11 Fla. L. Weekly Supp. 831a
Insurance — Personal injury protection — Coverage — Magnetic resonance imaging — Medicare Part B fee schedule–Statute defining reasonable amount MRI provider may collect does not require that claim form state Medicare fee schedule amount or provide penalty denying payment where form contains amount different from fee schedule amount
ONE STOP MEDICAL, INC., a/a/o CLEVELAND DEVEAUX, Plaintiff, vs. UNITED AUTOMOBILE INSURANCE COMPANY, a Florida corporation, Defendant. County Court, 11th Judicial Circuit in and for Miami-Dade County, Civil Division. Case No. 03-5717 SP 26 (03). June 30, 2004. Cristina Pereyra-Shuminer, Judge. Counsel: Jonathan R. Friedland, Jonathan R. Friedland P.A., Miami, for Plaintiff. Vera E. Gilford, Office of the General Counsel, United Automobile Insurance Company, for Defendant.
ORDER GRANTING PLAINTIFF’S MOTION FOR SUMMARY JUDGMENT REGARDING DEFENDANT’S SECOND AFFIRMATIVE DEFENSE IN THEIR AMENDED ANSWER DATED JANUARY, 2004
THIS CAUSING having come on to be heard on May 25, 2004 on Plaintiff’s Motion for Summary Judgment regarding Defendant’s Second Affirmative Defense in their Amended Answer of January, 2004 and the Court having heard argument of counsel, reviewed appropriate case law and reviewed Plaintiff’s and Defendant’s supplemental briefs regarding the issue and being otherwise advised in the premises, it is here upon
ORDERED AND ADJUDGED that said Motion be and the same is hereby GRANTED. The Court finds that the MRI fee schedule contained in section 627.736(5)(b)(5), Florida Statute merely defines the reasonable amount which an MRI service provider may collect from an insurer or insured. Florida Statute 627.736(5)(b)(5) does not require that the HCFA billing form state the fee schedule amount and does not set forth a penalty denying the MRI service provider payment of the fee schedule amount should the HCFA form contain an amount which differs from the MRI fee schedule amount. The Plaintiff, ONE STOP MEDICAL, INC., has provided proof of a covered loss by billing $1,850.00 for the MRI performed on CLEVELAND DEVEAUX and said billing does not violate Florida Statute 627.736(5)(b)(5).
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