ÿWPC 5 ®8Ñ¶Þ k-5Ò<,eRžÿÏG‘‚6•Òƒ ºSŽ¨:íen•’æö÷Úã…1’S2Dáhð8ãûçW¦!“¤HnHŠ ÓwÚÙ MÓÏóœ«êåøMªiÒØAØG¹N+÷ E»ºpæM ‡ËÞSå„½Ý ºÁZ¦ÁêN¸9©!Þb&”‚R¾Âh]“ "OÓ(NøF€jK…qÈ"`)-ÙAäü0 ]×@Aî×Ô£6Uh;c±Åÿ2ÌLQý@Ðc#Ix¿, ý+m<’@UÌ÷ë!XÕœìðkž,Y°Žf=o¨›Ý®P¤VÜ@ÀijÕš ±áK®^À«rãp“‚peB³>pìü”§ì:\sE.ÄïÃ7Oö-óAÁiÃœ¶äÌFAðB§8õÇ»už3qY&jPÕŽo·xšG ¾,DË×gzìúPà«F€æÐXý§Ý‡eAñóãbG4rÃ]ú³4·d)X_’¹0Û'‡xc37Ù©ÎN”H©÷tu Y©loâiÔ>št¾é™í¦´ëéÙ@©òAðÍÖ} ¼dÿsšmi®i«¤§ÑÕëH¶ñ¬?bÅ\G ä«ï؅Þ1‰n|¢…;"b %\^ b 0ˆnU(NöwD4H\ zkÒå· m¹ ®Ð #Á~ Æ? ÆÆËÆ‘-WN„ 0D†JÊEdçzqaÌÒ6žyÔAM ,Ž!Ž!ýº%º%º%º%º%4·'·'ë(UN)¾O); - - - -bH.H.H.H.H.H.H.H.H.H.H.·P.P.P.P.P.P.P.P.P.P.P.P.P.P.P.P.P.P.P.P.P.P.P.P.P. 0ë0000 Bò0ò0 0¤1 D3³1 D-æ1 0K22 AS^2Ʊ2 0¤w3 0D4 A«_4»ŠqK-s (`£ª$¡¡Ñ€.ÑÑ8€½­»»d»»d8ÑÑ ý ÑÓ  Ó(í€"  Z6Times New Roman Regularš‚,-[¥3|x ˜C:\PROGRA~1\COREL\WORDPE~1\TEMPLATE\CUSTOM~1\REVISE~1.WPTC:\Program Files\Corel\WordPerfect Office 2000\Template\Custom WP Templates\revised standard opinion.wptÿU‹ÿÀÀÀ HighersDonelsonBearmanBlueCrossBlueShieldBlueCareShockley W.S. P.J.CatesWarnockTennCare MCOsXantusHealthPlan T.R.reviewablemovantduplicativeRiverpark MCO˜HP LaserJet 4050 Series PCL 6ÈÈ,,,,ÈÈ0Level 1Level 2Level 3Level 4Level 5‚Level 1Level 2Level 3Level 4Level 5„Level 1Level 2Level 3Level 4Level 5…Level 1Level 2Level 3Level 4Level 5 #Ý ƒR>Ž$ÝÓ  Óà  àòòÚ  Ú1Ú  ÚóóÔ€ô¶ýò»»ÔÝ  ÝÔ_ÔBlueCross€BlueShield€of€Tennessee,€Inc.,€and€Volunteer€State€Health€Plan,€Inc.,€are€collectively€referred€toÐ ° Ðin€this€Opinion€as€ð ðBlueCare.ðð(#Ã$òòÚ  Ú0Ú  Úóó @Ý ƒR>Ž$ÝÓ  Óà  àòòÚ  Ú8Ú  ÚóóÔ€ô¶ýò»»ÔÝ  ÝÔ_ÔIn€the€December€14€order,€the€trial€court€again€observed€that€BlueCare€authorized€all€of€the€admissions€at€issueÐ ° Ðand,€based€on€that€authorization,€River€Park€treated€each€patient.€€After€treatment,€BlueCare€initially€disallowed€all€ofÐ tÄ Ðthe€claims.€€River€Park€was€required€to€appeal€in€order€to€obtain€any€payment€at€all.€€The€trial€court€noted,€ð ðThis€patternÐ 8ˆ Ðcontinues€through€today.ðð ZÝ ƒR>Ž$ÝÓ  Óà  àòòÚ  Ú3Ú  ÚóóÔ€ô¶ýò»»ÔÝ  ÝÔ_ÔThe€purpose€of€utilizing€this€type€of€system€was€to€control€spiraling€medical€costs€while€broadening€theÐ ° Ðcovered€population€to€include€non„Medicaid€insured€and€uninsurable€persons.€€òòò òSee€Xantusóóó ó,€2000€Tenn.€App.€LEXIS€319,Ð tÄ Ðat€*5„*7.€€(Tenn.€Ct.€App.€May€17,€2000).€€TennCare€increased€the€covered€population€from€800,000€under€MedicaidÐ :Š Ðto€1.2€million€under€TennCare€in€one€year.€€ò òSee€òòid.óó€ó óat€*8. ÝÝ ƒR>Ž$ÝÓ  Óà  àòòÚ  Ú6Ú  ÚóóÔ€ô¶ýò»»ÔÝ  ÝÔ_ÔThe€trial€court€denied€River€Parkððs€attempt€to€add€a€claim€based€on€a€theory€of€conversion.€ gÝ ƒR>Ž$ÝÓ  Óà  àòòÚ  Ú12Ú  ÚóóÔ€ô¶ýò»»ÔÝ  ÝÔ_ÔÔ‡(ô¶ýòòô¶ýÔFrom€our€review€of€the€transcript€of€the€July€31€hearing,€it€is€unclear€whether,€in€the€beginning,€River€ParkÐ ° Ðsought€full€compensation€for€both€emergency€and€non„emergency€services€provided€to€BlueCare€enrollees.€€Nevertheless,Ð tÄ ÐRiver€Park€clarified€its€position€in€its€post„trial€motions€that€it€sought€full€compensation€only€for€emergency€servicesÐ 8ˆ Ðprovided€to€BlueCare€enrollees€after€December€31,€1999.€€The€trial€court€held€only€that€BlueCare€was€unjustly€enrichedÐ üL Ðas€to€River€Parkððs€treatment€of€emergency€patients.€€Whether€every€patient€for€whom€River€Park€seeks€compensationÐ À Ðwas€an€emergency€patient€is€relevant€to€damages,€to€determine€the€amount€River€Park€will€be€entitled€to€recover.€€Thus,Ð „Ô Ðas€we€have€determined,€admitting€evidence€that€relates€to€damages€in€the€liability€phase€would€be€harmless.€€Ô#†ô¶ýòò(ô¶ý#Ô ÂÝ ƒR>Ž$ÝÓ  Óà  àòòÚ  Ú5Ú  ÚóóÔ€ô¶ýò»»ÔÝ  ÝÔ_ÔBlueCare€served€its€notice€to€terminate€participation€in€the€TennCare€system€as€an€ð ðat€riskðð€insurance€companyÐ ° Ðeffective€July€1,€2000.€€As€of€that€date,€BlueCare€became€a€ð ðnon„riskðð€administrative€services€organization,€which€actsÐ tÄ Ðas€a€clerical€bill€payer€for€the€State.€€ ,Ý ƒR>Ž$ÝÓ  Óà  àòòÚ  Ú7Ú  ÚóóÔ€ô¶ýò»»ÔÝ  ÝÔ_ÔThe€trial€court€specifically€rejected€River€Parkððs€conversion€claim,€even€though€it€had€refused€to€allow€RiverÐ ° ÐPark€to€add€that€claim€to€its€complaint. oÝ ƒR>Ž$ÝÓ  Óà  àòòÚ  Ú14Ú  ÚóóÔ€ô¶ýò»»ÔÝ  ÝÔ_ÔWe€note€that,€as€we€held€in€this€Opinion,€the€trial€court€may€reconsider€whether,€based€on€the€evidenceÐ ° Ðpresented,€the€127€inpatients€listed€in€Exhibit€31€should€be€included€in€the€category€of€ð ðemergencyðð€patients. 7Ý ƒR>Ž$ÝÓ  Óà  àòòÚ  Ú9Ú  ÚóóÔ€ô¶ýò»»ÔÝ  ÝÔ_ÔBecause€the€trial€courtððs€December€14,€2000€order€superceded€its€order€filed€on€August€29,€2000,€it€is€theÐ ° ÐDecember€14€order€that€is€the€subject€of€our€review.€€€ "Ý ƒR>Ž$ÝÓ  Óà  àòòÚ  Ú13Ú  ÚóóÔ€ô¶ýò»»ÔÝ  ÝÔ_ÔThe€trial€court€reiterated:€ð ðRiver€Park€only€provides€inpatient€services€to€BlueCare€enrollees€when€theyÐ ° Ðpresent€to€River€Park€and€River€Park€is€informed€that€the€admission€is€an€emergent€admission;ðð€€ð ðRiver€Park€wasÐ tÄ Ðinformed€in€each€[inpatient]€case€by€the€admitting€Ô_ÔPCPsÔ_Ô€that€these€inpatient€admissions€are€emergency€admissions;ððÐ 8ˆ Ðð ðUnder€federal€law,€River€Park€cannot€refuse€the€admission€of€any€of€these€[Ô_Ôin]patientsÔ_Ô,€because€both€BlueCare€and€itsÐ üL ÐÔ_ÔPCPsÔ_Ô€have€informed€River€Park€that€these€admissions€are€emergent€admissions;ðð€and€ð ðBy€federal€law€River€Park€mustÐ À Ðprovide€these€emergency€services€to€any€[emergency€room]€patient€without€regard€to€insurance€until€the€patient€isÐ „Ô Ðstabilized.ðð óÝ ƒR>Ž$ÝÓ  Óà  àòòÚ  Ú15Ú  ÚóóÔ€ô¶ýò»»ÔÝ  ÝÔ_ÔRiver€Park€alleges€that€ð ðgoods,ðð€along€with€the€services,€were€also€converted.€€However,€it€submitted€noÐ ° Ðevidence€that€any€such€goods€were€involved€in€caring€for€the€BlueCare€enrollees,€nor€did€it€submit€evidence€of€the€valueÐ tÄ Ðof€any€such€goods.€€Therefore,€we€construe€its€claim€as€one€for€conversion€of€ð ðservicesðð€only. *Ý ƒR>Ž$ÝÓ  Óà  àòòÚ  Ú11Ú  ÚóóÔ€ô¶ýò»»ÔÝ  ÝÔ_ÔAfter€the€trial€court€had€heard€the€additional€proof,€it€observed€that€River€Parkððs€motion€to€amend€wasÐ ° Ðð ð[p]rimarily€a€motion€to€reconsider.ðð€ Ñ ° Ñ(ÖÃ9 Z‹6Times New Roman Regular ´Ý ƒR>Ž$ÝÓ  Óà  àòòÚ  Ú2Ú  ÚóóÔ€ô¶ýò»»ÔÝ  ÝÔ_ÔGenerally,€the€federal€government,€acting€through€the€Health€Care€Financing€Administration€(ð ðÔ_ÔHCFAÔ_Ôðð)€of€theÐ ° ÐDepartment€of€Health€and€Human€Services,€sets€certain€minimum€standards€for€state€Medicaid€programs,€such€asÐ tÄ ÐTennCare,€and€provides€partial€funding€for€those€programs.€€The€states€then€supply€the€balance€of€the€necessary€fundingÐ 8ˆ Ðand€are€responsible€for€delivery€of€covered€services€to€eligible€individuals.€ò òòòState€ex€rel.€Pope€v.€Xantus€Healthplan€ofÐ üL ÐTennessee,€Inc.óóó ó,Ô‡XJ9Xòô¶ýÔ€Ô#†ô¶ýòXXJ9Ù#ÔNo.€M2000„00120„Ô_ÔCOAÔ_Ô„R10„CV,€2000€Tenn.€App.€LEXIS€319,€at€*3„*4€(Tenn.€Ct.€App.€May€17,Ð Â Ð2000).ò òó ó 1Ý ƒR>Ž$ÝÓ  Óà  àòòÚ  Ú4Ú  ÚóóÔ€ô¶ýò»»ÔÝ  ÝÔ_ÔIndeed,€MCOs€compete€to€enroll€individuals€in€their€plan€in€order€to€receive€more€capitation€payments.€Ð ° Ðò òòòXantusó óóó,€2000€Tenn.€App.€LEXIS€319,€at€*8.€€- ù- ­Ý ƒR>Ž$ÝÓ  Óà  àòòÚ  Ú10Ú  ÚóóÔ€ô¶ýò»»ÔÝ  ÝÔ_Ô€€River€Parkððs€counsel€stated€at€oral€argument€that€ð ðmuch€of€[this€evidence]€was€in€the€record,ðð€but€that€theÐ ° Ðtrial€court€either€did€not€understand€it€initially€or€did€not€appreciate€it.€€Counsel€acknowledged€that€much€of€the€evidenceÐ tÄ Ðwas€duplicative.€€(|G2>Ž$¤¤Ý ƒ£ª!ÝÑ€.ÑÑ8€Å»»dXXdì8ÑÑ ý ÑÓ  ÓÝ  Ýà  àòòÚ  Ú0Ú  ÚóóÔ€ô¶ýò»»Ô d(|3ÁQ$££Ý ƒ£ª!ÝÑ€.ÑÑ8€Å»»dXXdì8ÑÑ ý ÑÓ  ÓÝ  ÝVVVV'ÿÿdxd)!ÈÈÈÈdxdx( ±þ$’’ò òFigure€Ú  Ú1Ú  Úó ó^_X`YEþÿ<<CÿÿƒLevel 1Level 2Level 3Level 4Level 5(|3ÁQ$¢¢Ý ƒ£ª!ÝÑ€.ÑÑ8€Å»»dXXdì8ÑÑ ý ÑÓ  ÓÝ  Ý($$””ò òÚ  Ú1Ú  Úó óX[Z&OLE 2.0 Box <=8ÿÿÿÿÿÿÿÿÿÿCÿÿ HKKKKÝ ƒ£ª!ÝÑ€.ÑÑ8€Å»»ddÈ8ÑÑ ý ÑÓ  ÓÝ  ÝÔ_ÔÑ  ÑÔ€¼Å»»»ÔÑ8€J9XXdì»»d8ÑÑ  ÑÑ€'OYÑà@ü ü ìàÔ‡îÅÔIN€THE€COURT€OF€APPEALS€OF€TENNESSEEˆÐ ° Ðà@kk$ìàAT€NASHVILLEÔ#†¼Å»îî#ԈРÖ& ÐÓ  ÓNovember€6,€2001€SessionÐ üL ÐÌò òRIVER€PARK€HOSPITAL,€INC.€Ð  p Ðv.€Ð 4 „ ÐBLUECROSS€BLUESHIELD€OF€TENNESSEE,€INC.,€and€Ð H ˜ ÐVOLUNTEER€STATE€HEALTH€PLAN,€INC.,€d/b/a€BLUECAREÔ‡XJ9X»¼ÅÔó óÐ \ ¬ ÐÌà@@½½ìàò òAn€Appeal€from€the€Chancery€Court€for€Warren€CountyÐ \¬  Ðà@@øøìàNo.