TX Supreme Court Decides Important Case Regarding 18.001 Medical Billing Affidavits

The Texas Supreme Court has decided a landmark case about contesting medical billing affidavits under Texas Civil Practice and Remedies Code §18.001(f).  In re Allstate Indemnity Co., No. 20-0071 (Tex. May 7, 2021).  This decision restores §18.001 to its role as a purely procedural statute and rejects its application as a death penalty for defendants on the issue of past medical expenses.  It balances the field on contesting past medical expenses and vindicates the arguments we have advanced on behalf of our clients.

First, the Court found that a registered nurse with over a decade of experience in medical billing and coding medical charges was a competent expert on the issue of the reasonableness of medical expenses.  The Court rejected the argument that charges by a hospital or healthcare provider may be challenged only by someone in the same medical field.

Second, the counteraffidavit gave reasonable notice of the basis for contesting the bills.  It identified each contested charge, gave the reason each charge was excessive, and compared the charges to median charges for the same services in that geographic area.  The Court rejected the argument that the nurse’s opinion was conclusory because she relied on a particular database to determine the median charge for specified services.  Section 18.001 does not require the trial court to determine the admissibility of the expert’s opinions.

Third, §18.001(f) does not require trial courts to assess or determine if the expert’s opinions are reliable under Texas Rule of Evidence 702 or Daubert/Robinson.  That is a separate admissibility issue to be addressed at trial.

Fourth, §18.001 has no exclusionary effect.  An uncontroverted billing affidavit may come into evidence, but the failure to serve a compliant counteraffidavit has no impact on the opposing party’s ability to challenge reasonableness or necessity at trial.  Nothing in §18.001 provides for excluding controverting evidence in the absence of a proper counteraffidavit.