11 Fla. L. Weekly Supp. 1071b
Insurance — Personal injury protection — Coverage — Medical benefits — Bills were not “overdue” at time complaint was filed, and are not collectible, where insurer sent explanation of benefits to provider regarding claims and timely requested supporting documentation for services provided and/or invoice from supplier to determine proper payment for medical equipment, and provider failed to respond prior to filing suit
DOCTOR’S PAIN MANAGEMENT as assignee of DALON FINLEY, Plaintiff, vs. PROGRESSIVE AUTO PRO INSURANCE COMPANY, Defendant. County Court, 9th Judicial Circuit in and for Orange County. Case No. CCO-03-10953. August 13, 2004. Leon B. Cheek, III, Judge. Counsel: James Pacitti. Chandra L. Miller, Thompson Goodis Thompson Groseclose & Richardson, P.A., St. Petersburg.
ORDER ON DEFENDANT’S MOTION FOR SUMMARY JUDGMENT
THIS CAUSE having come before the Court on Defendant’s Motion for Summary Judgment on August 6, 2004, and the Court having heard argument of counsel and being otherwise duly advised in the premises, the Court makes the following findings:
1. The Complaint in this case was filed on July 31, 2003.
2. Plaintiff is a health care provider which accepted an assignment of benefits from Defendant’s insured, Dalon Finley.
3. Plaintiff provided treatment and sold various medical supplies to Ms. Finley on June 10, 2003, June 24, 2003, July 22, 2003, October 6, 2003, October 20, 2003 and October 27, 2003.
4. Specifically, on June 10, 2003, Plaintiff sold Biofreeze (CPT A9150), a cervical pillow (CPT E0943), and a pair of electrodes (CPT 99070) to Plaintiff; on June 24, 2003 and July 22, 2003 Plaintiff billed CPT 99213 for an office visit; on October 6, 2003, October 20, 2003 and October 27, 2003, Plaintiff billed CPT 97010 for the application of moist heat and CPT 97124 for massage therapy.
5. Defendant sent to Plaintiff EOBs regarding said claims requesting supporting documentation for the services provided and/or an invoice from the supplier to determine proper payment for the medical equipment.
6. Plaintiff did not send any invoices to Defendant or otherwise respond to the EOBs prior to filing the instant action.
7. Defendant made timely requests for information pursuant to Section 627.736(6)(b), Florida Statutes, thus tolling the time for payment of the claims for dates of service June 10, 2003, June 24, 2003, July 22, 2003, October 6, 2003, October 20, 2003 and October 27, 2003.
8. Because of Plaintiff’s failure to comply with Florida Statute 627.736(6)(b) said bills were not “overdue” at the time of filing the Complaint and are not collectible.
It is therefore:
ORDERED AND ADJUDGED that Defendant’s Motion for Summary Judgment is GRANTED without prejudice as to those bills were additional information has been requested pursuant of Florida Statute 627.736(6)(b), it is further;
ORDERED AND ADJUDGED that Defendant’s Motion for Summary Judgment is DENIED as to those bills alleged that Plaintiff failed to comply with the Pre-suit notice requirement as set forth in Florida Statute 627.736(11).
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