Medicare Part B and other statutory fee schedules were permitted as a basis for reimbursement in the recent case Timothy M. Kehrig, DC, P.A. v. Mercury Insurance Company of Florida, heard by a Palm Beach County court.
The plaintiff filed suit charging that Mercury did not pay 80% of the amount billed for medical services. Rather, the defendant determined payment by calculating 80% of 200% of the charges allowed in the Medicare Part B fee schedule.
The question in dispute was whether Mercury could pay benefits in accordance with the fee contained in Fla. Stat. §627.736(5)(a)(2) (2008) and the policy.
The court ruled that Mercury could limit payment in accordance with statutory fee schedules.
Separately, a Pinellas County court recently permitted Mercury to limit payment by using statutory fee schedules in the PIP dispute Orthopedic Specialists v. Mercury Insurance Company of Florida.
The case related to a 2011 injury in which Mercury reimbursed the medical services provider at a rate of 80% of 200% of the benefits available under Medicare Part B.
“Medical benefits” were defined in the policy as meaning “eighty (80%) percent of all reasonable expenses allowed by the No-Fault Law, subject to the applicable fee schedules and payment limitations, for medically necessary …”
The court cited Geico General Ins. Co. v. Virtual Imaging Services, Inc., stating that the description of medical benefits payment “is not inconsistent with application of the fee schedules and limitations.”
Click on the link to read the Final Judgment for Defendant in the matter Timothy M. Kehrig, DC, P.A. v. Mercury Insurance Company of Florida, (Case No. 50-2011-SC-008363).
Click on the link to read the Final Summary Judgment in the matter Orthopedic Specialists v. Mercury Insurance Company of Florida, (Case No. 13-000073-SC).
Both cases involved a “U85 (05/2010)” endorsement to the policy.