12 Fla. L. Weekly Supp. 265a
NOT FINAL VERSION OF OPINION
Subsequent Changes at 12 Fla. L. Weekly Supp. 867a
Insurance — Personal injury protection — Provider’s policy of giving 50% discount to patients who pay for medical treatment in cash, rather than through insurance, violates state law — Although small percentage of reductions for cash payment might be understandable given cost of doing business with insurance companies, 50% reduction amounts to charging insurance companies an premium rate, which is illegal — Court notes that pro bono or reduced fee medical rates for indigents are not affected by ruling
KENNETH HAWTHORNE, M.D., as assignee of KALAVATIBEN PATEL, Plaintiff, v. PROGRESSIVE EXPRESS INSURANCE COMPANY, Defendant. County Court, 7th Judicial Circuit in and for Volusia County. Case No. 2002-34885-COCI. December 15, 2004. Steven deLaroche, Judge. Counsel: Kimberly Simoes, for Plaintiff. Steven R. Robinson, Cameron Hodges Coleman LaPointe Wright, P.A., Daytona Beach, for Defendant.
ORDER ON DEFENDANT’S MOTION FOR SUMMARY JUDGMENT
THIS CAUSE, having come before the Court for consideration and the Court having heard arguments of counsel and being otherwise fully advised, the Court makes the following findings of fact and law:
1. That the Defendant, hereinafter “PROGRESSIVE EXPRESS INSURANCE COMPANY”, moved for summary judgment based upon the Plaintiff’s violation of Sections 627.365 and 817.234, Florida Statutes.
2. The Plaintiff initiated a lawsuit against the Defendant alleging that a bill for medical treatment for date of service September 23, 2002 was not paid properly. Dr. Hawthorne tendered a bill to PROGRESSIVE EXPRESS INSURANCE COMPANY for Three Hundred Eighty-Eight and NO/100 Dollars ($388.00) for CPT Code 99204. The Defendant allowed payment of One Hundred Ninety-Eight and NO/100 Dollars ($198.00).
3. On December 10, 2003, the deposition of the Plaintiff, Dr. Kenneth Hawthorne, was taken in the above-styled case. At that time Dr. Hawthorne testified to essentially having a fee schedule for individual patients who paid for medical treatment through insurance and a separate schedule for individuals who paid for medical treatment in cash. From Dr. Hawthorne’s testimony, individuals paying for medical treatment in cash received approximately a fifty percent discount from the total amount of the bill. However, if an individual paid for medical treatment through insurance, the insurance carrier was billed one hundred percent of the total bill.
4. I do find that the Doctor giving a fifty percent discount for cash patients violates the statute. Although the Court can reasonably understand that there’s a cost of doing business with the insurance companies, and a certain small percentage of reductions for cash payment would be understandable, however, fifty percent is startling. If the Doctor is willing to take only half up front from someone with dollar bills in their hand, it would seem to me that he is charging the insurance companies a premium rate, which is illegal.
5. The Court is also persuaded by the argument that $10,000 of insurance, or more like $8,000 of insurance because of the 20 percent discount built into the PIP statute, should stretch as far as $10,000 in cash.
6. For these reasons, it is hereby ORDERED AND ADJUDGED that the Defendant’s Motion for Summary Judgment be GRANTED as the Plaintiff, Dr. Kenneth Hawthorne, violated Section 627.365 by giving a fifty percent discount to cash patients while charging patients who utilize health insurance to pay for medical treatment one hundred percent of the billed amount. The Court is concerned, however, that this ruling will have somewhat of a chilling effect on pro bono medical services. Because if a doctor charges a patient nothing or an extremely reduced rate because of some sort of pro bono program that is similar to what the Bar has, although I’m not aware of the medical profession having something like that, that the insurance companies will come back and argue that, that extremely low rate is now the acceptable fee. So I am excepting from this ruling pro bono or reduced fee medical rates for the indigent.
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