11 Fla. L. Weekly Supp. 457a

Insurance — Personal injury protection — Summary judgment — Factual issue — Insurer’s motion for summary judgment is denied where motion alleges that provider/assignee submitted bills in excess of allowable amounts that are not reasonable per se and not payable under statute, and provider provided opposing affidavit stating that bills were reasonable and that provider billed all patients same price for services but accepted reimbursement of lesser allowable amounts imposed by contractual limitations and statutory fee schedules

ADVANCED IMAGING GROUP, INC. (As assignee of TERESA CALLEJAS), Plaintiff, v. ALLSTATE INSURANCE COMPANY, An insurance company authorized to do business in Florida, Defendant. County Court, 13th Judicial Circuit in and for Hillsborough County, Civil Division. Case No. 2002-8942 SC. Division K. March 15, 2004. Eric R. Myers, Judge. Counsel: Bradley Souders. Troy McRitchie.

ORDER DENYING DEFENDANT’S MOTION FOR SUMMARY JUDGMENT

THIS CAUSE having come before the Court this February 24, 2004 to hearing the Defendant’s Motion For Summary Judgment And Supporting Memorandum of Law and the Court having heard from respective counsel, having reviewed the record and otherwise being fully advised, it is hereupon:

ORDERED AND ADJUDGED the Court DENIES the Defendant’s Motion For Summary Judgment and Supporting Memorandum of Law.

The Defendant’s motion alleged the Plaintiff submitted bills with prices in excess of the allowable amounts cited by §6 27.736(5)(b)5, alleging these bills were not reasonable per se, alleging they were in violation of the statute and therefore not payable.

The Plaintiff provided an Affidavit of Advanced Imaging Group, Inc. alleging:

· the bills were reasonable;

· the provider services a variety of patients having different contractual arrangements, different types of claims having different applicable statutes and fee schedules;

· the healthcare provider simply followed a uniform standard office procedure of billing a standard set price for certain diagnostic procedures;

· the provider follows a uniform price guide regardless of contractual arrangements;

· all patients/insurers are billed the same price(s);

· the office understood certain contractual or legal limitations may apply to billing; and

· the healthcare provider alleged it accepted lesser amounts allowable as reimbursement, as imposed by applicable contractual limitations or by applicable laws and/or by applicable statutory fee schedules, applicable in any particular matter.

Given the above and other matters argued at the hearing, the Court finds genuine issues of material fact remain as to whether the Plaintiff submitted compliant and reasonable billing to the Defendant. Accordingly, the Court DENIES the Defendant’s Motion For Summary Judgment.

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