11 Fla. L. Weekly Supp. 136b
Insurance — Personal injury protection — Action against insurer which paid 80% of amount allowed to participating providers under Medicare Part B for cervical MRI but failed to adjust amount to Medical Consumer Price Index for Florida — Because at time insurer paid for MRI, prior to amendment to PIP statute, no criteria existed to calculate amount that MRI fee schedule should be adjusted under statute based on CPI for Florida, as no CPI existed for Florida, statute placed insurer in impossible position of having to guess appropriate CPI to apply — Summary judgment granted in favor of insurer
FLORIDA MOBILE MRI, INC. (as assignee of Javier Collazo), Plaintiff, v. PROGRESSIVE EXPRESS INSURANCE COMPANY, Defendant. County Court, 11th Judicial Circuit in and for Miami-Dade County. Case No. 03-16144 SP 23 (02). December 10, 2003. Raphael Steinhardt, Judge. Counsel: Maury L. Udell, Marlow, Connell, Valerius, Abrams, Adler, Newman & Lewis. Alejandro M. Garcia, Law Offices of Toral and Associates.
ORDER GRANTING FINAL SUMMARY JUDGMENT IN FAVOR OF DEFENDANT PROGRESSIVE EXPRESS INSURANCE COMPANY
THIS ACTION was heard on December 4, 2003 on Defendant’s Motion for Final Summary Judgment. After carefully reviewing and considering the Motion, the Memorandum of Law, the Court file, and arguments of counsel, the Court makes the following findings of fact and conclusions of law:
1. Plaintiff performed a cervical MRI on Defendant’s insured, Javier Collazo, on or about April 21, 2003.
2. Plaintiff billed for a cervical MRI under CPT 72146 TC in the amount of $1150.
3. Defendant paid Plaintiff $840.74, which is 80% of the 200% of the amount allowed to participating providers under Medicare Part B for year 2001 for the CPT code billed for the area in which treatment was rendered.
4. The amount paid by Defendant to Plaintiff was not adjusted to the Medical Consumer Price Index for Florida.
5. Prior to October 1, 2003, the effective date of the amendment to the PIP statute, no criteria existed to calculate the amount that the MRI fee schedule should be adjusted under §627.736(5)(b)(5) based upon the CPI, as no Florida CPI existed.
6.The Bureau of Labor Statistics (BLS) publishes monthly indexes for the national CPI as well as from regional indexes: north east, mid-west, south, and west. Indexes for major metropolitan areas are published monthly (3 areas): bi-monthly (11 areas), or semi-annually (12 areas).
7. Section 627.736(5)(b)(5), Florida Statute (2001) placed the Defendant in the impossible position of having to guess the appropriate CPI to apply.
8. The statute as enacted in 2001 was neither ambiguous or vague. The statute was simply in error.
ORDERED AND ADJUDGED as follows:
1. Defendant’s Motion for Final Summary Judgment is hereby GRANTED.
2. The Court hereby enters Final Judgment in favor of Defendant and Defendant shall go hence without delay.
3. The Court reserves jurisdiction to determine attorney’s fees and costs and to enforce this Judgment, if necessary.
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