21 Fla. L. Weekly Supp. 836a
Online Reference: FLWSUPP 2108DESIInsurance — Personal injury protection — Summary judgment — Reasonableness of charges — Medical provider met burden of proving its charge for MRI is reasonable — Opposing affidavit of non-expert PIP adjuster which was based on hearsay and was conclusory and self-serving was insufficient to create genuine issue of material fact — Summary judgment is granted in favor of provider
HALLANDALE OPEN MRI, LLC, as assignee of Jean Desir, Plaintiff, vs. UNITED AUTOMOBILE INSURANCE COMPANY, Defendant. County Court, 17th Judicial Circuit in and for Broward County. Case No. 13-04143 CONO 70. April 7, 2014. John D. Fry, Judge.
ORDER GRANTING PLAINTIFF’S MOTION FOR SUMMARY JUDGMENT
This cause, having come before the Court and the court having heard argument of counsel, and the Court being fully advised in the premises, it is hereby:
ORDERED and ADJUDGED that:
1. Plaintiff’s Motion for Summary Judgment is hereby granted. Final Judgment for the Plaintiff will be entered in favor of the Plaintiff as there are no further matters at issue.
2. In this case, the Plaintiff submitted a bill for $1650 for an MRI without contrast. In response to receiving the Plaintiff’s bill, the Defendant paid $912.74. As result of the reduction, the Plaintiff filed suit in small claims court in the amount of $407.26. The issue for the court is determine if $1650 is a reasonable charge for an MRI without contrast. Reasonable is a range and not a set number. If the Plaintiff’s charge is within the range of what is reasonable then the Plaintiff’s bill should have been paid by the Defendant without reduction. See Plantation Open MRI a/a/o Fernando Venegas v. State Farm, 12-1617 COCE 53 (Fla. Broward County Court 2013, Judge Robert Lee) [21 Fla. L. Weekly Supp. 589a].
3. The Plaintiff moves for Summary Judgment and in support relied on the affidavit of Ms. Norma Uziel, billing supervisor for the Plaintiff. Ms. Uziel has many years of experience working for the Plaintiff and has knowledge of running and billing for an MRI center. It undisputed in the record that many non hospital MRI centers in South Florida charged the same or more than the Plaintiff charged for this MRI (from $1600 to $2500). Hospitals charge as much as $5000 for this MRI. Additionally, the Plaintiff has been paid by many PIP insurers, including United, without reduction when the charged amount is $1650. Therefore, based on the totality of the information in the Plaintiff’s affidavit, the court finds Ms. Uziel’s detailed and specific affidavit is sufficient to meet the Plaintiff’s prima facie burden of proof to establish the Plaintiff’s charge of $1650 is a reasonable charge for an MRI without contrast conducted in Broward County in the year 2011.
4. In opposition, the Defendant relies upon the affidavit of Monica Johnson. Ms. Johnson is not an expert and the Defendant does not proffer her to be an expert. Based on the affidavit and the resume attached, Ms. Johnson has never worked for an MRI center or billed for an MRI center. Her experience is a PIP adjuster working for United Auto from 2007 to the present and before that time she worked for Progressive.
5. Ms. Johnson has taken no seminars on billing for MRIs. She has no experience or knowledge as to the MRI industry. Ms. Johnson states in her opinion the Plaintiff’s charge of $1650 is unreasonable because she has knowledge of what Medicare, Workers Comp, State Farm, health insurers, etc. allow.
6. The court finds this affidavit insufficient to create a question of fact as it is based on hearsay, it is conclusory and self serving. A conclusory affidavit of a party is insufficient to create a disputed issue of fact. Master Tech v. Matec, 49 So.3d 789, 791 (Fla. 3d DCA 2010) [35 Fla. L. Weekly D2381a]. Under Rule 1.510(e), a court may consider evidence at a Summary Judgment hearing only if it would be ‘admissible at trial.”
7. There are no documents attached to the affidavit to support this lay opinion. The affidavit fails to include any substantive competent admissible evidence to dispute the Plaintiff’s prima facie showing that its charge was reasonable.
8. The fact that Medicare, Workers Compensation, Tricare/Champus and health insurance, etc. pay less than the Plaintiff’s billed amount, by itself, does not result in a question of fact that the charged amount is unreasonable. To do so, would require the impermissible stacking of inferences as a reasonable inference that Medicare pays less is because that is what the Federal Government can afford to pay for medical services. Further, Medicare is not insurance. Atkins v. Allstate, 382 So.2d 1276 (Fla. 3d DCA 1980). It would be a reasonable inference that health insurance pays less than the billed amount because there is a flow of business and much less risk and expenses associated with billing health insurance as compare to car insurance as stated in the affidavit of Ms. Uziel.
9. This court cannot jump to the conclusion that since certain payors pay less than the charged amount in this case then there is a question of fact as to whether the charged amount of $1650 is unreasonable.
10. Thus, the court finds the opinion of Ms. Johnson as stated in her affidavit does not result in a question of fact for a jury particularly in light of the other evidence presented in this case.
* * *
