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HomeMy WebLinkAbout13-1069 r-- ~.,~ ~:: -~ry,~ ~ cma~ ' -3 '~ -... ~ ~ 1 G7r (V rt:.,.~ !' C:: J {_ __., -. Kimberly A. Bonner, Esquire :__ Supreme Court LD. #89705 _ ., James, Smith, Dietterick & Connelly, LLP PO Box 650 Hershey, PA 17033 (717)533-3280 (717) 533-2795 Attorneys for Plaintiff SURGICAL CARE AFFILIATES, IN THE COURT OF COMMON PLEAS LLC, CUMBERLAND COUNTY, PENNA PLAINTIFF v. NO. C `~ ~ ~ o ~O ~ Cc~ r ~ 1 ~~~n~ JACK B. GATES, DEFENDANT :CIVIL ACTION -LAW NOTICE TO DEFEND You have been sued in court. If you wish to defend against the claim set forth in the following pages, you must take action within twenty (20) days after this complaint and notice are served, by entering a written appearance personally or by attorney and filing in writing with the court your defenses or objections to the claims set forth against you. You are warned that if you fail to do so the case may proceed without you and a judgment may be entered against you by the court without further notice for any money claimed in the complaint or for any other claim or relief requested by the plaintiff. You may lose money or property or other rights important to you. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR x/03.75 ~d~~~, ~~~ i ~~ ~g~6~~ CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP Cumberland County Bar Association 32 S. Bedford Street Carlisle, PA 17013 (800) 990-9108 SURGICAL CARE AFFILIATES, LLC, PLAINTIFF v. JACK B. GATES, DEFENDANT IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNA . NO. I CIVIL ACTION -LAW AVISO USTED HA SIDO DEMONDADO/A EN CORTE. Si usted desea defenderse de las demandas que se presentan mas adelante en las siguientes paginas, debe tomar accion dentro do los proximos veinte (20) dias despues de la notifacaciQn de esta Demanda y Aviso radicando personalmente o por medio de un abogado una comperencencia escrita y redicanco en la Courte por escrito sus defensas de, y objecciones a, los demandas presentadas aqui en contra suya. Se le advierte de que si usted falls de tomar accion Como se describe anteriormente, el caso puede proceder sin usted y un fallo por cualquier sums de dinero reclamada en la demands o cualquier otra reclamacion o remedio solicitado por el demandante puede ser dictado en contra suya por la Corte sin mas aviso adicional. Usted puede perder dinero O propieded u otros derechos importantes pars usted. USTED DEBE LLEVAR ESTE DOCUMENTO A SU ABAGADO IMMEDIATAMENTE. SI USTED NO TIENE UN ABOGADO O NO PUEDE PAGARLE A UNO, LLAME A VAYA A LA SIGUEINTE OFICINA PARR AVERIGUAR DONDE PUEDE ENCONTRAR ASISTENCIA LEGAL. Cumberland County Bar Association 32 S. Bedford Street Carlisle, PA 17013 (800) 990-9108 Kimberly A. Bonner, Esquire Supreme Court I.D. #89705 James, Smith, Dietterick & Connelly, LLP PO Box 650 Hershey, PA 17033 (717)533-380 (717)533-2795 Attorneys for Plaintiff SURGICAL CARE AFFILIATES, LLC, PLAINTIFF ~. JACK B. GATES, DEFENDANT IN THE COURT OF COMMpN PLEAS CUMBERLAND COUNTY, PEMNA . NO. ` I3-~~~q G~,,, -f-~~~ CIVIL ACTION -LAW COMPLAINT The Plaintiff, Surgical Care Affiliates, LLC, t/d/b/a Grandview Surgery & Laser Center, by its attorneys, James, Smith, Dietterick & Connelly, LLP, hereby presents the following Complaint against the Defendant, Jack B. Gates, as follows: 1. Plaintiff, Surgical Care Affiliates, LLC, t/d/b/a Grandview Surgery & Laser Center (hereinafter referred to as "Grandview"), is an Alabama corporation, registered to do business in Pennsylvania, with its office located at 205 Grandview Avenue, Camp Hill, Cumberland County, Pennsylvania 17011. 2. Defendant, Jack B. Gates, is an adult individual, with his last known address at 456 State Street, Enola, Cumberland County, Pennsylvania 17025. COUNT I BREACH OF CONTRACT 3. Grandview incorporates Paragraphs 1 through 2 as if fully reproduced herein. 