creed, or color.
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`52.
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`Vidant now provides a cost estimator on its website, which demonstrates that
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`Vidant does not believe cost disclosure prior to treatment is a violation of EMTALA. On
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`information and belief, the cost estimator was not available prior to 2021.
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`53.
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`On information and belief, Vidant created the cost estimator to comply with 45
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`C.F.R. § 180.40, which required hospitals to disclose such prices as of January 1, 2021. There has
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`been no substantive change to EMTALA that would alter what Vidant is or is not permitted to
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`disclose with respect to the prices of services.
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`54.
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`In justifying its policy of refusing to disclose prices in advance, Vidant by letter
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`dated December 12, 2019 to Mr. Cansler claimed that “[i]n addition to being a violation of federal
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`law,” “[t]he discussion of healthcare pricing or costs with patients can deter patients and their
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`families from seeking assistance that they may desperately need.” Since 2019, there has been no
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`substantive change to patient motivations that would alter what Vidant can disclose to patients
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`about the prices of its services. And yet, Vidant now makes this some of information available on
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`its website, belying its EMTALA contentions that somehow that statute ties its hands.
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`C. Background on Defendants’ Unlawful Means of Attempting to Collect Debts.
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`55.
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`Vidant coerces patients into paying their excessive prices by threatening to send
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`them to collections, report them to credit reporting agencies, damaging their credit scores, and
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`imposition of interest and legal fees on top of a billed amount that is unreasonable and based on a
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`contract that is unenforceable for lack of a price term or contains an open price term.
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`56.
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`57.
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`Vidant sends repeated bills to patients stating short payment deadlines.
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`If a patient does not pay Vidant’s exorbitant rates on their timeline, they are sent
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`“Final Notices” threatening to refer the account to collections and/or credit reporting agencies with
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`even shorter ten-day deadlines.
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`58.
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`The “Final Notices” can arrive after the supposed deadline due to mail delays for
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`Vidant Health’s primarily rural customer base.
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`59.
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`Vidant Health then refers the bills to its debt collector, FirstPoint, which threatens
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`to send the debt for listing on the patient’s credit report. In its initial collection letter, FirstPoint
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`recites that it may report the debt to credit reporting agencies.
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`60.
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`FirstPoint is regularly engaged in the collection of debts from consumers using the
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`means and instrumentalities of interstate commerce, including but not limited to, the United States
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`mail and interstate telephone communications.
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`61. While not a licensed debt collector itself, Vidant through its billing office aided and
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`abetted FirstPoint in its debt collection activities and the Vidant and FirstPoint entities engaged in
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`concerted action, for example when Vidant would “recall” the debt from FirstPoint only to later
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`send another “Final Notice” then transmit the file back to FirstPoint.
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`D. Facts Regarding Plaintiff and his Experience with Defendants’ Unlawful Conduct.
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`62. Mr. Cansler has a Master’s Degree in Accounting, and works in managerial
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`capacity at a private company. As an accountant, he is used to strict ethical and legal compliance
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`in economic transactions.
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`63.
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`At all times relevant to this lawsuit, Mr. Cansler paid for private group health
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`insurance from Blue Cross.
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`64.
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`65.
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`At all times relevant to this lawsuit, Mr. Cansler had a “Blue Options” plan.
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`Under the Blue Options plan, Vidant Chowan Hospital was an “in-network
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`hospital,” meaning that Blue Cross and Vidant had negotiated allowed amounts for most
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`procedures Blue Cross’s insured patients were likely to receive.
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`66.
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`Blue Cross negotiates rates that it pays Vidant Chowan Hospital that are lower than
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`Vidant’s chargemaster. However, for many plans including Mr. Cansler’s Blue Options plan, the
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`allowed amounts remain unreasonably high, for many services in excess of 10 times the Medicare
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`rate for those procedures.
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`E. Mr. Cansler Receives Care from Vidant Chowan Hospital.
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`67.
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`On or about June 6, 2018, Mr. Cansler visited the Vidant Chowan Hospital
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`emergency room due to pain secondary to what he felt was a likely kidney stone (he subsequently
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`passed the stone). Mr. Cansler had experienced kidney stones before, so he was highly confident
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`that the pain he felt was due to a kidney stone.
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`68. Mr. Cansler has excellent credit and is not accustomed to having himself or his
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`family on the receiving end of collection efforts.
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`69. Mr. Cansler went to Vidant Chowan Hospital’s emergency room because there
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`were no urgent care facilities proximate to his home, and Vidant Chowan Hospital did not have
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`another mechanism for admitting patients with non-emergency but still time-sensitive medical
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`issues, such as having a kidney stone. Mr. Cansler understood that his condition was not an
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`emergency, and he would not have visited the emergency room if he had any other option for
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`receiving medical care.
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`Upon arriving at Vidant Chowan Hospital, Mr. Cansler paid $100.
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`During his visit, he received, among other services for which there were charges, a
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`70.
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`71.
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`CT scan.
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`72. Mr. Cansler’s medical records reflect the existence of a form titled “Authorization
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`& Consent for Treatment and Assignment of Benefits” signed by him on June 6, 2018, containing
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`these representations among others:
`
`a.
`
`b.
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`73.
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`“I hereby agree to pay all charges of Facility that are not covered or paid within a
`reasonable time by any medical insurance/coverage, whether or not I am otherwise
`legally obligated to pay.”
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`“I understand that I am financially responsible to the Hospital and physicians for
`charges not paid by insurance. If an unpaid balance is sent to a collection agency,
`I will be responsible for any legal fees and/or interest associated with collection of
`debt.”
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`The term “charges” is not defined and the form does not contain any other price
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`term. Under those circumstances, patients have not agreed to pay the inflated chargemaster or
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`allowed amounts. Patients owe only the reasonable cost for that service.
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`
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`74.
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`Had Mr. Cansler known that Vidant would seek to hold him personally financially
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`responsible for thousands of dollars for a CT scan, he would have elected not to receive the service
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`at Vidant on June 6, 2018. This would have been a medically appropriate decision.
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`
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`F. Mr. Cansler receives bills with unreasonable prices to which he did not assent.
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`75.
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`On or about June 19, 2018, Blue Cross sent Mr. Cansler an Explanation of Benefits
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`(“EOB”) statement. The EOB listed a total billed amount of $6,251.70.
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`76.
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`According to the EOB, Mr. Cansler received member savings of $662.68. Blue
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`Cross paid $1,326.11. The EOB noted that the amount the provider may bill Mr. Cansler was the
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`remaining $4,262.91, consisting of co-insurance of $884.08 and $3,378.83 within Mr. Cansler’s
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`deductible. The provider billed $4,000 for unspecified services.
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`77. Mr. Cansler was shocked and surprised to receive a bill for over $3,000 for a short
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`visit to an in-network hospital.
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`78. Mr. Cansler did not receive an itemized bill until September 2019, more than a year
`
`later and after he raised concerns. That itemized bill detailed that the $4,000 charge was for “HB-
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`CT ABDOMEN AND PELVIS W/O CONTRAST.” The bill listed the allowed amount for this
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`procedure as $3,576 with Blue Cross paying $456.61 of that amount. This left $3,119.39 which
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`Vidant Health claimed Mr. Cansler was required to pay for that CT scan.
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`79.
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`Before receiving that itemized bill in September 2019, Vidant sent Mr. Cansler
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`several other bills claiming that he owed thousands of dollars.
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`80.
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`On or about June 22, 2018, Vidant Health sent Mr. Cansler an initial bill for
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`$4,162.91, noting that Mr. Cansler had paid $100 toward the total. The bill stated that payment
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`was due July