10 Fla. L. Weekly Supp. 868a
Insurance — Personal injury protection — Preferred providers — No error in finding that insurer who had not directly contracted with medical provider for PPO rates was required to pay PIP benefits at statutory rate — Summary judgment awarding entire amount medical provider claimed may have been inappropriate where reasonableness of charges was an issue but, where issue was not raised on appeal, appellate court affirms
NATIONWIDE MUTUAL FIRE INSURANCE COMPANY, Appellant, v. DUKES CHIROPRACTIC HEALTH CLINIC, P.A. (a/a/o Tressa Thomas), Appellee. Circuit Court, 13th Judicial Circuit (Appellate) in and for Hillsborough County. Case No. 02-7736, Division X. County Ct. Case No. 00-17430. September 2, 2003. Sam D. Pendino, Judge. Counsel: Charles Tyler Cone, Fowler White Boggs Banker, P.A., Tampa, for Appellant. Timothy A. Patrick, Tampa, for Appellee.
[Lower court order at 9 Fla. L. Weekly Supp. 629b.]
OPINION
We affirm the decision of the trial court on the authority of Nationwide Mutual Insurance Company v. Central Florida Psychiatrists, P.A., 28 Fla. L. Weekly D1511 (Fla. 5th DCA June 27, 2003) (insurer required to pay at the statutory rate when it had not directly contracted with provider).
Notwithstanding our decision, however, it has not escaped our notice that, in its order granting summary judgment, the trial court stated that “Defendant (Appellant herein) cannot decide which rates will be reasonable, necessary, and related in this manner.” It then awarded the entire amount the healthcare provider claimed, effectively giving the healthcare provider the unilateral ability to determine rates.
Florida law is reasonably clear that it is as inappropriate to give the healthcare provider the ability to unilaterally determine “reasonable” charges as it is to give the insurer that ability. Both scenarios defeat the intent of the statute. Section 627.736(1)(a) requires the insurer to pay eighty percent of all reasonable expenses, and section 627.736(5), requires healthcare providers to charge only a reasonable amount for healthcare services and supplies rendered under the statute. (Emphasis supplied.) This indicates that one party’s suggestion of what constitutes a reasonable charge should not be taken without obtaining evidence from the other party, particularly when there is a dispute as to the amount. Here, the amount due was an issue, considering that the amount of the charges compared to the amount paid thereon differed by nearly $400.00. Although summary judgment may have been inappropriate for that reason, because the issue was not raised in the appeal, we do not act upon our observation.
It is therefore ORDERED that the decision of the trial court is AFFIRMED.
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