€7266€€€€€€Charles€D.€Ô_ÔHastonÔ_Ô,€ChancellorÐ H˜  ÐÌà@@ìì*ìàßA€V) °°` d€÷E<` AßÐ  p  ÐÌà@@TTìàNo.€M2001„00288„Ô_ÔCOAÔ_Ô„R3„CV€„€Filed€October€11,€Ô_Ô2002Ô_ÔÐ k  ÐÌßA€V) °°` dE<ò` AßÐ óC Ðó óÓ  ÓÌThis€case€involves€a€dispute€over€rates€paid€to€a€TennCare€health€care€provider.€€The€plaintiffÐ î> Ðhospital€had€been€a€participating€provider€for€the€defendant€TennCare€managed€care€organizationÐ Ú* Ð(ð ðMCOðð)€for€several€years,€being€paid€an€agreed€contractual€rate€for€services€provided€to€the€MCOððsÐ Æ Ðenrollees.€€When€the€partiesðð€contract€expired,€it€was€not€renewed.€€After€expiration€of€the€contract,Ð ² Ðthe€hospital€continued€to€provide€emergency€services€to€the€MCOððs€enrollees,€as€it€was€required€toÐ žî Ðdo€under€federal€law.€€For€those€emergency€services,€the€hospital€billed€the€MCO€at€its€full,€standardÐ ŠÚ Ðrates.€€The€MCO€refused€to€pay€the€hospitalððs€standard€rates,€and€instead€paid€the€hospital€the€sameÐ vÆ Ðrate€it€had€paid€under€the€partiesðð€expired€contract.€€This€was€the€same€rate€the€MCO€paid€hospitalsÐ b² Ðthat€were€participating€providers.€€The€hospital€filed€this€lawsuit€against€the€MCO,€seeking€to€recoverÐ Nž Ðits€full,€standard€rates€for€the€emergency€services€provided€to€the€MCOððs€enrollees€after€expirationÐ :Š Ðof€the€partiesðð€contract.€€After€hearing€proof€on€liability,€but€not€damages,€the€trial€court€initiallyÐ &v Ðdenied€recovery€on€all€grounds.€The€hospital€moved€for€reconsideration€and€to€reopen€the€proof.€€TheÐ b Ðtrial€court€granted€the€motion€and€ultimately€determined€that€the€MCO€had€been€unjustly€enrichedÐ þN Ðby€the€hospitalððs€provision€of€services€to€its€enrollees.€€Both€parties€appealed.€€We€affirm,€findingÐ ê : Ða€contract€implied€in€ò òó ólaw,€and€remand€to€the€trial€court€to€determine€a€reasonable€rate€for€servicesÐ Ö!&  Ðprovided€by€the€hospital€and,€based€on€this,€for€a€determination€of€damages.Ð Â"! ÐÌÓ(Óò òTenn.€R.€App.€P.€3;€Judgment€of€the€Chancery€Court€is€Affirmed€and€Remandedó óÐ š$ê# ÐÌòòÓ  ÓÔ#†¼Å»àXJ9Ä#ÔÔ‡XJ9X.¼ÅÔHolly€Kirby€Lillard,€J.óó,€delivered€the€opinion€of€the€court,€in€which€òòW.€Frank€Crawford,€P.J.,Ð r&Â!% ÐW.S.,óó€and€òòAlan€E.€Highers,€J.óó,€joined.Ð ^'®"& ÐÌGary€C.€Shockley€and€Brigid€M.€Carpenter,€Nashville,€Tennessee,€for€the€appellants,€BlueCrossÐ 6)†$( ÐBlueShield€of€Tennessee,€Inc.,€and€Volunteer€State€Health€Plan,€Inc.,€d/b/a/€BlueCare.Ð "*r%) ÐÌSteven€A.€Riley€and€Taylor€A.€Cates,€Nashville,€Tennessee,€for€the€appellee,€River€Park€Hospital,Ð ú+J'+ ÐInc.Ð æ,6(, ÐÐ Ò-")-ý ÐÑ'OYÑâ 'âÑ°°Ñâ 'âÑ  ÑWilliam€E.€Young€and€William€B.€Hubbard,€Nashville,€Tennessee,€for€amicus€curie,€TennesseeÐ ° ÐHospital€Association.Ð œì ÐÌAndrew€Yarnell€Beatty,€Nashville,€Tennessee,€for€amicus€curie,€Tennessee€Medical€Association.Ð tÄ ÐÓF ÓÌò òOPINIONó óÔ#†¼Å»XXJ9u #ÔÔ‡XJ9X»¼ÅÔÐ L œ ÐÌÔ#†¼Å»XXJ9j#ÔÔ‡XJ9X»¼ÅÔÓ  ÓÓ Óà  àÔ#†¼Å»XXJ9Â#ÔÔ€XJ9X»¼ÅÔPlaintiff/Appellee€River€Park€Hospital,€Inc.€(ð ðRiver€Parkðð),€is€a€Tennessee€corporation€thatÐ $ t Ðoperates€a€127„bed€hospital€in€McMinnville,€Tennessee.€€Defendant/Appellant€BlueCross€BlueShieldÐ  ` Ðof€Tennessee,€Inc.€(ð ðBlueCrossðð),€is€a€Tennessee€not„for„profit€corporation€with€its€principal€placeÐ ü L  Ðof€business€in€Chattanooga.€€Defendant/Appellant€Volunteer€State€Health€Plan,€Inc.€(ð ðVolunteerÐ è 8  ÐStateðð),€a€Tennessee„licensed€Health€Maintenance€Organization€(ð ðHMOðð),€is€a€subsidiary€ofÐ Ô$  ÐBlueCross.€€Through€Volunteer€State,€BlueCross€participates€as€a€managed€care€organizationÐ À  Ð(ð ðMCOðð)€in€TennCare,€under€the€trade€name€ð ðBlueCare.ðð׃×Ý ƒ#ÃÝòòÚ  Ú1Ú  ÚóóÝ  Ý×  ×€€Ð ¬ü  Ðà  àTennCare€is€Tennesseeððs€Medicaid€program.€€Medicaid€was€established€by€the€federalÐ „Ô  Ðgovernment€in€1965€to€provide€health€coverage€for€low„income€individuals,€as€opposed€to€theÐ pÀ ÐMedicare€program€designed€to€provide€health€coverage€to€the€elderly.Ô_Ô׃)×Ý ƒ#ÃÝòòÚ  Ú2Ú  ÚóóÝ  Ý×  ×Ô_Ô€€ò òòòState€ex€rel.€Pope€v.€XantusÐ \¬ ÐÔ_ÔHealthplanÔ_Ô€of€Tennessee,€Inc.óóó ó,€No.€M2000„00120„Ô_ÔCOAÔ_Ô„R10„CV,€2000€Tenn.€App.€LEXIS€319,Ð H˜ Ðat€*3€(Tenn.€Ct.€App.€May€17,€2000).€€Under€traditional€ð ðfee„for„serviceðð€Medicaid€programs,€theÐ 4„ ÐState€pays€health€care€providers€directly€for€services€administered€to€eligible€individuals.€Ð  p ÐReimbursement€rates€for€services€provided€to€Medicaid€enrollees€are€established€by€the€State.€TheÐ  \ Ðindividual€Medicaid€enrollee€is€free€to€utilize€the€physician,€hospital,€or€other€health€care€providerÐ øH Ðof€his€choice.€€Likewise,€the€health€care€provider€is€free€to€accept€or€decline€to€treat€MedicaidÐ ä4 Ðpatients.€€Ð Ð  Ðà  àTennCare€is€different€from€the€traditional€fee„for„service€Medicaid€program,€in€that€it€is€aÐ ¨ø Ðmanaged€care€Medicaid€system.׃¢×Ý ƒ#ÃÝòòÚ  Ú3Ú  ÚóóÝ  Ý×  ×€€Under€TennCare,€the€State€of€Tennessee€enters€into€ContractorÐ ”ä ÐRisk€Agreements€(ð ðrisk€agreementsðð)€with€private€MCOs.òòò ò€€Id.óóó ó€at€*7.€€Under€the€risk€agreements,€theÐ €Ð ÐMCO€receives€a€monthly€payment€from€the€State€known€as€a€ð ðcapitation€paymentðð€for€each€eligibleÐ l¼ Ðindividual€enrolled€with€that€MCO€(ð ðenrolleeðð).€€In€return€for€this€capitation€payment,€the€MCO€mustÐ ° Ðarrange€for€the€provision€of€medically€necessary€services€to€its€enrollee.€€ò òòòId.ó óóó€at€*7„*8.€€In€order€to€doÐ œì Ðthis,€each€MCO€develops€a€ð ðnetworkðð€of€health€care€providers€and€negotiates€with€the€health€careÐ ˆØ Ðproviders€to€accept€discounted€rates€for€the€services€provided.€€€ò òòòId.ó óóó€at€*8.€€If€the€MCO€pays€less€inÐ tÄ Ðprovider€fees€than€the€total€amount€received€in€capitation€payments,€it€earns€a€profit.€€If€the€amountÐ `° Ðspent€on€care€exceeds€the€capitation€payments,€the€MCO€bears€the€loss.€€òòò òóóó óIn€this€way,€the€MCOs,€notÐ L œ Ðthe€State,€bear€the€financial€risk€involved€in€the€administration€of€health€care€services€to€personsÐ 8 ˆ Ðeligible€for€TennCare.€€ò òòòId.óóó óÐ $ t Ðà  àEach€eligible€TennCare€recipient€enrolls€with€the€MCO€of€his€choice.׃*×Ý ƒ#ÃÝòòÚ  Ú4Ú  ÚóóÝ  Ý×  ×€€The€MCO€assignsÐ ü L  Ðeach€enrollee€in€its€plan€to€a€primary€care€physician,€also€referred€to€as€the€ð ðPCPðð€or€ð ðgatekeeper.ðð€Ð è 8  ÐThe€MCO€pays€the€PCP€a€per€capita€rate€to€perform€his€ð ðgatekeepingðð€function,€to€ensure€that€eachÐ Ô$  Ðenrollee€receives€only€medically€necessary€health€care€services€and€to€refer€the€enrollee€to€otherÐ À  Ðhealth€care€providers€for€the€medically€necessary€health€care€services€that€the€PCP€could€not€provide,Ð ¬ü  Ðincluding€hospitalization.€€If€the€MCO€enrollee€has€an€emergency€situation,€he€may€go€directly€to€aÐ ˜è  Ðhospital€emergency€room€without€first€getting€approval€from€his€PCP.€€Under€the€federal€EmergencyÐ „Ô  ÐMedical€Treatment€and€Active€Labor€Act,€42€U.S.C.€ðð€1395dd€(ð ðEMTALAðð),€a€hospital€òòmustóóÐ pÀ Ðprovide€services€to€a€person€with€an€emergency€medical€condition€until€the€personððs€condition€hasÐ \¬ Ðstabilized,€without€regard€to€whether€the€person€has€insurance.€€The€MCO€has€obligations€as€well;Ð H˜ Ðunder€the€risk€agreements€entered€into€by€the€MCOs€with€the€State,€the€MCO€is€obligated€to€pay€theÐ 4„ Ðhealth€care€provider€for€any€emergency€services€provided€to€its€enrollee.€€Ð  p Ðà  àBlueCare€entered€into€a€risk€agreement€with€the€State€of€Tennessee€to€become€a€TennCareÐ øH ÐMCO.׃×Ý ƒ#ÃÝòòÚ  Ú5Ú  ÚóóÝ  Ý×  ×€€When€the€TennCare€program€began€in€1994,€BlueCare€contracted€with€River€Park€for€RiverÐ ä4 ÐPark€to€become€a€participating€provider€in€the€BlueCare€network.€€The€most€recent€version€ofÐ Ð  ÐBlueCareððs€contract€with€River€Park,€known€as€the€ð ðBlueCare€Attachmentðð€to€the€River€ParkÐ ¼  ÐInstitution€Agreement,€was€effective€on€October€1,€1996.€€The€parties€operated€under€the€BlueCareÐ ¨ø ÐAttachment€from€October€1,€1996,€through€December€31,€1999.Ð ”ä Ðà  àDuring€the€course€of€River€Parkððs€contractual€relationship€with€BlueCare,€River€Park€becameÐ l¼ Ðdissatisfied€with€the€rate€of€reimbursement€paid€by€BlueCare.