20 Fla. L. Weekly Supp. 1095a
Online Reference: FLWSUPP 2011BURGInsurance — Personal injury protection — Discovery — Interrogatories — Reasonableness of charges — Medical provider is ordered to provide better responses to discovery requests concerning usual and customary charges and payments accepted by provider
HOLLYWOOD CHIROPRACTIC & ACUPUNCTURE, a/a/o JACQUELINE BURGOS, Plaintiff, vs. UAIC, a Florida corporation, Defendant. County Court, 17th Judicial Circuit in and for Broward County, Civil Division. Case No. 12-22006 COCE (53). August 8, 2013. Honorable Robert W. Lee, Judge.
ORDER ON DEFENDANT’S MOTION TO COMPELBETTER ANSWERS TO DEFENDANT’SREASONABLENESS CHARGE INTERROGATORIESAND REASONABLENESS CHARGEREQUEST FOR PRODUCTION
THIS CAUSE having come before the Court on August 5, 2013 on Defendant UNITED AUTOMOBILE INSURANCE COMPANY’S Motion to Compel Better Answers to Defendant’s Reasonableness Charge Interrogatories and Reasonableness Request for Production and the Court having reviewed the motion, having heard argument of counsel, having reviewed relevant legal authority and being sufficiently advised in the premises, finds as follows:Background
This lawsuit arises out of a breach of contract action for Personal Injury Protection (“PIP”) Benefits regarding medical services rendered by the Plaintiff HOLLYWOOD CHIROPRACTIC & ACUPUNTURE. The issue remains whether the medical services provided by the Plaintiff were reasonable in price.
Defendant propounded discovery upon Plaintiff consisting of reasonableness charge interrogatories and reasonableness charge request for production. More specifically, Defendant’s reasonableness charge interrogatories 3 and 9 requested information regarding the names of all insurance providers in which the Plaintiff billed and the name of the person with the most knowledge regarding Plaintiff’s accounts receivable, respectively. Interrogatory 5 requested Plaintiff to list the amount that Plaintiff was reimbursed by other insurance providers for each CPT Code at issue in the preceding three years.
As it relates to Defendant’s Reasonableness Charge Request for Production, request 4 requested copies of all “HMO and PPO agreements between [Plaintiff] (or any entity through which [Plaintiff] provided medical services) and any managed care provider, HMO, PPO, or others, in effect on the dates of service at issue.” Requests, 5, 6 and 8 requested that Plaintiff provide “copies of all HCFA 1500, CMS 1500 and/or UB 92 forms or other statements” issued to uninsured persons, PIP insurers and PPO patients, respectively, for the CPT codes at issue in this case for a 30 day period before and a 30 day period after the dates of service at issue. Request 11 requested that Plaintiff provide “any and all Explanation of Benefits or other documentation in provider’s possession indicating reimbursement” from any all insurers including PPO insurance providers for a 30 day period before and a 30 day period after the dates of service at issue. Request 13 requested that Plaintiff provide “any and all bills, ledgers, billing statements or other documents” reflecting the amount that Plaintiff was reimbursed by other insurance providers for each CPT Code at issue in the preceding three years. Requests 14 and 15 requested documentation regarding whether the deductible was waived or collected and whether the co-payment was waived or collected, respectively. In response, Plaintiff raised various objections to the aforementioned requests and interrogatories.Conclusions of Law
Plaintiff has the burden of establishing that the medical bills at issue are reasonable. See Allstate Ins. Co. v. Derius, 773 So.2d 1190 (Fla. 4th DCA 2000) [25 Fla. L. Weekly D2730a]. Fla. Stat. §627.736(5)(a)(1) defines a “reasonable” charge as follows:
“In no event, however, may such a charge be in excess of the amount the person or institution customarily charges for like services or supplies. With respect to a determination of whether a charge for a particular service, treatment, or otherwise is reasonable, consideration may be given to evidence of usual and customary charges and payments accepted by the provider involved in the dispute, and reimbursement levels in the community and various federal and state medical fee schedules applicable to automobile and other insurance coverages, and other information relevant to the reasonableness of the reimbursement for the service, treatment, or supply.”
Evidence of a reasonable charge includes what a provider accepts, as well as “reimbursement levels in the community” and “various federal and state medical fee schedules applicable to automobile and other insurance coverages.” See Fla. Stat. §627.736(5)(a)(1) (2008). See also Allstate Ins. Co. v. Holy Cross Hosp., Inc., 961 So. 2d 328, 335 (Fla. 2007) [32 Fla. L. Weekly S453a] (finding that “[w]hat a provider customarily charges or has previously accepted are important factors for determining whether a fee is reasonable.”).
Fla. Stat. §627.736(5)(a)(1) provides in pertinent part that the reasonableness of a charge is determined by considering the following factors: (1) the usual and customary charges and payments accepted by the provider; (2) reimbursement levels in the community; (3) various federal and state medical fee schedules applicable to automobile and other insurance coverages; and (4) other information relevant to the reasonableness of the reimbursement for the service, treatment or supply.
Therefore, it is ORDERED AND ADJUDGED that the objections raised by Plaintiff HOLLYWOOD CHIROPRACTIC & ACUPUNTURE to Interrogatories 3, 5 and 9 of Defendant UNITED AUTOMOBILE INSURANCE COMPANY’S Reasonable Charge Interrogatories are overruled. Plaintiff HOLLYWOOD CHIROPRACTIC & ACUPUNTURE shall provide answers to Interrogatories 3, 5 and 9 within thirty (30) days from the date of this Order. The information requested in Interrogatory 5 shall be limited to the year 2008, the year that the services were rendered in this matter, and to the extent that it concerns PPO agreements, such information shall be provided to this Honorable Court for in camera inspection within ten (10) days from the date of this Order in order to evaluate what if any of the documents contain confidential information, and whether they otherwise have any information that may lead to the discovery of admissible evidence.
It is further ORDERED AND ADJUDGED that the objections raised by Plaintiff HOLLYWOOD CHIROPRACTIC & ACUPUNTURE to Production Requests 5, 6, 8, 11, 13, 14 and 15 of Defendant UNITED AUTOMOBILE INSURANCE COMPANY’S Reasonable Charge Request for Production are overruled. Plaintiff HOLLYWOOD CHIROPRACTIC & ACUPUNTURE shall respond to Production Requests 5, 6, 8, 11, 13, 14 and 15 within thirty (30) days from the date of this Order. The information requested in Production Request 13 shall be limited to the year 2008, the year that the services were rendered in this matter, and to the extent that it concerns PPO agreements, such information shall be provided to this Honorable Court for in camera inspection within ten (10) days from the date of this Order in order to evaluate what if any of the documents contain confidential information, and whether they otherwise have any information that may lead to the discovery of admissible evidence.
It is further ORDERED AND ADJUDGED that in reference to Production Request 4, Plaintiff HOLLYWOOD CHIROPRACTIC & ACUPUNCTURE shall provide to this Honorable Court for in camera inspection the information regarding PPO agreements between Plaintiff or any entity through which Plaintiff provided medical services and any managed care provider, PPO, or others, in effect on the dates of service at issue within ten (10) days from the date of this Order in order to evaluate what if any of the documents contain confidential information, and whether they otherwise have any information that may lead to the discovery of admissible evidence.
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