27 Fla. L. Weekly Supp. 646a
Online Reference: FLWSUPP 2707CONTInsurance — Personal injury protection — Coverage — Medical expenses — Reasonableness of charges — Summary judgment — Insurer’s motion for summary judgment on issue of reasonableness of charges, based on testimony that on case-by-case basis medical provider sometimes offers discounts to cash patients paying for services at time they are rendered, is denied, as there is no evidence that provider has program, custom or policy of charging cash patients less
MIAMI BCH NATURAL SPORTS MEDICINE INC, a/a/o Carlos Contreras, Plaintiff(s) / Petitioner(s) v. UNITED AUTO INS CO, Defendant(s) / Respondent(s). County Court, 11th Judicial Circuit in and for Miami-Dade County. Case No. 2014-018696-CC-23, Section ND02. September 12, 2019. Natalie Moore, Judge. Counsel: Robert B. Goldman, Florida Advocates, Dania Beach, for Plaintiff.
ORDER DENYING DEFENDANT’S MOTIONFOR SUMMARY JUDGMENT ON REASONABLENESS
THIS CAUSE having come before the Court on August 27, 2019, upon the Motion for Summary Judgment on Reasonableness of the Defendant, United Automobile Insurance Company (“United Auto”), and the Court having considered the motion and the case law cited therein, having considered the summary judgment evidence, having heard argument of counsel and being otherwise fully advised, it is
ORDERED AND ADJUDGED that United Auto’s Motion for Summary Judgment is DENIED, for the reasons set forth below.
The summary judgment evidence reflects that Miami Beach Natural Sports Medicine, Inc. d/b/a Miami Beach Family & Sports Chiropractic Center (“Miami Beach Chiropractic”) and Dr. Todd Narson provided chiropractic and rehabilitative care and treatment to Carlos Contreras (“Patient”), after Patient presented to Dr. Narson with complaints of neck pain and stiffness after his involvement in a motor vehicle accident. According to Dr. Narson’s affidavit, Miami Beach Chiropractic’s charges for such care and treatment were Miami Beach Chiropractic’s usual and customary charges; the same charges that Miami Beach Chiropractic would charge all payors, including individual patients and insurance companies. Dr. Narson’s affidavit also indicated that on a case-by-case basis, Miami Beach Chiropractic sometimes allows time of service discounts, where payment is made at the time of rendition of the service.
United Auto’s motion for summary judgment asserts that, based upon Dr. Narson’s deposition testimony, that Miami Beach Chiropractic charges and/or accepts discounted amounts from cash patients for the same services as those provided in this case Defense argues that the deposition shows that Miami Beach Chiropractic has charged United Auto an amount that exceeds that which Miami Beach Chiropractic customarily charges for like services, in violation of Sec. 627.736(5)(a), Fla. Stat.1
In support of its summary judgment motion, United Auto has cited Chiropractic Radiology Consultants, P.A. (a/a/o Gregory Miller) v. Progressive American Ins. Co., 15 Fla. L. Weekly Supp. 1004b (Miami-Dade County, 2008), Progressive Consumers Ins. Co. v. Craig A. Newman, D.C. (a/a/o Reem Riley), 15 Fla. L. Weekly Supp. 129a (13th Judicial Circuit (Appellate) for Hillsborough County, 2007) and Kenneth Hawthorne, M.D., a/a/o Kalavatiben Patel v. Progressive Express Ins. Co., 12 Fla. L. Weekly Supp. 867a (Volusia County, 2005). These cases are factually distinguishable and not controlling as to the issue before this Court.
In Newman, the medical provider had implemented a formal cash discount program (as opposed to payment discounts being offered on a case-by-case basis). Similarly, in Hawthorne, the medical provider had maintained a fee schedule for cash patients and a separate fee schedule for individuals who paid for medical services through medical insurance. In Chiropractic Radiology Consultants, the medical provider had agreements with various entities, which resulted in the medical provider’s charging an insurer an amount that was fifteen (15) times greater than that which was charged to those entities with which the provider had agreements.
As there is no summary judgment evidence in this case that Miami Beach Chiropractic had a program, custom, or policy of charging cash patients less, but rather, that Miami Beach Chiropractic would charge the same amounts to all patients, but sometimes, on a case by case basis, decide to allow a discount on payment , it is hereby ORDERED AND ADJUDGED that Defendant’s Motion for Summary Judgment on Reasonableness is DENIED.
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1Sec. 627.736(5)(a) provides that a medical provider’s charge “may not exceed the amount the person or institution customarily charges for like services or supplies”
