12 Fla. L. Weekly Supp. 444b
Insurance — Personal injury protection — Coverage — Medical expenses — MRI — No merit to argument that trial court erred in granting summary disposition in favor of medical provider when it was never established that MRI bill was reasonable where provider agreed to insurer’s request to move scheduled summary disposition hearing to later date subject to proviso that record would be frozen as of original hearing date, and issue of reasonableness of MRI bill raised in peer review was not disclosed prior to original hearing date — Although statute limits what may be charged for MRI service, MRI charge in excess of fee schedule amount does not provide absolute defense to payment — No error in entering summary judgment in favor of provider where affidavit of treating physician indicated why MRI was ordered, affidavits of provider’s corporate representative and records custodian verified that MRI was performed, authenticated billing records and indicated how provider credits patient and insurer under fee schedule, and insurer failed to present contrary evidence sufficient to reveal genuine issue
UNITED AUTOMOBILE INSURANCE COMPANY, Appellant, v. A-1 MOBILE MRI, INC., a/a/o LOURDES JONES, Appellee. Circuit Court, 17th Judicial Circuit (Appellate) in and for Broward County. Case No. 04-13238 (05). January 25, 2005. Counsel: Michael J. Neimand. Roberts J. Bradford.OPINION
(Richard D. Eade, Judge.)THIS CAUSE comes before the Court upon Appellant’s, United Automobile Insurance Company, Appeal of the trial court’s Order Granting Final Summary Disposition in favor of Appellee, A-1 Mobile, MRI, Inc., a/a/o Lourdes Jones. The Court having considered the record, applicable law and otherwise being duly advised in the premises, dispenses with oral argument, and finds and decides as follows:
This case arises out of a dispute over billing for an MRI scan performed by Appellee following an automobile accident. Appellee submitted a bill to Appellant, which failed to pay. On April 20, 2004, counsel for Appellee agreed to Appellant’s request to move a scheduled Summary Disposition hearing to April 27, 2004, subject to the proviso that the record would be frozen as of April 21, 2004. At that time, Appellant represented the only defenses to the claim for nonpayment were the following: (1) the insured failed to appear for an examination under oath and an independent medical examination, (2) the amount reflected on the bill for the MRI scan was in excess of the amount allowable under the fee schedule.
On April 27, 2004, Appellant filed an affidavit and peer review of a medical doctor that had opined some five months prior that the MRI scan was not reasonable, necessary or related. At a June 14, 2004 hearing, the trial court found Appellant was judicially estopped from introducing this peer review report as it was untimely filed. Ultimately, holding there were no material issues of disputed fact, a final judgment in favor of Appellee, in the amount of $976.29 for the MRI scan, along with prejudgment interest in the amount of $183.83, was entered on August 10, 2004.
Appellant now argues the trial court erred in granting the summary disposition since it was never established the MRI bill was reasonable, and the amount of the bill was statutorily impermissible. §627.736(5)(b)(5), Fla. Stat. This Section reads in pertinent part: “Beginning November 1, 2001, allowable amounts that may be charged to a personal injury protection insurance carrier and insured for magnetic resonance imaging services shall not exceed. . .200 percent of the allowable amounts the under Medicare Part B for the year 2001, for the area in which the treatment was rendered.”
According to Appellant, until the MRI provider submits a proper bill in compliance with the statutory guidelines, no actual bill exists that is overdue and payable. Appellant further contends since Appellee submitted a bill for $1,500.00, far above the statutory maximum, Appellee was not entitled to have the subsection’s presumption of reasonableness apply, and the trial court was required to deny the Motion for Summary Disposition.
The Court disagrees with Appellant’s arguments. First, the issue of reasonableness raised in the peer review should have been disclosed prior to April 21, 2004. Second, although the statute serves to limit what may be charged for an MRI service, it does not follow that an MRI charge in excess of the fee schedule amount provides an absolute defense to payment.
Summary disposition is appropriate where the pleadings and affidavits conclusively show there are no genuine issues of material fact, and the moving party is entitled to judgment as a matter of law, pursuant to Fla. Sm. C. R. 7.135. Once the movant has supported its motion with competent record evidence, the opposing party must come forward with counter-evidence sufficient to reveal a genuine issue. Corbitt v. Kuruvilla, 745 So.2d 545 (Fla. 4th DCA 1999).
Here, the record indicates an affidavit of the treating physician was provided for the trial court’s consideration indicating why the MRI scan was ordered. The trial court was also provided with affidavits of Appellee’s corporate representative and records custodian verifying the MRI scan was performed, authenticating the billing records and indicating how the company credits a patient and an insurer under the fee schedule. Appellee has failed to present contrary evidence sufficient to reveal a genuine issue. Accordingly, it is hereby
ORDERED AND ADJUDGED that the trial court’s Order Granting Final Summary Disposition is AFFIRMED.
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