14 Fla. L. Weekly Supp. 788b
Insurance — Personal injury protection — MRI — Allowable amount — Adjustment to Consumer Price Index for All Urban Consumers in South Region — Calculation — CPI calculation must be made annually and cumulatively, reflecting combined prior years’ increases from 2001 through date of treatment
AFO IMAGING, INC., a/a/o of Timothy Bard, Plaintiff, vs. HORACE MANN INSURANCE COMPANY, Defendant. County Court, 13th Judicial Circuit in and for Hillsborough County, Civil Division. Case No. 05-16878, Div. H. January 8, 2007. Eric R. Myers, Judge. Counsel: Michael B. Reiss and Christopher P. Calkin, Law Offices of Christopher P. Calkin, P.A., Tampa, for Plaintiff. Catherine M. Verona, for Defendant.
FINAL JUDGMENT
This cause, having come before the Court concerning Plaintiff AFO Imaging, Inc., a/a/o Timothy Bard’s, Entry of Final Judgment, and the Court having reviewed the file and respective pleadings, heard argument of counsel, and being fully advised in the premises it is hereby:
ORDERED and ADJUDGED as follows:
1. The Court is presented with Plaintiff’s Entry of Final Judgment.
2. The parties are in agreement that there are no material issues of fact. The parties agree that Timothy Bard received two MRIs from AFO Imaging, Inc., on January 20, 2005. That AFO Imaging, Inc., submitted a timely bill to Horace Mann Insurance Company, for these MRIs pursuant to Fla. Stat. 627.736. Horace Mann Insurance Company timely issued payment to the Plaintiff for the MRI’s at a reduced amount from the amount billed by Plaintiff. That suit was filed by the Plaintiff, for payment of Horace Mann Insurance Company’s reduction.
3. The parties believe that these undisputed facts give rise to an issue of law with respect to the interpretation of Fla. Stat. 627.736(5)(b)5 that needs to be decided by the Court.
4. Specifically, the issue brought before this Court is the interpretation of Fla. Stat. 627.736(5)(b)5, and whether the allowable rate that may be charged to a personal injury insurance insurer for a Magnetic Resonance Imaging (MRI) service is 200% of the 2001 Medicare Part B Fee Schedule adjusted:
a. annually on August 1st to reflect each of the prior calendar year’s changes to the Consumer Price Index from 2001 through the date of treatment; or,
b. annually on August 1st to reflect only the prior calendar year’s changes to the consumer price index for the year immediately preceding the date of treatment.
5. This Court hereby finds that an insurer may be charged 200% of the allowed amount under the participating physician fee schedule of Medicare Part B for the year 2001 adjusted annually on August 1 to reflect each of the prior calendar year’s changes in the Consumer Price Index from 2001 through the date of treatment.
6. The operative portion of the Statute is Fla. Stat. 627.736(5)(b)5:
“. . . . . .that allowable amounts that may be charged to a personal injury protection insurance insurer and insured for magnetic resonance imaging services provided. . . .shall not exceed 200 percent of the allowable amount under the participating physician fee schedule of Medicare Part B for the year 2001. . .adjusted annually on August 1 to reflect the prior calendar year’s changes in the annual Medical Care Item of the Consumer Price Index for All Urban Consumers in the South Region as determined by the Bureau of Labor Statistics of the United States Department of Labor for the 12-month period ending June 30 of that year.”
7. In order to correctly interpret the legislative intent of Fla. Stat. 627.736(5)(b)5, this Court must consider the plain meaning of the statute and take into account the significance of every word.
8. This Court interpreting the statute’s plain meaning finds that Fla. Stat. 627.736(5)(b)5 allows for an annual consumer price index increase for MRI charges on August 1st of each year, with the appropriate consumer price index increase “determined by the Bureau of Labor Statistics of the United States Department of Labor for the 12-month period ending June 30 of that year.” Fla. Stat. 627.736(5)(b)5.
9. The operative statute requires that, as of August 1, 2001, the amounts chargeable for MRI services in Florida must be adjusted annually by the applicable consumer price index increase each year. Once adjusted, that year’s adjusted amount must then be adjusted again on August 1st of the following year, and again for each and every subsequent year until the date of the treatment. The Court finds that this interpretation gives effect to the legislative intent inherent in the phrase, “adjusted annually on August 1 to reflect the prior calendar year’s changes.” Fla. Stat. 627.736(5)(b)5.
10. To hold otherwise would jeopardize the reimbursable amounts for MRI services from year to year, and not afford the medical provider a consumer price index increase to account for the cost of living increase.
11. Therefore, Final Judgment be and the same is hereby entered in favor of the Plaintiff, AFO Imaging, a/a/o Timothy Bard, and against Defendant, Horace Mann Insurance Company.
