14 Fla. L. Weekly Supp. 170a
Insurance — Personal injury protection — Coverage — Medical expenses — 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 August 1 of year MRI was performed — Correct CPI calculation reveals insurer paid medical provider less than allowable amount for MRI — No merit to argument that no CPI adjustment for 2002 was due because 2002 statute erroneously referred to nonexistent CPI for State of Florida where 2003 amendment clarified that payments were to be adjusted to CPI for south region — No merit to arguments that assignment from insured is not valid and that provider failed to comply with disclosure and acknowledgment form and demand letter requirements
ALL FAMILY CLINIC OF DAYTONA BEACH, INC. d/b/a FLORIDA MEDICAL ASSOCIATES as assignee for ANNA DUBELL, Plaintiff(s), vs. STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, Defendant(s). County Court, 7th Judicial Circuit in and for Volusia County. Case No. 2005 35028 COCI. December 27, 2006. H. Pope Hamrick, Jr., Judge. Counsel: Luis R. Gracia and Edward S. Rue, Rue & Ziffra, P.A., Port Orange, for Plaintiff. John L. Morrow, for Defendant.
ORDER GRANTING PLAINTIFF’S CROSS-MOTION FOR FINAL SUMMARY JUDGMENT
This cause coming on to be heard upon Defendant’s Motion for Summary Judgment and Plaintiff’s Cross-Motion for Summary Judgment, and the Court having reviewed legal authorities, considered the pleadings, affidavits, arguments of counsel, and being sufficiently advised on the premises, hereby finds and holds as follows:
I. FACTS
1. This action involved Plaintiff’s claim against Defendant, State Farm Mutual Automobile Insurance Company, for personal injury protection benefits relating to an MRI performed on Anna Dubell.
2. Anna Dubell was injured in an automobile accident on March 11, 2005. At the time of the accident, the Defendant insured Ms. Dubell under a policy of automobile insurance that provided personal injury protection benefits.
3. As part of the treatment rendered to Ms. Dubell, the Plaintiff, All Family Clinic of Daytona Beach, Inc., performed an MRI of the lumbar spine without contrast on September 23, 2005. Neither the relatedness of the MRI to the automobile accident nor the medical necessity of such is in dispute.
4. Plaintiff submitted a health care finance administration form (“HCFA”) to Defendant charging $1,309.69 for the MRI, which corresponds with CPT Code 72148. Both parties agree that pursuant to the Medicare Part B fee schedule the base charge for CPT Code 72148 is $558.49.
5. Defendant paid $1,277.12 of the charged amount, leaving a difference of $32.57.
6. As the charge was not paid in its entirety, Plaintiff sent a demand letter to Defendant pursuant to Florida Statute § 627.736(11) requesting, inter alia, payment for the remaining MRI balance plus postage, a statutory penalty and interest.
7. Defendant did not pay the amount requested in Plaintiff’s demand letter, and Plaintiff filed the present action.
8. The parties have each moved for summary judgment on four issues: (1) whether the fee schedule set forth in Fla. Stat. § 627.736(5)(B)(5) requires a Consumer Price Index adjustment beginning in August 1st of 2002 and cumulatively thereafter; (2) whether Plaintiff has standing to bring suit under a valid assignment of benefits from Anna Dubell; (3) whether Plaintiff complied with the disclosure and acknowledgement requirements of Florida Statute § 627.736(5)(e); and (4) whether Plaintiff complied with the pre-suit demand letter requirement contained in Florida Statute § 627.736(11).
II. CONCLUSIONS OF LAW AND RULING
9. As All Family Clinic of Daytona Beach, Inc., is a facility accredited by the American College of Radiology, the pertinent part of Florida Statute § 627.736(5)(b)(5), which governs charges for MRI services paid by personal injury protection insurers, provides as follows:
[A]llowable amounts that may be charged to a personal injury protection insurance insurer and insured for magnetic resonance imaging services provided in facilities accredited by the Accreditation Association for Ambulatory Health Care, the American College of Radiology, or the Joint Commission on Accreditation of Healthcare Organizations shall not exceed 200 percent of the allowable amount under the participating physician fee schedule of Medicare Part B for year 2001, for the area in which the treatment was rendered, 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 l2-month period ending June 30 of that year.
10. The Court agrees with Plaintiff’s position that the proper frequency and method of the CPI calculation is annually and cumulative so that the fee schedule amount for the year in question reflects the combined increases from the base year of 2001 through August 1st of the year in which the MRI was performed. These adjustments should reflect the change in prices for the 12-month period ending June 30th of that year. Since the statute sets the participating physician fee schedule of Medicare Part B for the year 2001 as the base upon which MRIs should be charged, the first CPI adjustment occurred in August 1st, 2002. On that date the Defendant had to make a payment adjustment to reflect the prior year’s changes in the 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.
11. Defendant did not make the August 1st, 2002 Consumer Price Index adjustment to the amount paid to Plaintiff for the MRI. The Court holds that the Plaintiff correctly calculated the amount due for the MRI as set forth in the affidavit submitted in support of its Motion for Summary Judgment. Thus, the Court hereby finds that Defendant’s argument that Plaintiff billed more than allowed for the MRI is without merit.
12. The Court holds that the 2003 amendment to Florida Statute § 627.736(5)(b)(5), stating that MRI payments are to be adjusted pursuant to the “Medical Care Item of the Consumer Price Index for All Urban Consumers in the South Region. . .” was a clarifying amendment, not a substantive change in the statute. See Clearview Imaging, L.L.C. v. State Farm Mut. Auto. Ins. Co., 932 So. 2d 423, 426 n.2 (Fla. 2nd DCA 2006). As a result, the Court rejects Defendant’s position that no CPI adjustment for 2002 was due because the statute was in error and no CPI existed for the State of Florida.
13. The Court hereby rejects Defendant’s argument that Plaintiff did not have standing to bring this action based on the argument that the assignment obtained by the Plaintiff from Ms. Dubell is not valid. As the Court previously ruled when addressing Defendant’s Motion to Dismiss, the assignment obtained by the Plaintiff is valid and enforceable.
14. The Court has considered Defendant’s argument that Plaintiff failed to comply with the disclosure and acknowledgement form requirement of Florida Statute § 627.736(5)(e) and finds it to be without merit.
15. In regards to Defendant’s argument that Plaintiff failed to comply with the pre-suit demand letter requirement of Florida Statute § 627.736(11), the Court finds said argument to be without merit.
16. Accordingly, the Court finds that there is no genuine issue as to any material fact and Plaintiff is entitled to judgment as a matter of law. Fla. R. Civ. P. 1.510.
Based upon the foregoing it is hereby ORDERED AND ADJUDGED that Plaintiff’s Cross-Motion for Summary Judgment is GRANTED and Defendant’s Motion for Summary Judgment is DENIED.
The Plaintiff, All Family Clinic of Daytona Beach, Inc. d/b/a Florida Medical Associates, as assignee of Anna Dubell, shall recover $32.57 for medical expenses under the applicable personal injury protection coverage, and $2.96 for prejudgment interest on overdue benefits, for a total of $35.53 from Defendant, State Farm Mutual Automobile Insurance Company for which let execution issue.
The Court hereby reserves jurisdiction for the purpose of awarding attorney’s fees and costs to Plaintiff pursuant to Florida Statutes 627.736 and 627.428.