€€River€Park€was€also€frustrated€withÐ X ¨ Ðthe€amount€of€time€and€money€required€to€follow€BlueCareððs€elaborate€ð ðutilization€managementÐ D!” Ðproceduresðð€or€ð ðutilization€review€guidelines.ðð€€BlueCare€required€compliance€with€these€proceduresÐ 0"€  Ðin€order€to€obtain€payment€for€services€rendered.€€In€1999,€River€Park€lost€$2.3€million€on€BlueCareÐ #l! Ðenrollees.€Consequently,€by€letter€dated€July€26,€1999,€River€Park€gave€notice€to€BlueCare€that€RiverÐ $X" ÐPark€would€terminate€its€BlueCare€Attachment€effective€January€1,€2000.€€River€Park€sought€toÐ ô$D # Ðrenegotiate€its€contract€with€BlueCare€to€obtain€a€higher€rate€of€reimbursement€and€simplerÐ à%0!$ Ðreimbursement€procedures.€€Through€a€series€of€meetings€and€conference€calls,€the€partiesððÐ ° Ðnegotiations€continued€from€October€1999€through€March€2000.€€€Ð œì Ðà  àUltimately,€the€parties€could€agree€to€continue€under€the€former€contract€only€with€respectÐ tÄ Ðto€obstetrical€services.€€Otherwise,€the€parties€could€not€reach€an€agreement.€€Therefore,€River€ParkÐ `° Ðbecame€an€out„of„network€provider€as€of€January€1,€2000.€€During€the€negotiations,€BlueCare€toldÐ L œ ÐRiver€Park€several€times€that€if€the€parties€could€not€agree€on€a€new€contract,€BlueCare€would€payÐ 8 ˆ ÐRiver€Park€only€the€rate€of€reimbursement€it€had€paid€under€the€old€contract,€because€BlueCareÐ $ t Ðmaintains€a€policy€of€paying€out„of„network€hospitals€the€same€rate€that€it€pays€in„network€hospitals.€Ð  ` ÐRiver€Park€refused€to€be€bound€by€the€terms€of€the€old€contract€after€January€1,€2000.€€River€ParkÐ ü L  Ðrepeatedly€insisted€that€if€the€parties€could€not€reach€a€new€agreement,€River€Park€would€chargeÐ è 8  ÐBlueCare€the€hospitalððs€reasonable,€standard€rates€for€services€provided€to€BlueCare€enrollees€byÐ Ô$  ÐRiver€Park€after€that€date.€€River€Park€told€BlueCare€that€its€acceptance€of€any€payment€by€BlueCareÐ À  Ðð ðdoes€not€waive€our€right€to€full€and€complete€payment€required€by€law.ðð€Ð ¬ü  Ðà  àOn€March€2,€2000,€the€parties€engaged€in€their€last€meaningful€conference€call€in€an€attemptÐ „Ô  Ðto€settle€their€dispute.€€At€that€time,€River€Park€told€BlueCare€that€it€would€accept€BlueCareððs€regularÐ pÀ Ðin„network€rates€for€in„patient€services,€but€said€that€it€would€require€48%€of€the€full,€standardÐ \¬ Ðcharges€for€out„patient€services€provided€during€January€and€February€2000.€€For€the€period€ofÐ H˜ ÐMarch€1€through€June€30,€2000,€River€Park€said€it€would€agree€to€accept€BlueCareððs€regular€in„Ð 4„ Ðnetwork€rate€for€all€services,€provided€BlueCare€would€agree€to€pay€River€Park€for€all€claimsÐ  p Ðauthorized€by€BlueCare,€bypassing€BlueCareððs€exhaustive€utilization€management€procedures.€Ð  \ ÐBlueCare€rejected€River€Parkððs€proposal€and€made€no€counter„proposal.Ð øH Ðà  àOn€March€8,€2000,€River€Park€filed€this€lawsuit.€€In€its€original€complaint,€River€Park€soughtÐ Ð  Ð(1)€a€declaratory€judgment€that,€pursuant€to€Tennessee€Code€Annotated€ðð€56„32„209,€BlueCare€wasÐ ¼  Ðrequired€to€notify€its€enrollees€that€its€contract€with€River€Park€was€terminated;€(2)€a€declaratoryÐ ¨ø Ðjudgment€that€River€Park€had€no€obligations€under€its€previous€agreement€with€BlueCare€and€thatÐ ”ä ÐBlueCare€was€required€to€compensate€River€Park€according€to€River€Parkððs€reasonable,€standardÐ €Ð Ðrates;€(3)€a€determination€that€BlueCare€had€impliedly€agreed€to€pay€River€Park€its€reasonable,Ð l¼ Ðstandard€rates€for€services€rendered€to€BlueCare€enrollees€after€December€31,€1999,€and€thatÐ X ¨ ÐBlueCare€had€breached€the€implied€agreement;€and€(4)€a€determination€that€BlueCare€was€unjustlyÐ D!” Ðenriched€by€its€refusal€to€pay€River€Parkððs€reasonable,€standard€rates€for€services€rendered€toÐ 0"€  ÐBlueCare€enrollees€after€December€31,€1999.€€River€Park€filed€a€motion€for€expedited€discovery€andÐ #l! Ða€speedy€trial.€€BlueCare€filed€its€answer€and€a€counterclaim.€€In€its€responsive€pleading,€BlueCareÐ $X" Ðsought€a€declaratory€judgment€that€its€method€of€paying€out„of„network€providers€the€in„network€rateÐ ô$D # Ðis€authorized€by€its€risk€agreement€with€the€State€and€by€the€applicable€TennCare€regulations,€Tenn.Ð à%0!$ ÐComp.€R.€&€Regs.€ch.€1200„13„12„.08(1)€and€(2)(a)€(hereinafter€ð ðRule€1200„13„12„.08ðð).€€It€assertedÐ Ì&"% Ðthat€Rule€1200„13„12„.08€set€the€rate€to€be€paid€to€an€out„of„network€provider€such€as€River€Park€atÐ ¸'#& Ðâ âthe€same€rate€paid€to€an€in„network€provider€for€the€same€service.€Ð ¤(ô#' ÐÓ Óà  àOn€July€7,€2000,€River€Park€was€permitted€to€amend€its€complaint€to€add€an€additional€Ð ° Ðtheory€of€recovery€based€on€the€Tennessee€Consumer€Protection€Act.׃×Ý ƒ#ÃÝòòÚ  Ú6Ú  ÚóóÝ  Ý×  ×€€€River€Park€also€soughtÐ œì Ðâ âò òó óattorneyððs€fees€under€Tennessee€Code€Annotated€ðð€47„18„109(e),€which€provides€for€a€discretionaryÐ ˆØ Ðaward€to€a€prevailing€party€under€the€Tennessee€Consumer€Protection€Act.€€In€answer€to€the€amendedÐ tÄ Ðcomplaint,€BlueCare€added€a€counterclaim€for€disparagement€under€Tennessee€Code€Annotated€Ð `° Ððð€€47„18„104(b)(8),€based€on€letters€from€River€Park€to€three€local€obstetricians.€€In€the€letters,€RiverÐ L œ ÐPark€said€that€BlueCare€was€unresponsive€to€River€Parkððs€needs€and€that€BlueCareððs€efforts€to€moveÐ 8 ˆ Ðobstetrics€patients€to€in„network€hospitals€showed€ð ðBlue€Crossððs€lack€of€concern€for€the€healthcareÐ $ t Ðneeds€of€our€patients€in€Warren€County.ðð€Ð  ` ÐÌÓ Óà  àOn€July€27,€2000,€the€court€entered€an€order€bifurcating€the€trial€into€separate€liability€andÐ è 8  Ðdamages€phases.€€The€liability€phase€of€the€trial€took€place€on€July€31€and€August€1,€2000.€ò òó óÔ‡(XJ9XXXJ9Ô€DuringÐ Ô$  Ðthat€phase,€the€parties€presented€the€testimony€of€several€witnesses€regarding€the€businessÐ À  Ðrelationship€between€River€Park€and€BlueCare,€and€regarding€the€system€by€which€BlueCare€paidÐ ¬ü  ÐRiver€Park€and€other€health€care€providers€for€services€rendered€to€BlueCare€patients.€€Terry€Gunn,Ð ˜è  Ðthe€CEO€of€River€Park,€testified€two€times€during€the€hearing.€€He€asserted€that€River€Park€hadÐ „Ô  Ðallowed€its€contract€with€BlueCare€to€expire€because€the€hospital€lost€$2.3€million€in€caring€forÐ pÀ ÐBlueCare€patients€in€1999.€€Gunn€explained€that€this€loss€was€caused€by€BlueCareððs€lowÐ \¬ Ðreimbursement€rates€and€its€burdensome€utilization€review€procedures.€€Gunn€said€that€River€ParkÐ H˜ Ðrepeatedly€told€representatives€of€BlueCare€that€it€expected€to€be€paid€full,€standard€rates€for€servicesÐ 4„ Ðprovided€to€BlueCare€patients€after€the€partiesðð€contract€expired€on€December€31,€1999.€€BlueCare,Ð  p Ðon€the€other€hand,€introduced€evidence€that€BlueCare€customarily€paid€out„of„network€hospitals€theÐ  \ Ðin„network€rates€for€services€provided€to€BlueCare€patients.€€The€evidence€showed€that,€consistentÐ øH Ðwith€its€custom,€BlueCare€told€River€Park€that€it€intended€to€pay€River€Park€its€out„of„network€ratesÐ ä4 Ðfor€services€provided€to€BlueCare€patients€after€the€expiration€of€the€partiesðð€contract.€€BlueCareÐ Ð  Ðrepresentative€Michael€Morton€testified€that€he€personally€met€with€all€of€BlueCareððs€Ô_ÔPCPsÔ_Ô€in€1999Ð ¼  Ðto€inform€them€that€River€Park€would€be€an€out„of„network€hospital€as€of€December€31€of€that€year.Ô#†XJ9XX(XJ9£C#Ôò òó óÐ ¨ø Ðà  àAt€the€conclusion€of€the€proof,€on€August€29,€2000,€the€trial€court€entered€an€order€on€theÐ €Ð Ðissue€of€liability.€€The€trial€court€described€the€sequence€of€events€after€the€negotiations€betweenÐ l¼ ÐBlueCare€and€River€Park€had€reached€an€impasse:Ð X ¨ Ðà8  àBlue€Care€informed€its€PCPððs€to€admit€patients€to€other€facilities.€€However,€theÐ 0"€  ÐPCPððs€only€had€admitting€privileges€at€Riverpark.€€The€PCPððs€called€Blue€Care€onÐ #l! Ðeach€of€the€[2]400€admissions€in€question€and€after€showing€a€medical€necessity,Ð $X" Ðwere€authorized€to€admit€to€Riverpark,€a€now€ð ðnon€contractðð€provider.€€òòRiverparkÐ ô$D # Ðhad€the€right€to€refuse€the€admission€of€each€patient,€but€chose€to€admitóó€afterÐ à%0!