4. Grandview is a facility that performs same-day out-patient surgery to patients who desire same. 5. On August 22, 2011, Defendant arrived at Grandview for a right ulnar nerve decompression. 6. When Defendant arrived at Grandview, it was confirmed that Defendant had health insurance through Capital Blue Cross of Pennsylvania. 7. Defendant signed Grandview's Financial Agreement, Assignment of Benefits and Release of Records prior to her surgery. A copy of this Agreement is attached hereto and identified as Exhibit "A." 8. Grandview submitted its bill for services rendered, totaling $3,369.00 to Defendant's insurance company on or about August 24, 2011. 9. Defendant's insurance company did not make any payment on this debt, but assigned the amount due and owing to Defendant's deductible. 10. According to the terms of Grandview's Financial Agreement, if accounts are forwarded for further collection efforts, Grandview is entitled to collection fees totaling 30% of the unpaid balance. 11. Collection fees incurred by Grandview total $461.70. 12. Defendant has continuously refused to make payment to Grandview for the balance due and otherwise ignored Plaintiff's demands for payment of same. 13. Plaintiff filed a Civil District Justice Complaint with Richard Dougherty on July 16, 2012. 14. Defendant did not pick up the complaint that was served upon him by certified mail by the District Court. 15. A constable for the District Court has made numerous attempts to personally serve-the complaint, but the Defendant has evaded all the attempts and instructed individuals at his residence to not answer the door when the constable attempted service. A copy of the Constable's service return is attached hereto an identified as Exhibit "B." 16. Plaintiff incurred costs in the amount of $194.05 in its attempt to have the complaint served. WHEREFORE, Plaintiff, Surgical Care Affiliates, LLC, t/b/d/a Grandview Surgery & Laser Center, demands judgment against Defendant Jack B. Gates, in an amount not in excess of $50,000.00, which amount requires submission of this matter to compulsory arbitration. COUNT II UNJUST ENRICHMENT 16. Grandview incorporates Paragraphs 1 through 15 as is fully reproduced herein. 17. Grandview provided Defendant with medical services, as requested by Defendant, totaling $1,539.00; Grandview having done so to the benefit of Defendant; Defendant became liable for the just and reasonable amount of the surgery. 18. Defendant has been unjustly enriched by accepting the service of Grandview and not paying the total amount due for same. 19. Grandview has demanded that Defendant pay the total amount due of $2,194.75, but Defendant has refused to do so. WHEREFORE, Plaintiff, Surgical Care Affiliates, LLC, t/b/d/a Grandview Surgery & Laser Center, demands judgment against Defendant Jack B. Gates, in an amount not in excess of $50,000.00, which amount requires submission of this matter to compulsory arbitration. RESPECTFULLY SUBMITTED, JAMES, SMITH, DIETTERICK ~ CO~INELLY, LLP BY: Kimberly A. onner, Esquire Supreme Court I.D# 89705 James, Smith, Dietterick & Connelly, LLP PO Box 650/Hershey, PA 17033 (717) 533-3280 (717) 533-2795 fax Attorneys for Plaintiff DATE: February,~~2013 a~ GRANDViEW SURGERY AND LASER CENTER .n urobte o~ Patient iD,~Visit #~ 2943G -1 Account #• X8617 !I _DATE r IME IN ~ LAST NAMc F{PST NAM'c ~ M j DEp0511 ~ ATTACHMENT p KJ8/22/; I ~09:OG ; G,4TES !JACK ! ; ! ~SCASLI M/F DOB t AuE IMSW ~ HOME PHONE i RIDE/PHONE ~ NEED TO .^.ALL ~ WILL BE HERE M ~ 12/ i 2169 41 ~ D ? 7 i 7-~ ~4-4b2? I -ADDRESS STRc'~ CITY COUNTt' STATE ZIP :456 STATE STREET ENOLA P•4 17G25 PRIOR ADMIT i SSN i DR(V-P. LICENSE OGt:.UPATION WORK PHONE I ~ 18a-54-5212 ~ ~ ~ 7 ] 7-J64-6151 RESPONSIBLe PARTY NAME ANi, ADDRESS IF DIFFERENT QOM A$OVE REiJ1TION TO RESPONSI$l.