21 Fla. L. Weekly Supp. 701a
Online Reference: FLWSUPP 2107DIAZInsurance — Personal injury protection — Discovery — Reasonableness of charges — Medical provider must answer interrogatories seeking identity of each payor/insurer to whom the provider has submitted bills, amount each payor/insurer was billed, and amount each payor/insurer paid to provider — Provider must produce billing statements issued to insurers and patients and explanations of benefits and other documents reflecting reimbursement received
HOLLYWOOD DIAGNOSTIC CENTER a/a/o RAFAEL DIAZ, Plaintiff, vs. UNITED AUTOMOBILE INSURANCE COMPANY, a Florida corporation, Defendant. County Court, 17th Judicial Circuit in and for Broward County, Civil Division. Case No. 12-18252 COCE (55). March 11, 2014. Sharon L. Zeller, Judge. Counsel: Mitzi Espino, Hallandale Beach, for Plaintiff. Russell Kolodziej, Office of the General Counsel, Trial Division of United Automobile, Miami Gardens, for Defendant.
ORDER ON PLAINTIFF’S OBJECTIONS TO DEFENDANT’S DISCOVERY
THIS CAUSE having come to be heard by this Honorable Court, all parties having notice and this Court being fully advised it is hereby, 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 Diagnostic. The issue remains whether the medical services provided by the Plaintiff were reasonable in price.
Defendant propounded discovery upon the Plaintiff consisting of reasonableness charge interrogatories and reasonableness charge request for production. More specifically, Defendant’s reasonableness charge interrogatory 3, seeks the identity of each payor/insurer who the Plaintiff has submitted bills to, whether they are PIP insurers, HMO, PPO, and/or worker compensation. Interrogatory 4, seeks the amount each insurer/payor in response to interrogatory number 3 was billed by the Plaintiff, and Interrogatory number 5 asks what each insurer/payor reimbursed to the Plaintiff/Provider. The Plaintiff objected to this interrogatory and stated same was irrelevant and not likely calculated to lead to the discovery of admissible evidence.
Defendant’s reasonable charge production, numbers 5, 6, 7, 8, 9, and 10 seek the HCFA 1500, CMS 1500 and/or UB 92 forms, and or other billing statements issued to uninsured persons, PIP insurers, HMO patients, PPO patients, Medicare and Medicaid patients for 30 days before the treatment at issue and 30 days after the treatment at issue. Further, Request for Production 11, asks for the production of all explanations of benefits or other information in the providers possession indicating the reimbursement from any and all insurers and payors for a 30 period before the treatment at issue and 30 days after the treatment at issue. In all requests, the patients name and identifying information can he removed to protect patient privacy. Plaintiff objected to each item as the information sought was irrelevant and not reasonably calculated to lead to the discovery of admissible evidence.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 payment 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.”).
In this case, the information sought relates directly to the Plaintiff’s prima facia case and proving that their charge is reasonable, and is directly relevant to the Defendant in being able to rebut the Plaintiff’s position.
Therefore, it is ORDERED AND ADJUDGED, that the objections raised by the Plaintiff, Hollywood Diagnostic, to Interrogatory 3, 4 and 5 of Defendant’s reasonable charge interrogatories is overruled and the Plaintiff Hollywood Diagnostic shall provide an answer to interrogatory number 3, 4 and 5 in thirty (30) days. Further, Plaintiff has agreed to provide answers to interrogatories 2, 6, 7, and 8, which the Plaintiff has thirty (30) days to answer.
It is further ORDERED AND ADJUDGED, that the objections raised by the Plaintiff, Hollywood Diagnostic, to numbers 5, 6, 7, 8, 9, and 10 of Defendant’s reasonable charge request for production is overruled. However, per agreement of the parties, if the objections to request for production 5, 6, 7, 8, 9, and 10 are overruled, in lieu of production of the documents, the Plaintiff will supply a better answer to reasonable charge interrogatory number 4. As such, the Plaintiff will supply a better response to reasonable charge interrogatory number 4 within thirty (30) days. Further, the objection raised by Plaintiff, Hollywood Diagnostic, to number 11 of Defendant’s reasonable charge request for production is overruled. The Plaintiff has thirty (30) days to provide a response. Finally, the Plaintiff has agreed to provide an answer to request for production 2, which the Plaintiff has (30) days to provide an answer.
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