$ Ðinforming€Blue€Care€that€it€expected€itððs€[sic]€full€regular€payment,€and€informingÐ Ì&"% ÐBlue€Care€that€it€could€transfer€the€patient€to€a€participating€facility.€€Blue€Care€didÐ ¸'#& Ðnot€transfer€nor€did€it€agree€to€pay€any€rate€other€than€the€old€contract€rate.€€TheÐ ¤(ô#' Ðpatient€was€treated€and€Blue€Care€òòdisallowed€all€2400€claimsóó,€necessitatingÐ )à$( ÐRiverpark€to€rebill€and€appeal€its€decision€to€obtain€any€payment,€even€though€theÐ ° Ðadmission€was€pre„approved.€Blue€Care€reevaluated€the€admissions€and€undertookÐ œì Ðto€show€that€many€were€not€medically€necessary.ЈØÐ Ð  Ð(Emphasis€added).€€Thus,€the€trial€courtððs€August€29€order€was€premised€on€its€finding€that€RiverÐ `° ÐPark€had€the€right€to€refuse€to€admit€the€patients€at€issue.€€The€trial€court€denied€River€Parkððs€requestÐ L œ Ðfor€a€declaratory€judgment€that€BlueCare€was€required€to€notify€its€enrollees€that€its€contract€withÐ 8 ˆ ÐRiver€Park€was€terminated,€finding€that€River€Park€lacked€standing€to€seek€a€declaratory€judgmentÐ $ t Ðunder€Tennessee€Code€Annotated€ðð€56„32„209,€or,€in€the€alternative,€that€the€issue€was€moot.€€TheÐ  ` Ðtrial€court€also€rejected€River€Parkððs€allegation€of€an€express€contract,€an€implied€contract,€unjustÐ ü L  Ðenrichment,€conversion,€and€its€claims€based€on€the€Consumer€Protection€Act.׃×Ý ƒ#ÃÝòòÚ  Ú7Ú  ÚóóÝ  Ý×  ×€€The€trial€courtÐ è 8  Ðobserved:Ð Ô$  Ðà8  àThe€Court€finds€that€while€there€is€no€contract,€expressed€or€implied,€the€Court€doesÐ ¬ü  Ðtake€note€of€Tenn€Care€Regulation€1200„13„1208.€€Riverpark€is€now€under€noÐ ˜è  Ðcontract€and€because€the€parties€have€not€agreed€on€any€rate,€nothing€less€than€theÐ „Ô  Ðprovider€contract€applies.€€Blue€Care,€by€preapproving€the€enrollee€admission€asÐ pÀ Ðmedically€necessary,€should€be€estopped€from€using€its€constructual€[sic]€utilizationÐ \¬ Ðguidelines€to€later€disapprove€payment€after€service€has€been€rendered€as€there€is€noÐ H˜ Ðcontract.Ð4„Ð Ð  ÐThe€trial€court€concluded€that€ð ðRiverpark€ò òó óis€entitled€to€be€paid€for€the€preapproved,€medicallyÐ  \ Ðnecessary€admissions€and€Blue€Careððs€arbitrary€refusal€to€pay€has€caused€Riverpark€ò òó óunnecessaryÐ øH Ðexpense€and€appeal.€€Riverparkððs€ò òó órequest€for€damages€above€the€contract€price€on€all€theories€isÐ ä4 Ðaccordingly€dismissed.ðð€€The€August€29€order€did€not€address€BlueCareððs€counterclaims€forÐ Ð  Ðdisparagement€or€ò òó óits€request€for€attorney€fees,€nor€was€the€order€certified€as€a€final€order.€€Ð ¼  Ðà  àOn€September€6,€2000,€BlueCare€filed€a€motion€for€additional€findingsò òó ó€on€its€counterclaims,Ð ”ä Ðwhich€it€claimed€were€not€addressed€in€the€trial€courtððs€August€29€order.€€On€September€18,€2000,Ð €Ð ÐRiver€Park€filed€a€motion€to€set€a€trial€date€for€the€damages€phase.€€Also€on€that€date,€River€ParkÐ l¼ Ðfiled€a€motion€for€additional€findings€of€fact€and€to€modify€the€August€29,€2000€order,€and€RiverÐ X ¨ ÐPark€sought€as€well€as€to€have€the€August€29€ruling€certified€as€a€final€order€so€that€the€parties€couldÐ D!” Ðappeal.€€In€its€motion€for€additional€findings,€ò òó óRiver€Park€requested€findings€regarding€the€rate€atÐ 0"€  Ðwhich€BlueCare€must€pay€River€Park€for€services€rendered€to€persons€who€are€deemed€to€beÐ #l! Ðð ðemergenciesðð€who,€according€to€federal€law,€may€not€be€refused€by€the€hospital.€€Responding€toÐ $X" ÐBlueCareððs€motion€for€additional€findings,€River€Park€asserted€that€BlueCare€was€not€entitled€to€seekÐ ô$D # Ðadditional€findings€on€their€counterclaimsò òó ó,€because€those€claims€were€Ô_ÔnonmeritoriousÔ_Ô.€€BlueCareÐ à%0!$ Ðresponded€to€River€Parkððs€motions,€stating€that€the€original€order€had€already€addressed€the€issuesÐ Ì&"% Ðpresented€by€River€Park,€and€that€River€Park€had€not€presented€any€new€facts€or€evidence€thatÐ ¸'#& Ðwarranted€reconsideration€of€the€trial€courtððs€initial€conclusions.€€On€September€29,€2000,€River€ParkÐ ¤(ô#' Ðfiled€an€amended€motion€for€additional€findings,€asking€the€trial€court€to€reopen€the€proof€regardingÐ ° Ðthe€provision€of€emergency€services€to€BlueCare€enrollees.€€BlueCare€opposed€that€motion€on€theÐ œì Ðgrounds€that€all€of€the€proof€on€that€issue€had€been€available€at€the€trial€on€the€liability€phase,€andÐ ˆØ Ðthus€River€Park€had€provided€the€trial€court€with€no€basis€for€reopening€the€proof.€€BlueCare€alsoÐ tÄ Ðsought€discretionary€costs€under€Rule€54.02(2)€of€the€Tennessee€Rules€of€Civil€Procedure.€€€òòò òó óóóÐ `° Ðà  àOn€November€27,€2000,€the€trial€court€held€a€hearing€on€all€of€the€partiesðð€post„trial€motions.€Ð 8 ˆ ÐThe€trial€court€granted€River€Parkððs€motion€to€reopen€the€proof€and,€at€the€hearing,€allowed€RiverÐ $ t ÐPark€to€call€two€additional€witnesses.€€River€Park€presented€testimony€from€Dr.€Otis€Campbell,€aÐ  ` Ðlocal€physician€serving€as€a€PCP€for€BlueCare.€€Dr.€Campbell€testified€that€all€of€his€patientsÐ ü L  Ðadmitted€to€River€Park€after€January€1,€2000,€were€emergencies,€and€that€all€other€BlueCare€enrolleesÐ è 8  Ðadmitted€to€River€Park€by€other€physicians€ò òó ósince€January€1,€2000,€were€also€emergencies.€€River€ParkÐ Ô$  Ðalso€presented€additional€testimony€from€Terry€Gunn,€the€CEO€of€River€Park,€who€had€testified€atÐ À  Ðthe€July€31€trial.€€Gunn€testified€that€all€of€River€Parkððs€admissions€of€BlueCare€enrollees€sinceÐ ¬ü  ÐJanuary€1,€2000,€were€emergency€admissions,€and€that€River€Park€had€directed€all€elective€BlueCareÐ ˜è  Ðpatients€to€other€facilities€since€that€date.Ð „Ô  Ðà  àOn€December€14,€2000,€the€trial€court€entered€an€order€that€superceded€the€August€29€order.€Ð \¬ ÐAs€in€the€August€29€order,€the€trial€court€rejected€River€Parkððs€request€for€a€declaratory€judgmentÐ H˜ Ðthat€BlueCare€was€required€to€notify€enrollees,€River€Parkððs€assertion€that€BlueCare€breached€an€Ð 4„ Ðexpress€or€implied€contract,€its€claim€of€conversion,€and€its€claims€under€the€Tennessee€ConsumerÐ  p ÐProtection€Act.€€The€trial€court,€however,€changed€its€ruling€on€River€Parkððs€claim€of€unjustÐ  \ Ðenrichment€and€held€in€favor€of€River€Park.€€The€trial€court€determined€that,€contrary€to€its€initialÐ øH Ðfindings€in€the€August€29€order,€River€Park€did€òònotóó€have€the€right€to€refuse€the€admission€of€eachÐ ä4 ÐBlueCare€patient.€€Rather,€the€trial€court€found€that,€for€the€127€inpatient€admissions€at€issue,€ð ðRiverÐ Ð  ÐPark€had€no€choice€but€to€provide€these€patients€with€hospital€servicesðð€because€they€were€allÐ ¼  Ðemergency€admissions.€€With€respect€to€patients€who€visited€River€Parkððs€emergency€room,€the€trialÐ ¨ø Ðcourt€found:Ð ”ä ÐÓ Óà8  àà ` àBetween€January€1,€2000€and€June€30,€2000,€there€were€1799€visits€byÐ l¼ ÐBlueCare€enrollees€to€River€Parkððs€emergency€room.€€Since€June€30,€2002,€there€haveÐ X ¨ Ðbeen€many€more.€€BlueCare€has€only€paid€River€Park€amounts€calculated€atÐ D!” ÐBlueCareððs€old€contract€rate€for€those€visits€and€refused€to€pay€River€Parkððs€bills€atÐ 0"€  Ðis€regular,€customary€rates€as€invoiced.€€By€federal€law€River€Park€must€provide€theseÐ #l! Ðemergency€services€to€any€patient€without€regard€to€insurance€until€the€patient€isÐ $X" Ðstabilized.€€BlueCare€is€legally€obligated€by€its€contract€with€the€State€to€pay€forÐ ô$D # Ðemergency€medical€services€provided€to€its€enrollees.€€There€was€no€agreementÐ à%0!$ Ðâ âconcerning€the€amount€of€payment€for€these€emergency€services.ÐÌ&"%Ð Ð  ÐÓ ÓBased€on€these€new€findings,€the€trial€court€held€that€BlueCare€had€been€unjustly€enriched€byÐ ° Ðreceiving€services€provided€to€its€enrollees€by€River€Park€after€January€1,€2000.׃×Ý ƒ#ÃÝòòÚ  Ú8Ú  ÚóóÝ  Ý×  ×€€BlueCareððsÐ œì Ðâ âcounterclaims€based€on€disparagement€and€the€Consumer€Protection€Act€were€rejected,€and€the€trialÐ ˆØ Ðcourt€denied€BlueCareððs€motion€for€discretionary€costs.€€The€December€14€order€was€certified€asÐ tÄ Ðfinal€for€purposes€of€appeal€pursuant€to€Rule€54.02€of€the€Tennessee€Rules€of€Civil€Procedure.