23 Fla. L. Weekly Supp. 339a
Online Reference: FLWSUPP 2304WHITInsurance — Personal injury protection — Discovery — Medical provider is required to produce documents reflecting amounts accepted by provider for CPT codes at issue from in-network health insurers, out of network health insurers and cash paying patients for six months before first date of service through six months after last date of service — Provider must also produce complete medical file on insured, including records prior to accident
ADRIENE D. HILL, D.C., P.A. assignee of White, Sandy, Plaintiff, v. STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, Defendant. County Court, 2nd Judicial Circuit in and for Wakulla County. Case No. 2013-102-SC. March 16, 2015. Jill Walker, Judge. Counsel: Rinaman & Associates, P.A., Jacksonville, for Defendant.
ORDER ON DEFENDANT’S MOTION TO COMPELBETTER RESPONSES TO DEFENDANT’S DISCOVERYAND DEFENDANT’S MOTION FOR PARTIAL SUMMARYJUDGMENT WITH RESPECT TO CPT CODE 98914
THIS CAUSE came before the Court at the March 4, 2015 hearing on Defendant’s Motion to Compel Better Responses to Defendant’s Discovery and Defendant’s Motion for Partial Summary Judgment with Respect to CPT code 98914, and the Court being otherwise fully advised in the premises, finds as follows:
1. Plaintiff brought this Personal Injury Protection (“PIP”) action against Defendant on November 13, 2013 for purportedly underpaid PIP benefits for dates of service July 24, 2009 through October 3, 2013.
2. On or about January 21, 2014, Defendant propounded to Plaintiff its first Request to Produce and Interrogatories.
3. On or about February 4, 2014, Plaintiff filed a Motion to Extend Time in Which to Respond to Defendant’s Request for Production and Defendant’s Interrogatories.
4. On or about August 29, 2014, Plaintiff provided responses to Defendant’s Request to Produce and unverified responses to Defendant’s Interrogatories. Then, on September 5, 2014, Plaintiff provided verified responses to Defendant’s Interrogatories.1
5. On or about September 2, 2014, and pursuant to Local Rule 88-2, counsel for Defendant sent a good faith letter to counsel for Plaintiff advising of the insufficiency of Plaintiff’s responses, with respect to discovery requests regarding reasonableness of the charge, as well as the issue of whether treatment was reasonable, necessary, or related to the subject motor vehicle accident. Plaintiff did not contact Defendant regarding the good-faith letter, causing Defendant to file a Motion to Compel Better Responses on September 18, 2014.
6. To date, Plaintiff has not produced any documentation evidencing reasonableness of the charge in response to Defendant’s Request to Produce. Defendant sought reasonableness of the charge information to use as evidence of the usual and customary payments accepted by the provider, which is permitted by the Florida Statutes, which states, in pertinent part:
“F.S. § 627.736(5) Charges for treatment of injured persons.
(a) 1. Any physician, hospital, clinic, or other person or institution lawfully rendering treatment to an injured person for a bodily injury covered by personal injury protection insurance may charge the insurer and the insured only a reasonable amount . . . [i]n 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 . . .”.
7. The interrogatories and the documents requested were propounded by Defendant to obtain evidence on the reasonableness of Plaintiff’s charge and the amount of payment Plaintiff believes to be reasonable for a certain service. Plaintiff’s assertion that Defendant’s payment is unreasonable — the very reason for bringing this lawsuit — is without merit unless Plaintiff can provide supporting documentation to prove what amount is reasonable. For additional support, Defendant provided several Orders evidencing that the information requested by Defendant is frequently permitted by Florida Courts.
8. At the hearing on March 4, 2015, counsel for Plaintiff argued that the information sought by Defendant is not relevant to the issues in this case, nor will the information be relevant during the trial. This Court disagrees with Plaintiff’s argument, as the plain language in F.S. § 627.736(5)(a)(1) specifically identifies “payments accepted by the provider involved in the dispute” as one of the factors to consider in determining whether Plaintiff’s charges were reasonable.
9. Further, counsel for Plaintiff argued that the information sought would be an extreme burden to Plaintiff to produce explanations of benefits for each CPT code at issue, or other documentation evidence the amounts accepted by other payors. This Court is unpersuaded by Plaintiff’s arguments and finds that it is Plaintiff’s burden to prove the reasonableness of its charge. Furthermore, as noted above, Florida Courts frequently permit the information Defendant is requesting in its discovery.
10. Based on the above-cited case law and argument from both Counsel, this Court finds that Plaintiff must produce within sixty (60) days from the date of this Order a document (such as an explanation of benefits) evidencing payment for every CPT code at issue and the amounts Plaintiff accepted in payment for January 24, 2009 through January 10, 20132 from each of the following payors:
All “In-Network” Health Insurers, such as HMO and PPO
All “Out of Network” Health Insurers
All Cash Paying Customers
11. With respect to Defendant’s request for Plaintiff’s complete patient file for Ms. White, including medical records prior to the subject accident, this Court finds this request relevant to the issue of whether the treatment at issue was reasonable, necessary, or related to the subject MVA. Plaintiff must produce within thirty (30) days from the date of this Order the complete patient file of Ms. White.
12. With respect to Defendant’s Motion for Partial Summary Judgment with respect to CPT code 98914, filed on December 30, 2014, this Court GRANTS Defendant’s Motion for Partial Summary Judgment.
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1On or about August 12, 2014, this Court executed an agreed order for Plaintiff to respond to Defendant’s discovery by September 3, 2014. Although Plaintiff’s Interrogatory responses were filed beyond the deadline listed in the Agreed Order, Defendant does not contest the responses as untimely.
2This time period reflects six months before the first date of service (July 24, 2009) through six months after the last date of service at issue with respect to reasonableness of the charge (July 10, 2012). For the dates of service at issue after July 10, 2012, the issue is whether the treatment was reasonable, necessary, or related to the subject motor vehicle accident.
