Dustin Limberg, on behalf of himself and all others similarly situated, Plaintiff and Appellant
Sanford Medical Center Fargo, a North Dakota corporation, Sanford Health Network North, a North Dakota corporation, Sanford North, a North Dakota corporation and Sanford, a North Dakota corporation and Does 1 through 25, inclusive, Defendants and Appellees
from the District Court of Cass County, East Central Judicial
District, the Honorable Thomas R. Olson, Judge.
L. Kramer (argued), Daniel E. Phillips (appeared), Mike
Miller (on brief), and Todd M. Miller (on brief), for
plaintiff and appellant.
Vanessa L. Anderson (argued) and W. Todd Haggart (on brief),
for defendants and appellees.
V. Sandstrom, Justice.
1] Dustin Limberg appeals after the district court dismissed
his lawsuit against Sanford Medical Center for failing to
state a claim for which relief could be granted. On appeal,
he argues the district court should not have dismissed the
case. Because the district court appropriately dismissed the
case, we affirm the judgment.
2] According to the complaint, Limberg sought emergency
department care and treatment at Sanford Medical Center
Fargo. He did not have insurance and was asked to sign, and
did sign, Sanford's "Statement of Financial
Responsibility and Release of Information" form
("the contract"). The contract provided:
I agree that I am financially responsible for all charges
related to services provided by Sanford. I also agree to
abide by Sanford's payment guidelines. I understand that
these guidelines are available for my review, upon request to
Sanford. I understand that if I have additional questions
about my financial responsibility for Sanford's charges,
I may contact Sanford Business Services.
acknowledges that all patients sign this contract upon
admission, regardless of whether they have some form of
insurance or are self-pay patients.
3] Limberg explained in his complaint how Sanford calculates
gross charges to bill patients for its services. Sanford
maintains spreadsheets which include code numbers,
descriptions, and gross charges for each of the thousands of
items that are provided to patients upon request. Within the
hospital industry, these spreadsheets are called
Chargemasters. The Chargemaster rates, however, may differ
from what Sanford receives as payment from governmental
programs, commercial insurers, or HMOs because Sanford's
reimbursement rates from these payers are governed by
separate governmental regulations, contracts with insurers,
or agreements with HMOs. Therefore, patients covered by
governmental health care plans, commercial insurance plans,
or other privately negotiated fixed fee agreements do not pay
the Chargemaster rates. Self-pay patients such as Limberg,
however, who are solely responsible for payment, are charged
the Chargemaster rate. Limberg was not insured during the
visit in this case and therefore was a self-pay patient.
Limberg agrees his hospital bill was based on the
4] After receiving his bill for the visit, Limberg filed a
class action lawsuit seeking a declaratory judgment that
Sanford's billing practices were unfair, unconscionable,
or unreasonable because the contract contained an "open
price" term. He claimed the term "all charges"
as referenced in the Sanford contract was ambiguous and he
and the class were liable to Sanford only for the reasonable
value of the treatment and services provided to them. Sanford
moved for dismissal, which the district court granted.
5] The district court had jurisdiction under N.D. Const. art.
VI, § 8, and N.D.C.C. § 27-05-06. Limberg's
appeal is timely under N.D.R.App.P. 4(a). This Court has
jurisdiction under N.D. Const. art. VI, §§ 2 and 6,
and N.D.C.C. § 28-27-01.
6] On appeal, Limberg argues Sanford's billing practices
are unfair, unconscionable, and unreasonable because the
contract, signed by all patients seeking care at Sanford,
contains an "open price" term and is ambiguous.
Sanford argues the contract contains no "open