€€BothÐ `° Ðparties€now€appeal€that€order.׃ ×Ý ƒ#ÃÝòòÚ  Ú9Ú  ÚóóÝ  Ý×  ×€€In€addition,€the€Tennessee€Hospital€Association€and€the€TennesseeÐ L œ ÐMedical€Association€have€filed€amicus€curie€briefs.€€€€Ð 8 ˆ Ðà  àBlueCare€first€argues€that€the€trial€court€erred€in€reopening€the€proof€and€in€making€additionalÐ  ` Ðfindings€of€fact€because€all€of€the€proof€was€available€prior€to€the€July€31€hearing€on€liability.€Ð ü L  ÐBlueCare€also€claims€that€it€was€error€to€admit€River€Parkððs€post„trial€evidence€because€it€violatedÐ è 8  Ðthe€personal€knowledge,€hearsay,€and€best€evidence€rules.€€BlueCare€claims€as€well€that€the€evidenceÐ Ô$  Ðshould€be€excluded€because€River€Park€violated€the€discovery€rules€by€failing€to€discloseÐ À  Ðinformation.€€On€the€trial€courtððs€ruling€that€BlueCare€was€unjustly€enriched€by€receiving€RiverÐ ¬ü  ÐParkððs€treatment€of€its€enrollees,€BlueCare€maintains€that€even€if€BlueCare€were€enriched,€suchÐ ˜è  Ðenrichment€was€not€unjust.€€BlueCare€also€argues€that€the€trial€court€erred€in€denying€itsÐ „Ô  Ðcounterclaims€based€on€disparagement€and€the€Consumer€Protection€Act.€€Finally,€BlueCare€assertsÐ pÀ Ðthat€the€trial€court€erred€in€rejecting€its€claim€for€discretionary€costs.€€Ð \¬ Ðà  àRiver€Park€appeals€as€well,€arguing€that€the€trial€court€erred€in€dismissing€its€breach€ofÐ 4„ Ðcontract,€conversion,€and€Consumer€Protection€Act€claims.€€However,€River€Park€asks€this€Court€toÐ  p Ðaffirm€the€trial€courtððs€conclusion€that€BlueCare€was€unjustly€enriched,€its€denial€of€BlueCareððsÐ  \ Ðcounterclaims,€and€its€denial€of€BlueCareððs€motion€for€discretionary€costs.€€In€their€amicus€briefs,Ð øH Ðthe€Tennessee€Hospital€Association€and€the€Tennessee€Medical€Association€join€in€the€argumentsÐ ä4 Ðmade€by€River€Park€on€the€claim€of€unjust€enrichment.€€The€Tennessee€Hospital€Association€arguesÐ Ð  Ðthat€the€rate€of€reimbursement€for€an€out„of„network€provider€such€as€River€Park€is€governed€by€the€Ð ¼  Ðcommon€law,€not€the€regulation€relied€upon€by€BlueCare.€€Ð ¨ø Ðà  àWe€review€the€trial€courtððs€findings€of€fact€de€novo€upon€the€record,€accompanied€by€aÐ €Ð Ðpresumption€of€correctness€of€those€findings€unless€the€preponderance€of€the€evidence€is€otherwise.€Ð l¼ ÐTenn.€R.€App.€P.€13(d).€€We€afford€no€such€presumption€to€the€trial€courtððs€conclusions€of€law.€òòò òÔ‡(XJ9XXXJ9ÔSeeóóó óÐ X ¨ Ðòòò òState€v.€Ô_ÔLevandowskiÔ_Ôó óóó,€955€S.W.2d€603,€604€(Tenn.€1997);€ò òòòÔ_ÔRidingsÔ_Ô€v.€Ralph€M.€Parsons€Co.,óóó ó€914Ð D!” ÐS.W.2d€79,€80€(Tenn.€1996).Ô#†XJ9XX(XJ9!}#ÔÐ 0"€  Ðò òòòó óóóà  àAt€the€outset,€BlueCare€argues€at€length€that€the€trial€court€abused€its€discretion€in€reopeningÐ $X" Ðthe€proof€to€allow€for€the€admission€of€additional€evidence€and€in€changing€its€decision€based€on€thatÐ ô$D # Ðevidence.€€BlueCare€emphasizes€that€all€of€the€additional€evidence€submitted€by€River€Park€wasÐ ° Ðavailable€at€the€time€of€the€July€31€hearing,€and€argues€that,€under€ò òòòHarris€v.€Ô_ÔChernÔ_Ôó óóó,€33€S.W.3d€741Ð œì Ð(Tenn.€2000),€River€Park€has€shown€no€justification€for€re„opening€the€proof.€€BlueCare€has€a€validÐ ˆØ Ðpoint;€however,€assuming€Ô_ÔarguendoÔ_Ô€that€the€trial€court€erred€in€reopening€the€proof,€any€error€in€thisÐ tÄ Ðregard€would€be€harmless€error.€€The€additional€testimony€admitted€in€the€November€27€hearing€onlyÐ `° Ðreiterated€the€point€argued€by€counsel€in€the€July€31€hearing,€namely,€that€River€Park€soughtÐ L œ Ðreimbursement€only€for€services€rendered€in€emergency€cases,€and€established€that€the€127€inpatientÐ 8 ˆ Ðcases€listed€in€Exhibit€31€should€be€included€in€the€category€of€emergency€cases.€€River€ParkÐ $ t Ðsubmitted€substantial€evidence€at€the€July€31€hearing€regarding€the€effects€of€EMTALA.׃9×Ý ƒ#ÃÝòòÚ  Ú10Ú  ÚóóÝ  Ý×  ×€€Moreover,Ð  ` Ðit€is€undisputed€that€River€Park€is€obligated€under€EMTALA€to€render€services€to€emergency€patientsÐ ü L  Ðwithout€regard€to€insurance.€€Therefore,€the€trial€courtððs€initial€conclusion€that€River€Park€ð ðhad€theÐ è 8  Ðright€to€refuse€the€admission€of€each€patientðð€authorized€by€BlueCare€was€obviously€wrong.€€Clearly,Ð Ô$  Ðthe€trial€court€could€correct€its€erroneous€factual€finding,€and€it€could€have€done€so€without€theÐ À  Ðbenefit€of€additional€evidence.€€The€trial€court€indicated€at€the€November€27€hearing€ò òó óthat€it€wasÐ ¬ü  Ðinclined€to€reconsider€its€earlier€finding,€commenting€that€it€had€ð ðhad€second€thoughts€about€theÐ ˜è  Ðissue€of€unjust€enrichmentðð€prior€to€the€rehearing.׃%Ü×Ý ƒ#ÃÝòòÚ  Ú11Ú  ÚóóÝ  Ý×  ׀Р„Ô  Ðà  àOne€of€the€trial€courtððs€revised€findings€may€have€been€based€on€the€additional€testimony,Ð \¬ Ðnamely,€that€the€127€inpatient€admissions€listed€in€Exhibit€31€were€emergency€cases.€€This€proof,Ð H˜ Ðhowever,€is€not€determinative€of€the€overall€issue€of€whether€River€Park€is€entitled€to€receiveÐ 4„ Ðadditional€compensation€for€providing€emergency€services€to€BlueCare€enrollees.€€Rather,€it€isÐ  p Ðpertinent€to€the€amount€of€additional€compensation€to€which€River€Park€is€entitled,€i.e.,€the€damages.€Ð  \ ÐThus,€had€the€trial€court€not€heard€this€testimony€at€the€November€27€hearing,€it€could€hear€theÐ øH Ðevidence€in€the€damages€phase€of€the€bifurcated€proceedings.׃,×Ý ƒ#ÃÝòòÚ  Ú12Ú  ÚóóÝ  Ý×  ×€€€Under€all€of€these€circumstances,Ð ä4 Ðwe€must€conclude€that,€even€assuming€the€trial€court€erred€in€admitting€additional€testimony,€anyÐ Ð  Ðsuch€error€must€be€deemed€harmless€and€is€not€a€basis€for€reversal€on€appeal.€€This€holdingÐ ¼  Ðpretermits€BlueCareððs€arguments€that€the€additional€testimony€was€not€admissible€because€it€violatedÐ ¨ø Ðthe€personal€knowledge,€hearsay€and€best€evidence€rules,€and€the€argument€that€it€should€have€beenÐ ”ä Ðexcluded€because€River€Park€violated€the€discovery€rules.€€Ð €Ð Ðà  àBoth€parties€argue€issues€related€to€their€claims€based€on€contract.€€River€Park€argues€that€theÐ ° Ðtrial€court€erred€in€finding€that€the€parties€had€no€implied€agreement€that€BlueCare€would€pay€RiverÐ œì ÐPark€its€full€standard€rate€for€out„of„network€emergency€services€provided€to€BlueCare€enrollees.€Ð ˆØ ÐBlueCare€maintains€that€the€rate€to€be€paid€an€out„of„network€provider€such€as€River€Park€isÐ tÄ Ðestablished€by€regulation,€Rule€1200„13„12„.08,€and€that€since€this€rule€establishes€the€rate€BlueCareÐ `° Ðpaid,€there€was€no€unjust€enrichment.€€We€address€first€the€regulation€relied€upon€by€BlueCare,€andÐ L œ Ðthen€discuss€the€existence€of€a€contract.Ð 8 ˆ Ðà  àBlueCare€argues€that€it€was€authorized€to€pay€River€Park€its€in„network€rates€by€Rule€1200„Ð  ` Ð13„12„.08,€which€provides€in€pertinent€part:Ð ü L  Ðà8  àà ` à(1)€In€situations€where€a€managed€care€organization€authorizes€a€serviceÐ Ô$  Ðrendered€by€a€provider€who€is€not€under€contract€with€the€managed€care€organization,Ð À  Ðpayment€to€the€provider€òòcannot€be€less€than€the€amount€that€would€have€been€paidÐ ¬ü  Ðto€a€provider€under€contract€óówith€the€managed€care€organization€for€the€sameÐ ˜è  Ðservice.€€As€a€condition€of€payment,€òònon„contract€providers€shall€accept€paymentÐ „Ô  Ðfrom€managed€care€organizations€as€payment€in€full€óóexcept€for€applicableÐ pÀ Ðdeductibles,€co„payments€and€special€fees.Ð\¬Ð Ð  Ðà8  àà ` à(2)€Participation€in€the€TennCare€program€will€be€limited€to€providers€who:Ð4„Ð Ð  Ðà8  àà ` à(a)€òòAccept,€as€payment€in€full,€the€amounts€paid€by€the€managed€careÐ  \ Ðorganizationóó,€including€enrollee€cost„sharing,€or€the€amounts€paid€in€lieu€of€theÐ øH Ðmanaged€care€organization€by€a€third€party€(Medicare,€insurance,€etc.)€.€.€.€.€€€€Ðä4Ð Ð  ÐTenn.€Comp.€R.€&€Regs.€ch.€1200„13„12„.08(1)€and€(2)(a)€(emphasis€added).€€The€parties€agree€€thatÐ ¼  Ðthis€regulation€sets€a€ð ðfloorðð€for€the€payment€for€such€services,€by€stating€that€ð ðpayment€to€the€[out„Ð ¨ø Ðof„network]€provider€cannot€be€less€than€the€amount€that€would€have€been€paid€to€[an€in„network]Ð ”ä Ðprovider.