13 Fla. L. Weekly Supp. 1205a
Insurance — Personal injury protection — Demand letter — Sufficiency — Demand letter and attached itemized bill were sufficient to satisfy statutory requirements and place insurer on notice as to amount of bill — No violation of self-referral statutes occurred — Summary judgment regarding reasonableness of charges is granted in favor of medical provider
COMPLETE WELLNESS MEDICAL CENTER AS ASSIGNEE OF JOEL ANDERSON, Plaintiff, vs. PROGRESSIVE EXPRESS INSURANCE COMPANY, Defendant(s). County Court, 7th Judicial Circuit in and for Volusia County. Case No. 2005-30323 COCI. October 3, 2006. H. Pope Hamrick, Jr., Judge. Counsel: Kimberly P. Simoes, Susan W. Tolbert, P.L., Daytona Beach. Angela J. Stewart, Orlando.
ORDER ONDEFENDANT’S MOTION FOR FINAL SUMMARY JUDGMENT AND PLAINTIFF’S MOTION FOR FINAL SUMMARY JUDGMENT
THIS CAUSE having come before the Court for consideration, and the Court having heard arguments of counsel and being otherwise fully advised, it is hereby
CONSIDERED, ORDERED AND ADJUDGED:
1. Both Plaintiff and Defendant moved for Final Summary Judgment pursuant to Rule 1.510, Florida Rules of Civil Procedure.
2. Defendant’s Motion for Final Summary Judgment regarding the Demand Letter pursuant to F.S. 627.736(11) is denied. This Court finds the demand letter and the attached itemized bill were sufficient to satisfy the statutory requirements and placed the parties on notice as to the amount of the bill.
3. Defendant’s Motion for Final Summary Judgment regarding the alleged self referral is hereby denied. This Court finds there was no violation of the self-referral statutes, 456.052 or 456.053.
4. Both Plaintiff and Defendant have moved for Final Summary Judgment regarding the reasonableness of Plaintiff’s charges for medical services. Defendant’s Motion for Summary Judgment regarding the reasonableness of the Plaintiff’s charges for medical services is Denied and Plaintiff’s Motion for Summary Judgment regarding reasonableness of charges for medical services is granted. This Court finds the charges were not excessive and were reasonable and customary charges for the area.
5. Plaintiff is awarded $82.40 in PIP benefits based on the following calculation:
a. Plaintiff charged $150.00 for CPT code 95851 for medical services rendered on November 19, 2004. Progressive allowed $73.00 and paid 80% pursuant to its contract with the assignor in the amount of $58.40. Progressive was obligated to pay 80% of $150.00 in the amount of $120.00. Progressive owes a balance of $61.60 in benefits.
b. Plaintiff charged $125.00 for CPT code 97001 for medical services rendered on November 29, 2004. Progressive allowed $99.00 and paid 80% pursuant to its contract with the assignor in the amount of $79.20. Progressive was obligated to pay 80% of $125.00 in the amount of $100.00. Progressive owes a balance of $20.80 in benefits.
6. Final Summary Judgment is hereby entered in favor of Plaintiff, and against the Defendant, in the amount of $82.40. The Court reserves jurisdiction to award Plaintiff attorney’s fees and costs and statutory interest.