= PARTIi R=SPON518LE PARTY SSN j RESPONSIBLE PARTY EMPLOYER R'cSPONSIBt~ PARTY PHONE ELF CSAME i ~ SAME _ i PRIMARY INSURANCE COh4PANY NAME/NAME OF Iiv'SURc'D ~ SECONDARY INSURANCE COMPANY NAME/NAME OF INSURED ~:APITAL BC OF P.A (PPO} -GATES, JACK I3 t ~'O BUX 779503 &-IAR.R}SBURG, PA 17177-450 i D. #1SSt~i ivROIIP X i AUTHORIZATION ! l.D. #.'S5N GROUP N ,AUTHORIZATION j YWP8G1 I~6758200 j 00521122 1~PR ; ~ I INSUREC'S EMPLOYER Ah[D PHONE INSURER'S EMPLOYER AND PHONE I SURGEON I DOl ~ CLAIM!! `ATTENTIUN ~ I-IIM~MELWRIGHT, BRETT' A I i i DIAGNOSIS R1GNT CUBITAL TUNNEL SYNDROME PROPOSED SURGERY (i) RIGHT ULNAR. NERVE DECOMPRESSION R ~fNdAFJCi~ AG4REEMEi~'t, ASSI~uNMEtdTi f3F ~EIVE~'~"S AtVE3 FiE;.E~SE ELF ~E~CrR©~S} (hereby assign to and authorize payment directly to the facility Warned above (the "faGGty") of ati benefits due me under Medicare, iviedicaid: or any insurance policy providing benefits for facilitt: charges, for services rendered by theraciltty and anesthesia provider as designated, A photostatic copy of this agreement shaft tie considered effective and valid as the original, I irrevocably agree that the facility may discbse, to the extent allowed by iaw, my medical and linanclal record to fe} any affiliate of the faciffry, specifrcaliy including Surgical Care Aff:fiates and its employees and agents. including entities under contract wfth same to provide quality andlor utiGaation review; (b) any person or entity which may be liable under contract or by law to the facility or to ms, or any perm or entity responsible for ail or part of the facility's cnarges, speciftcaHy including any irsurance company or their agents or employees; (c! any person or entity to whom I have bean referred by the faclity or by my physician for continued care; (d) any physi:~an treating, consulting or otherwise performing services for me, inGuding his or her employees end agents; (e) the Centers for Medicare and Mad"rca'Id Services, any otner govemmenial ar accrediting agency, or their agents or employees. Afl facfi~`iy charges are due and owing at discharge. In consideration of the services to be rendered, to the extent not expresaly prohibited by taw or by the contsact between the facility and my third party payor, i HEREBY ACzRPE, WHETHER l AM Sl3NING A5 PATIENT OR GUARANTOP,, TO PAY ALL SUMS DUE TH. FACILITY HT THE USUAL AND CUSTOMARY CHARGE OF THE FAC1LiTY. 1 hereby waive ail claims of exemption. Should the accourf be referred to an attorney or collection agency fnr rofiecifon, ;shaft pay reasonable attorney's fees and collection expenses wnether suit is filled or not. Detinquenf accoursis and amauMS (those not paid within 6G days from the date of service] may bear interest on trte unpaid amoun? up to the maximum amount allowed by iaw. I understand that i sin firsanciaiiy responsible for charges not°paid within said 80 days and for charges not covered by this assignment. I understand that the facility files for reimbursement from my insurer or other paver as a csurtesy, and failure on the part of the insurer io make ayment shalt not relieve me of my obflgation to pay flee faciifiy. I certffythat 1 am the patient orthat i am financiatfy responsible for the services rendered and do hereby uncanditionalN guararriy the payment of ell arwunis when and as due ~aciNty employees are NOT able to define your insurance coverage. if you have coverage quest?ons, you are advised to call your rnstrrance carrier. CAUTION: DO NOT SIGN THIS AGP,EcMENT UNLESS YOU UNDERSTAND ]TS CONTENTS f ~}r t _ PA ~ r `'' u DATE !1 J I ~~ • ~ ~~ ~?~-. ~, ~. (=~ rd n nAT X -S a ~ ~=-- ~- - L7. y R t ~y ~~~~ r'"~ ~r" Fliryl tValnA) s~",~~ t I (~~ FAI-367312 k«r tyf 0 ~:•T?V °Q` SIG vanes •t Plaintiff Information Sheet Unable to serve civil process for reason listed below Docket # CV ~ 1 Ll -1 ~-- o Defendant no longer resides at address on complaint, Current resident is Notes: o Address listed on complaint is vacant. Notes: After diligent effort, Unable to make contact and serve complaint in time for hearing, However address appears occupied. (Recommend Plaintiff request new hearing date. additional fees will be added to service!) Notes: o Address listed does not exist or is incomplete. Defendant is aware I am trying to serve process (pertelephone cauj and apparently instructs everyone at address listed on complaint not to open tth-e door to anyone. (Not a lot I can do!