ðð€€However,€BlueCare€insists€that€this€regulation€also€creates€a€ð ðceiling,ðð€that€is,€a€Ð €Ð Ðmaximum€required€payment.€€BlueCare€relies€on€the€language€in€the€regulation€stating€that,€ð ð[a]s€aÐ l¼ Ðcondition€of€payment,€non„contract€providers€shall€accept€payment€from€managed€care€organizationsÐ X ¨ Ðas€payment€in€full€.€.€.€.ðð€€BlueCare€argues€that€the€plain€and€ordinary€meaning€of€the€regulation€isÐ D!” Ðthat,€in€order€to€participate€in€TennCare,€non„network€providers€must€accept€the€in„network€rate€fromÐ 0"€  ÐMCOs€as€payment€in€full.€Ð #l! Ðà  àRiver€Park€argues€that€the€ð ðshall€acceptðð€provision€in€the€regulation€is€intended€to€be€aÐ ô$D # Ðprohibition€on€ð ðbalance€billing,ðð€the€practice€of€the€provider€billing€the€enrollee€for€any€amountÐ à%0!$ Ðcharged€by€the€provider€but€not€paid€by€the€MCO.€€River€Park€asserts€that€the€regulation€requires€theÐ Ì&"% Ðprovider€to€accept€payment€from€the€MCO€ð ðas€payment€in€fullðð€only€as€against€the€enrollee,€not€asÐ ¸'#& Ðagainst€the€MCO.€€In€other€words,€the€regulation€establishes€a€floor,€but€not€a€ceiling;€it€does€notÐ ¤(ô#' Ðprevent€the€MCO€and€the€provider€from€reaching€an€agreement€for€the€MCO€to€pay€an€out„of„Ð )à$( Ðnetwork€provider€a€rate€higher€than€that€paid€to€in„network€providers.Ð |*Ì%) Ðà  àIn€support€of€its€argument€that€the€regulation€relied€upon€by€BlueCare€is€intended€to€prohibitÐ ° Ðbalance€billing,€River€Park€notes€that€a€Tennessee€statute€requires€that€TennCare€provider€contractsÐ œì Ðinclude€a€clause€prohibiting€billing€the€MCO€enrollee€for€anything€except€ð ðreasonable€copaymentÐ ˆØ Ðand€uncovered€expenses.ðð€€Tenn.€Code€Ann.€ðð€56„32„205(c).€€Pursuant€to€this€statute,€the€riskÐ tÄ Ðagreement€entered€into€between€the€State€of€Tennessee€and€the€MCO€prohibits€a€provider€fromÐ `° Ðbilling€an€enrollee€for€amounts€other€than€deductibles,€coinsurance€and€specifies€ð ðexcept€asÐ L œ Ðpermitted€by€TennCare€Rule€1200„13„12.08.€.€.€.ðð€€Contractor€Risk€Agreement€Paragraph€203.k.€Ð 8 ˆ ÐBoth€River€Park€and€the€Tennessee€Hospital€Association€maintain€that€interpreting€the€regulationÐ $ t Ðas€requiring€a€health€care€provider€that€is€out„of„network€to€accept€as€payment€in€full€theÐ  ` Ðreimbursement€rate€set€by€the€MCO€for€in„network€providers€is€inconsistent€with€one€of€the€statedÐ ü L  Ðgoals€of€TennCare,€that€is,€to€remove€the€State€from€being€involved€in€setting€rates€for€health€careÐ è 8  Ðservices€and€allow€rates€to€be€set€by€the€market.€Ð Ô$  Ðà  àConsidering€the€language€in€Rule€1200„13„12„.08€and€the€arguments€on€appeal,€we€mustÐ ¬ü  Ðconclude€that€the€regulation€was€intended€to€prevent€balance€billing€as€against€an€enrollee€and€wasÐ ˜è  Ðnot€intended€to€allow€MCOs€to€unilaterally€set€maximum€reimbursement€rates€for€out„of„networkÐ „Ô  Ðproviders.€€The€language€in€the€Rule€is€clearly€a€floor,€stating€expressly€that€the€reimbursement€rateÐ pÀ Ðfor€a€non„contract€provider€ð ðcannot€be€lessðð€than€the€amount€paid€to€a€contract€provider.€€There€is,Ð \¬ Ðhowever,€no€language€that€makes€this€amount€a€ceiling;€the€regulation€does€not€say€that€the€amountÐ H˜ Ðpaid€to€a€non„contract€provider€ð ðcannot€be€moreðð€than€the€amount€paid€to€a€contract€provider,€norÐ 4„ Ðdoes€it€say€that€the€amounts€paid€to€contract€providers€and€non„contract€providers€must€be€the€same.€Ð  p ÐThe€regulation€states€that€a€non„contract€provider€ð ðshall€accept€paymentðð€from€the€MCO€ð ðas€paymentÐ  \ Ðin€full€except€for€applicable€deductibles,€co„payments€and€special€fees.ðð€€This€must€be€read€inÐ øH Ðconjunction€with€the€Tennessee€statute€requiring€TennCare€provider€contracts€to€prohibit€billingÐ ä4 Ðenrollees€for€anything€except€co„payments€and€uncovered€expenses,€as€well€as€the€risk€agreementÐ Ð  Ðexecuted€by€BlueCare€which€prohibits€a€provider€from€billing€an€enrollee€for€anything€other€thanÐ ¼  Ðdeductibles,€coinsurance€and€special€fees€ð ðexcept€as€permitted€by€TennCare€Rule€1200„13„12.08.Ð ¨ø Ð.€.€.ðð€€Ð ”ä Ðà  àIndeed,€BlueCareððs€interpretation€would€be€anomalous€to€the€whole€TennCare€scheme,Ð l¼ Ðwhereby€the€State€has€disavowed€the€task€of€setting€provider€rates€but€instead€seeks€to€rely€on€marketÐ X ¨ Ðforces.€€In€setting€up€TennCare,€the€State€submitted€to€the€federal€government€a€waiver€request,Ð D!” Ðseeking€to€waive€certain€Medicaid€requirements€in€order€to€establish€the€TennCare€program.€€In€theÐ 0"€  ÐTennCare€Waiver€Application,€the€State€asserts€that€TennCare€will€use€ð ðtraditional€market€forcesÐ #l! Ðto€assure€acceptable€levels€of€price,€quantity€and€quality€of€service.ðð€€The€Waiver€Application€statesÐ $X" Ðthat€ð ð[t]he€State€will€no€longer€be€involved€in€setting€the€rates€for€individual€providers.ðð€€ò òòòó óóóIt€wouldÐ ô$D # Ðbe€contrary€to€this€avowed€goal€to€interpret€the€regulation€as€involving€the€State€in€setting€maximumÐ à%0!$ Ðprovider€rates.€€Moreover,€BlueCareððs€interpretation€produces€an€inequitable€result,€giving€BlueCareÐ Ì&"% Ðundue€leverage€in€establishing€reimbursement€rates.€€BlueCare€argues€that€the€rate€is€set€byÐ ¸'#& Ðð ðnegotiationðð€and€market€forces,€but€the€negotiation€is€between€BlueCare€and€its€in„networkÐ ¤(ô#' Ðproviders,€not€between€BlueCare€and€River€Park.€€It€is€unreasonable€to€require,€by€regulation,€aÐ )à$( Ðhealth€care€provider€who€chooses€to€leave€BlueCareððs€network€because€the€reimbursement€ratesÐ |*Ì%) Ðresulted€in€consistent€losses€to€nevertheless€be€forced€to€accept€the€same€reimbursement€rates€afterÐ h+¸&* Ðleaving€BlueCareððs€network.€€On€the€whole,€we€conclude€that€Rule€1200„13„12„.08€must€beÐ ° Ðinterpreted€to€prohibit€balance€billing€against€MCO€enrollees,€and€not€to€authorize€MCOs€toÐ œì Ðunilaterally€cap€reimbursement€rates€for€non„contract€providers.€€Thus,€the€reimbursement€rate€to€beÐ ˆØ Ðpaid€River€Park€in€this€case€is€not€governed€by€Rule€1200„13„12„.08.Ð tÄ Ðà  àConsequently,€we€next€address€the€issues€related€to€breach€of€contract€and€unjust€enrichment.€Ð L œ ÐRiver€Park€argues€that€the€circumstances€warranted€a€finding€of€at€least€an€implied€agreement,€if€notÐ 8 ˆ Ðan€express€agreement,€that€BlueCare€would€pay€River€Park€its€full€standard€rates€for€emergencyÐ $ t Ðhealth€care€services€provided€to€BlueCare€enrollees.€€BlueCare€maintains€that€the€trial€court€did€notÐ  ` Ðerr€in€finding€there€was€no€agreement,€express€or€implied,€that€BlueCare€would€pay€River€Parkððs€fullÐ ü L  Ðstandard€rates,€but€argues€that€the€trial€court€erred€in€finding€unjust€enrichment.€€BlueCareððsÐ è 8  Ðargument€is€based€in€part€on€the€regulation€discussed€above;€in€addition,€BlueCare€asserts€that€itÐ Ô$  Ðrepeatedly€ð ðadvisedðð€and€ð ðinformedðð€River€Park€that€BlueCare€would€pay€no€more€than€its€standardÐ À  Ðin„network€rates,€as€set€out€in€the€BlueCare€provider€services€manual,€and€that€this€practice€isÐ ¬ü  Ðconsistent€with€ð ðindustry€customðð€for€MCOs€in€Tennessee.€Ð ˜è  Ðà  àGenerally,€contracts€can€be€either€express,€implied€in€fact,€or€implied€in€law.€ò òòòóóó ó€ExpressÐ pÀ Ðcontracts€and€contracts€implied€in€fact€result€from€a€meeting€of€the€minds€of€the€contracting€parties;Ð \¬ Ðthe€parties€mutually€assent€to€the€contractððs€terms.€€ò òòòSee€Whitmore€v.€Jonesó óóó,€No.€02A01„9901„CV„Ð H˜ Ð00002,€1999€Tenn.€App.€LEXIS€430,€at€*7„*8€(Tenn.€Ct.€App.€July€2,€1999)€(citing€òòò òJohnson€v.Ð 4„ ÐCentral€Ô_ÔNatððlÔ_Ô€Ins.€Co.€of€Omahaóóó ó,€356€S.W.2d€277,€281€(Tenn.€Ct.€App.€1962)).€€In€order€to€beÐ  p Ðenforceable,€such€contracts€must€be€sufficiently€definite€and€must€be€based€on€consideration.€€òòò òId.óóó ó€Ð  \ ÐThe€primary€difference€between€an€express€contract€and€a€contract€implied€in€fact€is€the€manner€inÐ øH Ðwhich€the€parties€manifest€their€assent.€ò òòòóóó ó€7€òòTenn.€Am.€Jur.€2dóó€òòContractsóó€ðð€98€(1997).€€In€an€expressÐ ä4 Ðcontract,€the€parties€assent€to€the€terms€of€the€contract€by€means€of€words,€writings,€or€some€otherÐ Ð  Ðmode€of€expression.€€ò òòòSee€Computer€Shoppe,€Inc.€v.