Submitted on Briefs: March 14, 2018
FROM: District Court of the First Judicial District, In and
For the County of Lewis and Clark, Cause No. DDV-2011-913
Honorable James P. Reynolds, Presiding Judge
Appellant: John M. Morrison, Morrison, Sherwood, Wilson &
Deola, PLLP, Helena, Montana, Lawrence A. Anderson, Attorney
at Law, P.C., Great Falls, Montana
Appellee: Randy J. Cox, Thomas J. Leonard, Randy J. Tanner,
Boone Karlberg P.C., Missoula, Montana
Jessica Gazelka appeals from an order of the First Judicial
District Court, Lewis and Clark County, granting St.
Peter's Hospital (the Hospital) partial summary judgment.
We affirm on alternate grounds and address the following
Does Montana's Preferred Provider Agreements Act
violate the Equal Protection Clause of the Montana
AND PROCEDURAL BACKGROUND
This is the second appeal in this case and we previously set
forth a detailed factual background in Gazelka v. St.
Peter's Hospital, 2015 MT 127, 379 Mont. 142, 347
P.3d 1287. Pertinent to this appeal, in 2010 and 2011,
Gazelka sought and received treatment from the Hospital for
various injuries and symptoms. The Hospital billed Gazelka
directly because she did not have health insurance when she
received the treatments at issue. However, almost all of
Gazelka's treatment costs were either covered by another
party's insurance or significantly discounted by the
Hospital's 50% financial-need discount.
Gazelka filed suit in District Court, arguing that the
statutes authorizing the Hospital's billing practices
violate the Equal Protection Clause of Article II, Section 4,
of the Montana Constitution. The Montana Preferred Provider
Agreements Act (MPPAA), §§ 33-22-1701 to -1707,
MCA, permits Preferred Provider Agreements (PPAs) in Montana.
A PPA is an agreement between an insurer and a healthcare
provider reducing the amount of money a provider will accept
as satisfaction for an insured person's treatment. Thus,
two patients may ultimately pay different amounts for
treatment depending on whether the patient is insured or
uninsured and, if insured, depending on the terms of a
particular PPA. If a patient is uninsured, she pays the
amount the provider charged, less any discount she may
receive through a provider's financial assistance
program. Uninsured persons are not parties to and do not
benefit from PPAs. If a patient is insured, she or her
insurer pays the amount the provider agreed to accept as
satisfaction for that treatment pursuant to the negotiated
PPA. Providers frequently have PPAs with multiple insurers,
and therefore one insurer's PPA may be more favorable to
a patient, requiring her or her insurer to pay less.
Gazelka contended that the MPPAA unconstitutionally
discriminates against uninsured patients and patients insured
by the insurers that did not negotiate the most favorable
PPA. She noted that the patients insured by the insurer that
negotiated the most favorable PPA pay less for the same
treatment than all other patients. Thus, Gazelka asked the
District Court to find that the MPPAA violates the Equal
Protection Clause of Article II, Section 4, and moved for
partial summary judgment. The Hospital responded with its own
motion for partial summary judgment, arguing that the MPPAA
is constitutional. The District Court agreed with the
Hospital, concluded that the MPPAA creates similarly situated
classes but does not violate Gazelka's right to equal
protection, and granted the Hospital's motion for partial
summary judgment. Gazelka appeals. We affirm the District
Court's decision on alternate grounds, as we determine
that Gazelka failed to identify similarly situated classes.
We review a grant of summary judgment de novo. Goble v.
Mont. State Fund, 2014 MT 99, ¶ 14, 374 Mont. 453,
325 P.3d 1211. Summary judgment is appropriate when there are
no genuine issues of material fact and the moving party is
entitled to judgment as a matter of law. M. R. Civ. P.
56(c)(3). If there are no genuine issues of material fact, we
review a district court's conclusion that the moving
party is entitled to judgment as a matter of law for
correctness. Mont. Cannabis Indus. Ass'n v.
State, 2016 MT 44, ¶ 11, 382 Mont. 256, 368 P.3d
1131, cert. denied, ___U.S.___, 136 S.Ct. 2523
This Court exercises plenary review of constitutional issues.
Mont. Cannabis Indus. Ass'n, ¶ 12. A
statute is presumed constitutional unless it "conflicts
with the constitution, in the judgment of the court, beyond a
reasonable doubt." Powell v. State Comp. Ins.
Fund, 2000 MT 321, ¶ 13, 302 Mont. 518, 15 P.3d
877. The party challenging the statute's
constitutionality bears the burden of proving the statute is
unconstitutional beyond a reasonable doubt. Goble,
¶ 15. If any doubt exists, it must be resolved in favor
of the statute. Mont. Cannabis Indus. Ass'n,
Montana's equal protection guarantee embodies "a
fundamental principle of fairness: that the law must treat
similarly-situated individuals in a similar manner."
McDermott v. State Dep't of Corr., 2001 MT 134,
¶ 30, 305 Mont. 462, 29 P.3d 992. "The function of
the equal protection clause 'is to measure the validity
of classifications created by state laws.'" ISC
Distribs. v. Trevor, 273 Mont. 185, 195, 903 P.2d 170,
176 (1995) (quoting ARA Servs. Inc. v. Sch. Dist.,
590 F.Supp. 622, 629 (E.D. Pa. 1984) ...