} Other ~~. 1~ ~ ~" 1L ~- ~" ~(-~ 'ec~ ~1~' L 1 N e..1Z ~i~.V fTld 12 ~ ~ a ate -~~- ~ev~ I ~ N W ~ ~~ ~~e ~es~~1L7 `~(~ O ,!' Ccc ,~ ~~~~ t~c~e a J SURGICAL CARE AFFILIATES, IN THE COURT OF COMMON PLEAS LLC, CUMBERLAND COUNTY, PENNA PLAINTIFF v. NO. JACK B. GATES, . DEFENDANT :CIVIL ACTION -LAW VERIFICATION I, Richard Habacivch, Administrator, of Surgical Care Affiliates, LLC, t/d/b/a Grandview & Laser Center, hereby verify the facts contained in the foregoing Complaint are true and correct to the best of my knowledge, information and belief. I understand that false statements herein are subject to the penalties of 18 Pa.C.S.A. §4904 relating to unsworn falsification to authorities. .~'' / / Richard Habacivch DATE: ~- ~ ~--( 3 SHERIFF'S OFFICE OF CUMBERLAND COUNTY Ronny R Anderson { Sheriff I xF Jody S Smith "" M t;, c,113 APR —14 � �}'�, Chief Deputy Richard W Stewart ="UMBER tf, Solicitor s .. P E N N S.Y I-Vi';f 11 A Surgical Care Affiliates LLC Case Number vs. Jack B Gates 2013-1069 SHERIFF'S RETURN OF SERVICE 03/28/2013 Ronny R Anderson, Sheriff, being duly sworn according to law, states he made diligent search and inquiry for the within named Defendant to wit: Jack B Gates, but was unable to locate the Defendant in his bailiwick. The Sheriff therefore returns the within requested Complaint& Notice as "Not Served" at 456 State Street, East Pennsboro/W. Fairview, Enola, PA 17025. Ten attempts at service were made but deputies were not able to make contact with anyone at this address before the complaint expired. SHERIFF COST: $78.46 SO ANSWERS, April 01, 2013 RbNW R ANDERSON, SHERIFF r_ _, UHE PRO 0k k , r'-t' �',�e 2014 dA 55- All 9: 59 Scott A.Dietterick,Esquire r- Supreme Court I.D.#55650 � Li1L O COUNT`` Kimberly A.Bonner,Esquire PENNSYLVANIA Supreme Court I.D.#89705 James,Smith,Dietterick&Connelly,LLP PO Box 650 Hershey,PA 17033 (717)533-3280 (717)533-2795 Attorneys for Plaintiff SURGICAL CARE AFFILIATES, •▪ IN THE COURT OF COMMON PLEAS LLC, •▪ CUMBERLAND COUNTY, PENNA PLAINTIFF . • (3-- �0109 v. . NO. 43-4968- JACK B. GATES, : DEFENDANT •▪ CIVIL ACTION - LAW PRAECIPE TO REINSTATE COMPLAINT TO THE PROTHONOTARY: Kindly reissued the Complaint, originally filed with this Court on February 26, 2013. RESPECTFU LY SUBMITTED, JAMES, SMI , DIE - •K & CONNELLY, LLP r A, BY: Al -40alle,IIIP Scott A. I ietterick, Esquire Supreme Court I.D# 55650 James, Smith, Dietterick & Connelly, LLP PO Box 650/Hershey, PA 17033 (717) 533-3280 (717) 533-2795 fax Attorneys for Plaintiff DATE: January 29, 2014f� ?'��� / Cam- /03V7 , A 3°//7b Ronny R Anderson Sheriff Jody S Smith Chief Deputy Richard W Stewart Solicitor SHERIFF'S OFFICE OF CUMBERLAND COUNTY LED-DFFIL:E THE PROTHONOTARY • F,I c -F-THE, SHERIFF 11AR I 7 AM 10; en UMBERLAND COUNTY PENNSYLVANIA Surgical Care Affiliates LLC vs. Jack B Gates Case Number 2013-1069 SHERIFFS RETURN OF SERVICE 03/12/2014 Sheriff Ronny R Anderson, being duly sworn according to law, states he made diligent search and inquiry for the within named Defendant to wit: Jack B Gates, but was unable to locate the Defendant in his bailiwick. The Sheriff therefore returns the within requested Complaint & Notice as "Not Served" at 456 State Street, East Pennsboro/W. Fairview, Enola, PA 17025. Eight attempts at service were made but deputies were not able to make contact to effecuate service before the complaint expired. SHERIFF COST: $79.34 SO ANSWERS, March 12, 2014 RON R ANDERSON, SHERIFF (e) C;ountyShite Sheriff, Teieoson, inc.