€Stateó óóó,€780€S.W.2d€729,€735€(Tenn.€Ct.€App.Ð ¼  Ð1989).€€In€a€contract€implied€in€fact,€the€conduct€of€the€parties€and€the€surrounding€circumstancesÐ ¨ø Ðshow€mutual€assent€to€the€terms€of€the€contract.€€òòò òSeeó óóó€òòò òAngus€v.€City€of€Jacksonó óóó,€968€S.W.2d€804,Ð ”ä Ð808€(Tenn.€Ct.€App.€1997).Ð €Ð Ðà  àIn€contrast,€contracts€implied€in€law€ð ðare€created€by€law€without€the€assent€of€the€partyÐ X ¨ Ðbound,€on€the€basis€that€they€are€dictated€by€reason€and€justice.ðð€€ò òòòId.€€óóó óThe€Tennessee€Supreme€CourtÐ D!” Ðhas€recognized€that€contracts€implied€in€law€are€also€discussed€in€terms€of€unjust€enrichment,€quasiÐ 0"€  Ðcontract,€and€quantum€Ô_ÔmeruitÔ_Ô:Ð #l! Ðà8  àò òòòActions€brought€upon€theories€of€unjust€enrichment,€quasi€contract,€contractsÐ ô$D # Ðimplied€in€law,€and€quantum€meruit€are€essentially€the€same.óóó ó€€Courts€frequentlyÐ Ü%,!$ Ðemploy€the€various€terminology€interchangeably€to€describe€that€class€of€impliedÐ È&"% Ðobligations€where,€on€the€basis€of€justice€and€equity,€the€law€will€impose€aÐ ´'#& Ðcontractual€relationship€between€the€parties,€regardless€of€their€assent€thereto.Р(ð#'Ð Ð  Ðò òòòÔ_ÔPaschallÔ_Ôððs,€Inc.€v.€Dozieróóó ó,€407€S.W.2d€150,€154€(Tenn.€1966)€(emphasis€added);€ò òòòsee€alsoóóó óÐ x*È%) Ðò òòòWhitehaven€Cmty.€Baptist€Church€v.€Hollowayóóó ó,€973€S.W.2d€592,€596€(Tenn.€1998)€(stating€thatÐ d+´&* Ðð ð[u]njust€enrichment€is€a€quasi„contractual€theory€under€which€a€court€may€impose€a€contractualÐ ° Ðobligation€on€the€parties€where€one€does€not€otherwise€existðð).€€In€order€to€establish€a€claim€basedÐ œì Ðon€this€type€of€contract,€the€plaintiff€must€show€that€(1)€a€benefit€has€been€conferred€upon€theÐ ˆØ Ðdefendant;€(2)€the€defendant€appreciated€the€benefit;€and€(3)€acceptance€of€the€benefit€under€theÐ tÄ Ðcircumstances€would€make€it€inequitable€for€the€defendant€to€retain€the€benefit€without€paying€theÐ `° Ðvalue€of€the€benefit.€€ò òòòAngusóóó ó,€968€S.W.2d€at€808€(quoting€òòò òPaschallððsó óóó,€407€S.W.2d€at€155).€€€€€€€€€€€€€Ð L œ Ðò òòòóóó óà  àFirst,€River€Park€argues€that€the€trial€court€should€have€found€that€these€parties€had€anÐ $ t Ðexpress€agreement,€or€at€least€an€agreement€implied€in€fact,€for€River€Park€to€provide€services€toÐ  ` ÐBlueCare€enrollees€at€the€hospitalððs€standard€rates.€€River€Park€asserts€that€such€a€contract€wasÐ ü L  Ðformed€each€time€BlueCare€gave€an€authorization€number€to€its€PCP,€authorizing€treatment€at€RiverÐ è 8  ÐPark.€€River€Park€points€out€that€EMTALA€requires€the€hospital€to€treat€emergency€patients,€andÐ Ô$  ÐBlueCareððs€contract€with€the€State€requires€BlueCare€to€pay€for€those€emergency€services.€€ò òòòSeeÐ À  Ðóóó óContractor€Risk€Agreement€ðððð€2„3.m.1,€2„3.w.€€River€Park€emphasizes€that€it€told€BlueCare€onÐ ¬ü  Ðnumerous€occasions€that€it€expected€full€payment€for€services€rendered€to€BlueCare€enrollees€afterÐ ˜è  ÐJanuary€1,€2000.€€Because€BlueCare€knew€of€this€expectation,€and€because€River€Park€never€agreedÐ „Ô  Ðto€accept€reduced€rates,€River€Park€claims€that€BlueCare€either€expressly€or€impliedly€agreed€to€payÐ pÀ ÐRiver€Park€its€full,€standard€rates.€€Ð \¬ Ðà  àAs€noted€above,€both€express€contracts€and€contracts€implied€in€fact€require€mutual€assentÐ 4„ Ðof€the€parties.€ò òòòSee€Jamestowne€on€Signal,€Inc.€v.€First€Fed.€Sav.€&€Loan€Assððnó óóó,€807€S.W.2d,€559,Ð  p Ð564€(Tenn.€Ct.€App.€1995).€€ò òó óIn€this€case,€ò òòòóóó óthe€parties€engaged€in€months€of€negotiations€and€attendedÐ  \ Ðseveral€meetings€in€an€attempt€to€agree€on€a€mutually€acceptable€reimbursement€rate€for€treatmentÐ øH Ðprovided€after€January€1,€2000.€€On€occasion,€River€Park€offered€to€accept€discounted€rates€ofÐ ä4 Ðreimbursement€under€certain€conditions;€in€fact,€River€Parkððs€final€offer€included€an€agreement€toÐ Ð  Ðaccept€BlueCareððs€in„network€rates€if€BlueCare€would€agree€to€waive€its€utilization€managementÐ ¼  Ðprocedures.€€BlueCare,€however,€never€agreed€to€any€of€River€Parkððs€proposals.€€BlueCare€repeatedlyÐ ¨ø Ðtold€River€Park€that€it€maintained€a€policy€of€not€negotiating€rates€with€individual€hospitals,€and€thatÐ ”ä Ðit€intended€to€pay€its€own€in„network€rates€for€any€services€provided€to€BlueCare€patients.€€The€factÐ €Ð Ðthat€BlueCare€authorized€its€PCPs€to€attempt€to€admit€patients€to€River€Park€is€unavailing,€becauseÐ l¼ Ðthese€admissions€were€for€emergency€patients€and€therefore€were€based€on€medical€necessity.€Ð X ¨ ÐBlueCareððs€authorization€of€these€admissions€was€not€an€implied€agreement€to€pay€River€ParkððsÐ D!” Ðstandard€rates.€€Under€these€circumstances,€we€cannot€find€that€BlueCare€either€expressly€orÐ 0"€  Ðimpliedly€assented€to€pay€River€Parkððs€standard€rates€for€services€provided€to€BlueCare€enrollees.€Ð #l! ÐThere€being€no€mutual€assent€between€the€parties€on€this€point,€we€affirm€the€trial€courtððsÐ $X" Ðdetermination€that€there€was€no€express€or€implied€agreement€between€the€parties€for€the€rate€ofÐ ô$D # Ðreimbursement€for€emergency€care€provided€to€BlueCare€enrollees€after€January€1,€2000.€€òòò òSeeÐ à%0!$ ÐJohnsonóóó ó,€356€S.W.2d€at€281.€€€Ð Ì&"% Ðà  àWe€next€address€the€finding€that€BlueCare€was€unjustly€enriched.€€The€trial€court€determinedÐ ¤(ô#' Ðthat€ð ðBlueCare€has€been€unjustly€enriched€by€River€Parkððs€provision€of€services€to€BlueCareÐ )à$( Ðenrollees.€€River€Park€is€entitled€to€recover€damages€for€this€unjust€enrichment€in€an€amount€to€beÐ |*Ì%) Ðdetermined€in€the€damages€phase€of€trial.ðð€€It€is€apparent€that€a€critical€factor€in€the€trial€courtððsÐ h+¸&* Ðdecision€was€its€revised€finding€that€River€Park€sought€recovery€only€for€the€ð ðemergencyðð€patients,Ð ° Ðwhich€it€was€required€to€treat€under€EMTALA.€€The€trial€court€emphasized€this€factor,€stating€moreÐ œì Ðthan€once€that€ð ðRiver€Park€had€no€choice€but€to€provide€these€[emergency]€patients€with€hospitalÐ ˆØ Ðservices.ðð׃×Ý ƒ#ÃÝòòÚ  Ú13Ú  ÚóóÝ  Ý×  ×€€Other€factors€noted€by€the€trial€court€were€that:€(1)€six€of€the€PCPs€for€BlueCare€hadÐ tÄ Ðadmitting€privileges€only€at€River€Park;€(2)€each€time€BlueCare€authorized€an€admission€to€RiverÐ `° ÐPark,€a€River€Park€representative€informed€BlueCare€that€it€expected€full€customary€payment€for€anyÐ L œ Ðservices€provided;€(3)€though€River€Park€gave€BlueCare€the€opportunity,€BlueCare€did€not€instructÐ 8 ˆ Ðits€PCPs€to€transfer€the€emergency€patients€to€an€in„network€hospital;€and€(4)€BlueCare€disallowedÐ $ t Ðall€of€River€Parkððs€claims€when€they€were€filed,€requiring€River€Park€to€expend€time€and€money€inÐ  ` Ðrebilling€and€appealing€in€order€to€obtain€any€payment,€and€that€this€pattern€continued€from€the€JulyÐ ü L  Ð31€hearing€to€the€November€27€hearing.Ð è 8  Ðà  àAs€noted€above,€the€terms€ð ðunjust€enrichmentðð€and€ð ðcontract€implied€in€lawðð€are€usedÐ À  Ðvirtually€interchangeably.€€ò òòòSee€Paschallððsó óóó,€407€S.W.2d€at€154.€€In€this€case,€both€parties€wereÐ ¬ü  Ðrequired€to€deal€with€one€another;€neither€had€any€choice.€€When€presented€with€an€emergencyÐ ˜è  Ðpatient,€either€through€the€emergency€room€or€through€admission€by€a€PCP,€under€the€EMTALA,Ð „Ô  ÐRiver€Park€has€no€choice€except€to€treat€the€patient,€regardless€of€whether€the€patient€is€a€BlueCareÐ pÀ Ðenrollee.€€Likewise,€under€its€risk€agreement€with€the€State,€BlueCare€is€required€to€pay€forÐ \¬ Ðemergency€medical€services€for€its€enrollees,€whether€the€services€are€provided€by€an€in„networkÐ H˜ Ðprovider€or€by€an€out„of„network€provider€such€as€River€Park.€€The€Contractor€Risk€AgreementÐ 4„ Ðprovides:Ð  p Ðà8  àThe€CONTRACTOR€[BlueCare]ððs€plan€shall€include€provisions€governingÐ øH Ðutilization€of€any€payment€by€the€CONTRACTOR€for€emergency€medical€servicesÐ ä4 Ðreceived€by€an€enrollee€from€non„contract€providers€.€.€.€.€Coverage€of€emergencyÐ Ð  Ðmedical€services€shall€not€be€subject€to€prior€authorization€by€the€CONTRACTOR.