21 Fla. L. Weekly Supp. 1069a
Online Reference: FLWSUPP 2110SIRKInsurance — Personal injury protection — Discovery — Medical provider’s negotiated rates with other insurers are not relevant to determination of what insurer must pay provider for MRI — Motion to compel is denied
PALMS MRI DIAGNOSTIC IMAGING CENTERS, INC, as assignee of Frank Sirker, Plaintiff, vs. STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, Defendant. County Court, 17th Judicial Circuit in and for Broward County. Case No. 11-14717 CONO 71. May 19, 2014. Schiff, Judge. Counsel: Cris Evan Boyar, Boyar and Freeman, P.A., Coral Springs, for Plaintiff. Adam Reed, for Defendant.
ORDER DENYING DEFENDANT’SMOTION TO COMPEL
THIS CAUSE came before the court on Defendant’s Motion to Compel Better Responses to Discovery. The Court having reviewed all pertinent documents, and having heard argument of counsel and denies the Defendant’s Motion as to Defendant’s request as follows:
1. The Plaintiff filed suit in small claims because the Defendant not pay 80% of the billed amount for the MRI at issue.
2. In discovery, the Defendant seeks copies of explanations of reviews from health insurers that have paid the Plaintiff’s bills in other cases. At the hearing, the Defendant agreed the Plaintiff does not have to produce the actual documentation because it may violate the privacy of the patients, even if redacted, but now asks for a matrix stating what the actual health insurers pay for 3 months before and 3 months after the MRI at issue. The Defendant then stated the Plaintiff can call the actual health insurer “insurer 1”, “insurer 2”, etc. in order to protect the privacy, confidentiality and trade secrets of the insurers that have contracted to pay a confidential amount with the Plaintiff.
3. The Plaintiff objects on various grounds including burdensome, relevance and materiality.
4. As it relates to relevancy neither the Plaintiff nor the Defendant used what health insurers pay when determining what is a reasonable charge. The PIP Statute does not specifically allow this discovery. Nor it is a specific factor in §627.736(5)(a) that a party can use in determining what is a reasonable charge. In this case, the Plaintiff used what other insurers pay when they pay a reasonable amount, what the Plaintiff’s competitors charge, and the range suggested in four different publications to determine the amount to bill for the MRI. The Defendant used 200% of Medicare, 2007 Part B, as this is the amount State Farm thinks is reasonable. Thus, neither party used this evidence as a basis in determining what is a reasonable charge.
5. As it relates to materiality, this requested information is not material to issues in dispute. The Defendant filed an affidavit of Mr. Spell to support their position and he opines health insurers pay up to 140% of Medicare.
6. The Plaintiff filed a stipulation stating in network HMO health insurers pay approximately medicare and in network PPO health insurers pay up to approximately 140% of Medicare for the MRIs.
7. Thus, the parties agree on this issue as to what typical health insurers allow and this discovery is no longer material. The court finds it would be burdensome and unnecessary to give the Defendant any more specific data to support the numbers both sides agree upon.
8. Regardless of this agreement, the court finds, and has found many times before in resolving PIP claims, the negotiated rates with health insurers and the “reasonable” amount that State Farm’s policy obligates it to pay, without more, are more prejudicial than probative, and likely to confuse or mislead a jury for the many different reasons as stated with specificity in those orders.
9. This court determines that any such negotiated rate contracts the Plaintiff may have with other insurers are simply not relevant to a determination of what price State Farm must pay the Plaintiff for its services in this case. See Hillsborough County Hospital v. Fernandez, 664 So.2d 1071 (Fla. 2nd DCA 1995) [20 Fla. L. Weekly D2650b].
10. This court agrees with many other trial judges in Florida that have addressed this exact issue as it relates to the discovery used in PIP cases and will use its discretion to deny the Defendant’s Motion to Compel. See Millennium a/a/o Butler v. State Farm, 13-008891 CONO 70 (Fla. Broward County 2014, Judge Fry) [21 Fla. L. Weekly Supp. 811a]; Rivero Diagnostic a/a/o Trujillo v. State Farm, Case number 13-12144 SP 25 (Fla. Dade County Court 2014, Judge Cohn) [21 Fla. L. Weekly Supp. 804a].
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