24 Fla. L. Weekly Supp. 711a
Online Reference: FLWSUPP 2409JUMOInsurance — Personal injury protection — Discovery — Motion to compel medical provider to produce documents detailing amounts charged to other payors and amounts accepted as payment is denied where provider has already produced reimbursement matrices that detail its charges to other insurers for CPT code at issue and amounts paid by those insurers
APPLE MEDICAL CENTER, LLC (a/a/o Ayoajayi, Jumoke), Plaintiff, v. STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, Defendant. County Court, 11th Judicial Circuit in and for Miami-Dade County. Case No. 12-19218 SP 23 (01). August 17, 2016. Myriam Lehr, Judge. Counsel: Robert B. Goldman, Florida Advocates, Dania Beach, for Plaintiff. Melissa McDavitt, Conroy Simberg, for Defendant.
ORDER DENYING DEFENDANT’S MOTION TOCOMPEL BETTER RESPONSES TO SECONDSUPPLEMENTAL REQUEST TO PRODUCE
THIS CAUSE having come before the Court on August 16, 2016, upon the Defendant’s Motion to Compel Better Responses to Second Supplemental Request to Produce, and the Court having considered the motion and the Plaintiff’s Response, having heard argument of counsel and being otherwise fully advised, it is
ORDERED that Defendant’s motion is DENIED, for the following reasons:
1. This is a PIP case in which Plaintiff, APPLE MEDICAL CENTER, LLC (a/a/o Ayoajayi, Jumoke) (“APPLE MEDICAL”) is seeking benefits from a policy of insurance issued by STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY (“STATE FARM”), for a CPT Code 99244 procedure performed on December 18, 2008, for which APPLE MEDICAL charged $600.
2. STATE FARM’s applicable automobile insurance policy provides that it will pay 80% of all reasonable expenses incurred for medically necessary medical services.
3. According to Defendant’s Motion to Compel Better Responses to Second Supplemental Request to Produce, Defendant “simply seeks information Florida Statute 627.736 and Florida Courts deem relevant in determining the reasonableness of a medical provider’s charges, by asking for documents detailing the amounts charged to other payors, and the amounts accepted as payment from them.”
4. In response to STATE FARM’S discovery requests, APPLE MEDICAL has provided Insurer Reimbursement matrices that detail APPLE MEDICAL charges for 99244 procedures performed in 2008 and 2009, including approximately 65 instances in which insurers such as STATE FARM, 21st Century Ins. Co., Affirmative Ins. Services of Florida, Allstate Prop. & Cas. Co., American Family Ins. Group, American Service Ins. Co., Assurance America Ins. Co., Geico, GMAC Insurance, Harbor Cas. Co., Infinity Ins. Co., Liberty Mut. Ins. Co., Mercury Ins. Group, Ocean Peachtree Casualty, Progressive Ins. Co., Security Nat. Ins. Co. and United Auto. Ins. Co., have approved APPLE MEDICAL’s $600 charge and the amounts paid by those insurers.
5. The Insurer Reimbursement matrices provided by APPLE MEDICAL reveal the following information —
· STATE FARM had approved APPLE MEDICAL’s identical $600 charge for CPT Code 99244 procedures performed in 2008, having reimbursed APPLE MEDICAL for one such procedure in the amount of 80% of APPLE MEDICAL’s charge within 30 days after the December 18, 2008 date of service in this case.
· Eight (8) separate insurers had approved APPLE MEDICAL’s identical $600 charge for nineteen (19) separate CPT Code 99244 procedures performed within 90 days prior and 90 days after the December 18, 2008 date of service in this case.
· Six (6) separate insurers had approved APPLE MEDICAL’s identical $600 charge for ten (10) separate CPT Code 99244 procedures performed within 60 days prior and 60 days after the December 18, 2008 date of service in this case.
· Several insurers had approved APPLE MEDICAL’s identical $600 charge for four (4) separate CPT Code 99244 procedures performed within 30 days prior and 30 days after the December 18, 2008 date of service in this case.
· Allstate Property & Cas. Ins. Co. approved APPLE MEDICAL’s identical $600 charge for a CPT Code 99244 procedure performed on December 18, 2008, just two days prior to the date of service in this case.
Accordingly, the Court finds that Plaintiff has complied with Defendant’s discovery request, having provided ample information regarding the reasonableness of its charges, including the amounts charged to other payors, and the amounts accepted as payment from them.