м Ð Ð  Ðà@$$(ìà*€*€*ˆÐ ”ä Ðà8  àThe€Contractor€shall€be€required€to€pay€for€all€emergency€medical€services€which€areÐ l¼ Ðmedically€necessary€until€the€clinical€emergency€is€stabilized.€€This€includes€allÐ X ¨ Ðmedical€services€that€may€be€necessary€to€assure,€within€reasonable€medicalÐ D!” Ðprobability,€that€no€material€deterioration€of€the€patientððs€condition€is€likely€to€resultÐ 0"€  Ðfrom,€or€occur€during,€discharge€of€the€patient€or€transfer€of€the€patient€to€anotherÐ #l! Ðfacility.Ð$X"Ð Ð  ЇThus,€while€neither€of€these€parties€may€have€wanted€to€deal€with€the€other,€both€were€left€with€noÐ ° Ðchoice.€€Under€these€circumstances,€we€must€find€a€contract€implied€in€law,€without€the€assent€ofÐ œì Ðeither€party,€on€the€basis€that€it€is€ð ðdictated€by€reason€and€justice.ðð€€ò òòòAngusó óóó,€968€S.W.2d€at€808.€Ð ˆØ ÐThus,€the€trial€courtððs€finding€of€a€contract€implied€in€law,€i.e.,€unjust€enrichment,€is€affirmed.Ð tÄ Ðà  àUnder€these€circumstances,€the€trial€court€must€determine€a€reasonable€rate€of€reimbursementÐ L œ Ðfor€all€of€the€emergency€admissions€at€issue.€€River€Park€argues€that€it€is€entitled€to€its€full€standardÐ 8 ˆ Ðrate€because€it€repeatedly€insisted€on€this€rate€with€BlueCare.€€River€Parkððs€standard€rate€for€itsÐ $ t Ðservices€is€pertinent€to€the€determination€of€a€reasonable€rate,€but€hardly€conclusive.€€Likewise,Ð  ` ÐBlueCare€maintains€that€its€reimbursement€rate€for€in„network€providers€is€clearly€a€reasonable€rate,Ð ü L  Ðand€relies€heavily€on€its€BlueCare€provider€services€manual€was€well€as€on€ð ðindustry€customðð€amongÐ è 8  ÐMCOs€of€paying€all€providers,€both€in„network€and€out„of„network,€the€same€rate.€€Again,€evidenceÐ Ô$  Ðof€BlueCareððs€in„network€rates,€as€well€as€evidence€of€industry€custom,€is€pertinent€but€certainly€notÐ À  Ðdeterminative.€€In€assessing€a€reasonable€reimbursement€rate,€the€trial€court€may€take€into€accountÐ ¬ü  Ðall€of€these€factors,€as€well€as€others€that€may€be€pertinent,€such€as€whether€the€rate€for€in„networkÐ ˜è  Ðproviders€is€appropriate€for€out„of„network€providers,€given€the€difference€in€the€volume€of€BlueCareÐ „Ô  Ðenrollees€treated.€€Moreover,€the€trial€court€may€consider€factors€that€increase€the€providerððs€costs,Ð pÀ Ðsuch€as€BlueCareððs€repeated€automatic€disallowance€of€claims€previously€authorized,€apparentlyÐ \¬ Ðonerous€and€costly€appeal€and€approval€procedures,€and€delays€in€payment.€€Therefore,€the€causeÐ H˜ Ðmust€be€remanded€for€a€determination€of€a€reasonable€rate€of€reimbursement€for€River€ParkððsÐ 4„ Ðprovision€of€medical€services€to€BlueCare€enrollees€who€were€ð ðemergencyðð€patients.ðð׃×Ý ƒ#ÃÝòòÚ  Ú14Ú  ÚóóÝ  Ý×  ×Ð  p Ðà  àRiver€Park€also€argues€that€the€trial€court€erred€in€dismissing€its€claims€for€conversion€andÐ øH Ðits€claims€under€the€Tennessee€Consumer€Protection€Act.€€With€respect€to€the€conversion€claim,€theÐ ä4 Ðtrial€court€refused€to€allow€River€Park€to€amend€its€complaint€to€include€a€claim€based€on€that€theoryÐ Ð  Ðof€recovery.€€Nevertheless,€in€the€order€that€is€the€subject€of€this€appeal,€the€trial€court€rejected€RiverÐ ¼  ÐParkððs€conversion€claim,€concluding€that€€ð ðno€ððconversionðð€has€taken€place.ðð€€Conversion€is€ð ðtheÐ ¨ø Ðappropriation€of€the€thing€to€the€partyððs€own€use€and€benefit,€by€the€exercise€of€dominion€over€it,€inÐ ”ä Ðdefiance€of€plaintiffððs€right.ðð€€ò òòòMammoth€Cave€Prod.€Credit€Assððn€v.€Oldhamóóó ó,€569€S.W.2d€833,€836Ð €Ð Ð(Tenn.€Ct.€App.€1977)€(quoting€ò òòòBarger€v.€Webbó óóó,€391€S.W.2d€664,€665€(Tenn.€1965)).€€River€ParkÐ l¼ Ðargues€that€BlueCare€converted€its€services€to€its€own€use€when€it€refused€to€pay€the€full€price€forÐ X ¨ Ðsuch€services.€€Intangible€services,€however,€are€not€subject€to€conversion€under€Tennessee€law.׃ ×Ý ƒ#ÃÝòòÚ  Ú15Ú  ÚóóÝ  Ý×  ׀РD!” Ðòòò òSeeó óóó€ò òòòB€&€L€Corp.€v.€Thomas€&€Thorngren,€Inc.óóó ó,€917€S.W.2d€674,€680€(Tenn.€Ct.€App.€1995).€Ð 0"€  ÐTherefore,€we€affirm€the€trial€courtððs€rejection€of€the€claim€of€conversion.€€In€addition,€we€affirm€theÐ #l! Ðtrial€courtððs€rejection€of€River€Parkððs€Consumer€Protection€Act€claim,€because€River€Park€did€notÐ $X" Ðadduce€evidence€that€BlueCare€engaged€in€ð ðunfair€or€deceptive€acts€or€practices€affecting€the€conductÐ ô$D # Ðof€any€trade€or€commerce.ðð€€Tenn.€Code€Ann.€ðð€47„18„104(a).€€€Ð à%0!$ Ðà  àBlueCare€argues€that€the€trial€court€erred€in€rejecting€its€two€counterclaims€brought€under€theÐ ° ÐConsumer€Protection€Act,€one€for€disparagement€under€Tennessee€Code€Annotated€ðð€47„18„Ð œì Ð109(e)(1),€and€one€for€the€recovery€of€attorneyððs€fees€as€the€prevailing€party€under€Tennessee€CodeÐ ˆØ ÐAnnotated€ðð€47„18„109(e)(1).€€BlueCareððs€claim€for€disparagement€was€based€on€letters€sent€to€threeÐ tÄ Ðobstetricians,€stating€that€BlueCare€was€unresponsive€to€River€Parkððs€needs,€that€it€was€ð ðpushingÐ `° Ðpatients€to€other€counties€for€their€care,ðð€and€that€BlueCareððs€efforts€to€move€obstetrics€patients€toÐ L œ Ðin„network€hospitals€ð ðshows€Blue€Crossððs€lack€of€concern€for€the€healthcare€needs€of€our€patientsÐ 8 ˆ Ðin€Warren€County.ðð€€Tennessee€Code€Annotated€ðð€47„18„104(b)€prohibits€ð ðdisparaging€the€goods,Ð $ t Ðservices€or€business€of€another€by€false€or€misleading€representations€of€fact.ðð€€The€trial€court€heldÐ  ` Ðthat€the€comments€made€in€the€letters€were€opinions€and,€thus,€did€not€constitute€ð ðfalse€or€misleadingÐ ü L  Ðrepresentations€of€fact.ðð€€We€agree,€and€affirm€the€trial€courtððs€rejection€of€this€claim.€€We€alsoÐ è 8  Ðaffirm€the€trial€courtððs€rejection€of€BlueCareððs€claim€for€attorneyððs€fees€as€a€prevailing€party,€becauseÐ Ô$  Ðit€was€not€the€prevailing€party€in€its€own€Consumer€Protection€Act€claim,€and,€although€it€prevailedÐ À  Ðas€to€River€Parkððs€claim€under€the€Act,€River€Parkððs€claim€was€not€without€a€legitimate€basis.€€€€Ð ¬ü  Ðà  àFinally,€we€affirm€the€trial€courtððs€denial€of€discretionary€costs€to€BlueCare€under€TennesseeÐ „Ô  ÐRule€of€Civil€Procedure€54.04(2).€€This€holding€does€not€prevent€BlueCare€from€raising€this€issueÐ pÀ Ðagain€at€the€conclusion€of€the€trial€below.Ð \¬ Ðà  àIn€sum,€we€find€that€any€error€by€the€trial€court€in€reopening€the€proof€was€harmless.€€We€findÐ 4„ Ðthat€Rule€1200„13„12„.08€establishes€a€floor€for€reimbursement€rates€for€non„contract€providers,€butÐ  p Ðdoes€not€establish€a€ceiling.€€We€affirm€the€trial€courtððs€finding€that€there€was€neither€an€expressÐ  \ Ðcontract€nor€a€contract€implied€in€fact€between€the€parties.€€We€affirm€the€trial€courtððs€finding€of€aÐ øH Ðcontract€implied€in€law€between€the€parties,€and€remand€for€the€trial€court€to€determine€a€reasonableÐ ä4 Ðrate€of€reimbursement€for€services€provided€by€River€Park€during€the€pertinent€time€period€toÐ Ð  Ðemergency€patients€who€were€BlueCare€enrollees.€€The€trial€court€may€also€consider€whether€all€ofÐ ¼  Ðthe€patients€for€whom€River€Park€seeks€reimbursement€were€ð ðemergencyðð€patients.€€We€affirm€theÐ ¨ø Ðtrial€courtððs€dismissal€of€River€Parkððs€claim€under€the€Tennessee€Consumer€Protection€Act€and€theÐ ”ä Ðrejection€of€River€Parkððs€claim€of€conversion.€€We€affirm€the€trial€courtððs€dismissal€of€BlueCareððsÐ €Ð Ðclaim€of€disparagement€and€its€claims€for€attorneyððs€fees,€as€well€as€the€denial€of€discretionary€costs.€Ð l¼ ÐAll€remaining€issues€on€appeal€are€pretermitted.€€This€cause€is€remanded€for€a€determination€ofÐ X ¨ Ðdamages.Ð D!” Ðà  àThe€decision€of€the€trial€court€is€affirmed€and€remanded€for€further€proceedings€notÐ #l! Ðinconsistent€with€this€Opinion.€€Costs€of€this€appeal€are€taxed€equally€to€the€appellants,€BlueCrossÐ $X" ÐBlueShield€of€Tennessee,€Inc.€and€Volunteer€State€Health€Plan,€Inc.,€d/b/a€Blue€Care,€and€their€suretyÐ ô$D # Ðand€the€appellee,€River€Park€Hospital,€for€which€execution€may€issue,€if€necessary.€Ð à%0!$ Ðòòò òó óóóà  àà ` àà ¸ àà  àà h àà À àà  àÌÓ ÓÌà  àà ` àà ¸ àà  àà h àà À àà  à___________________________________€Ð |*Ì%) Ðà  àà ` àà ¸ àà  àà h àà À àà  àHOLLY€KIRBY€LILLARD,€JUDGE