This case arises from the dismissal of a complaint filed by MCG Health, Inc. “MCG”, against Owners Insurance Company “Owners”. In sum, MCG filed a hospital lien for services provided to Braxton Morgan at the Medical College of Georgia after he was injured in an automobile accident caused by an individual insured by Owners. MCG then brought an action against Owners to collect on the lien. The trial court treated third-party defendants Braxton and Kylie Morgan’s cross-motion to dismiss the complaint as a motion for summary judgment and granted it, effectively dismissing MCG’s complaint for failing to state a claim for which relief could be granted. The Court of Appeals affirmed the decision in MCG Health, Inc. v. Owners Insurance Co. , 302 Ga. App. 812 692 SE2d 72 2010. We granted certiorari to consider whether the Court of Appeals erred in its construction of OCGA § 44-14-470. We now affirm the judgment. The underlying facts show that at the time Morgan received treatment at MCG, he was an active duty member of the United States Army covered by the United States Department of Defense TRICARE health insurance program “TRICARE”.1 MCG had a contract with Humana Military Healthcare Services, Inc. “HMHS” to provide certain healthcare services to beneficiaries of the TRICARE program. The contract set forth the terms by which MCG could recover for services provided to TRICARE beneficiaries. Paragraphs 2 and 4 required MCG to comply with TRICARE regulations. In addition, section 17 of the contract provided in pertinent part: No Liability to Beneficiaries for Charges. Hospital hereby agrees that in no event, including, but not limited to nonpayment by HMHS or the Government, HMHS insolvency or breach of this Agreement, shall Hospital bill, charge, collect a deposit from, seek compensation, remuneration or reimbursement or have any recourse against Beneficiaries, or persons other than HMHS acting on their behalf, for Covered Services provided pursuant to this Agreement. This Hospital Agreement provision shall not prohibit collection of fees for any non-covered service and/or Copayments in accordance with the terms of the Beneficiary’s coverage and this Agreement. Nothing in this Agreement shall be construed to limit the Hospital’s rights under OCGA § 44-14-470, et seq. Hospital shall have the right to seek to recover its charges, to the extent that said charges exceed what Health Plan or Payor pays Hospital pursuant to this Agreement, incurred as a result of Hospital’s providing Hospital Services to Members and which charges are the liability of a third party. The parties further agree that payment by Health Plan or Payor to Hospital does not extinguish Hospital’s lien or in any way limit Hospital’s rights under OCGA § 44-14-470, et seq. , except that the amount of the Hospital’s lien shall not include the amount of any payments by Health Plan or Payor to Hospital on behalf of a Member. In addition, Chapter 11, Section 5 of the TRICARE handbook, which was attached and incorporated into the contract, stated in pertinent part as follows: “5.5.2. It is important to note that prior to submission of a TRICARE claim, the hospital is not precluded from seeking recovery of its billed charge directly from the liable third party or insurer. . . . However, the hospital may not bill the beneficiary without filing a TRICARE claim.”
The total cost of the services MCG provided to Morgan was $18,259.61. Relying on the above-referenced language in section 17 of the contract referring to Georgia’s hospital lien statute and section 5.5.2 of the TRICARE manual, MCG filed a hospital lien for the full cost of services provided to Morgan pursuant to OCGA § 44-14-470 et seq . MCG did not file a claim with TRICARE for Morgan’s treatment at any time before or after filing the hospital lien. After MCG filed the hospital lien, Morgan entered into a release and settlement agreement with Owners for $50,000. MCG then filed a claim against Owners to collect on its lien.
