Jeanne Beverly, individually and on behalf of others similarly situated, Appellant,
Grand Strand Regional Medical Center, LLC, Respondent. Appellate Case No. 2016-001499
November 8, 2018
From Horry County Benjamin H. Culbertson, Circuit Court
L. Major, Jr. and Roy F. Harmon, III, of Harmon & Major,
PA, of Greenville; John Gressette Felder, Jr., of McGowan,
Hood & Felder, LLC, of Columbia; Chad Alan McGowan and
Jordan Christopher Calloway, both of McGowan, Hood &
Felder, LLC, of Rock Hill; and Jeffrey Christopher Chandler,
of Chandler Law Firm, of Myrtle Beach, for Appellant.
Lynn Werner, William R. Thomas, and Katon Edwards Dawson,
Jr., all of Parker, Poe, Adams & Bernstein, LLP, of
Columbia, for Respondent.
Beverly appeals the circuit court's order granting Grand
Strand Medical Center, LLC's (Grand Strand's) motion
to dismiss Beverly's claims for breach of contract, bad
faith, and unjust enrichment. Beverly argues the circuit
court erred in: (1) finding Beverly is not an intended
third-party beneficiary of the preferred provider contract
between Blue Cross Blue Shield (BCBS) of South Carolina and
Grand Strand and (2) dismissing Beverly's claim for
unjust enrichment, despite her complaint's allegation
that Grand Strand impermissibly collected payments from
Beverly and others "at a higher value than contracted
for with BCBS." We affirm in part, reverse in part, and
remand to the circuit court for further proceedings.
and Procedural History
April 29, 2005, Grand Strand contracted with BCBS of South
Carolina to become a preferred provider within the BCBS
preferred provider organization (PPO). In exchange for this status
and access to BCBS members (Members), Grand Strand promised
to bill BCBS directly for certain medical services delivered
to Members and to accept a discounted reimbursement
rate from BCBS for such services. Specifically, the
Institutional Agreement (the Agreement) prohibits Grand
Strand from "solicit[ing] any payment from
Members" and requires Grand Strand to "accept
the reimbursement terms and rates" BCBS established for
the PPO. After executing the Agreement, Grand Strand began
marketing itself to Members as a BCBS preferred provider.
September 6, 2012, Beverly was injured in an automobile
accident. That same day, she went to Grand Strand's
emergency room, where she was evaluated and treated by an
emergency room physician. Thereafter, Grand Strand sent
Beverly a bill for $8, 000.00. Because Beverly had previously
purchased a health insurance policy from BCBS-and thus became
a Member with access to the PPO network-Beverly did not
expect to receive such a bill.
filed suit against Grand Strand, asserting claims for breach
of contract, bad faith, and unjust enrichment. Beverly
claimed Grand Strand breached its contract with BCBS and
violated its contractual and fiduciary duties to her (and
other Members who contracted for access to the PPO network)
by billing her directly and charging her an amount exceeding
the contractual reimbursement rate.
Strand moved to dismiss and, following a hearing, the circuit
court dismissed Beverly's complaint. The circuit court
denied Beverly's subsequent Rule 59(e), SCRCP, motion to
alter or amend.
appeal from the dismissal of a case pursuant to Rule
12(b)(6), an appellate court applies the same standard of
review as the trial court." Rydde v. Morris,
381 S.C. 643, 646, 675 S.E.2d 431, 433 (2009). "In
considering such a motion, the trial court must base its
ruling solely on allegations set forth in the
complaint." Spence v. Spence, 368 S.C. 106,
116, 628 S.E.2d 869, 874 (2006). "If the facts and
inferences drawn from the facts alleged in the complaint,
viewed in the light most favorable to the plaintiff, would
entitle the plaintiff to relief on any theory, then the grant
of a motion to dismiss for failure to state a claim is
improper." Id. "At the Rule 12 stage,
therefore, the first decision for the trial court is to
decide only whether the pleading states a claim."
Skydive Myrtle Beach, Inc. vs. Horry Cty., 426 S.C.
175, 180, 826 S.E.2d 585, 588 (2019).
argues the circuit court erred in finding a Member is not an
intended third- party beneficiary of the Institutional
Agreement between BCBS and Grand Strand because the Agreement
adds Grand Strand to a PPO network structured to provide
direct benefits to Members. She further asserts the
Agreement's purported "beneficiary disclaimer"
does not bar her claims because the disclaimer's own