8 Fla. L. Weekly Supp. 868a
Insurance — Personal injury protection — Dispute between medical provider and insurer — Notice of initiation of treatment creates an additional thirty days for medical provider to submit bills to insurer for initial examination and treatment only, not all bills for services rendered
PREMIER PLUS HEALTHCARE, assignee of TORRES CLAUDIA, Plaintiff, vs. UNITED SERVICES AUTOMOBILE ASSOCIATION, Defendant. County Court, 17th Judicial Circuit in and for Broward County, Civil Division. Case No. 01-01160 SP COSO DIV-62. September 10, 2001. Steven P. Deluca, Judge. Counsel: James D. Underwood. Miriam R. Merlo, Josephs, Jack, Gaebe, Miranda and Cole, Miami.
ORDER GRANTING SUMMARY JUDGMENT INFAVOR OF DEFENDANT
This cause was considered on July 24, 2001, on the Motion of Defendant, UNITED SERVICES AUTOMOBILE ASSOCIATION, for final summary judgment. After hearing argument of counsel and being fully advised in the premises, the Court makes the following findings:
1. This is an action for payment of Personal Injury Protection (PIP) Benefits filed by the Plaintiff/medical provider pursuant to an assignment of benefits. The assignor/insured, Claudia Torres, was involved in an automobile accident on March 6, 2000.
2. Plaintiff submitted a Notice of Initiation of Treatment to the Defendant on March 29, 2000 which was received by the Defendant on April 3, 2000.
3. The Notice of Initiation of Treatment stated that medical treatment was initiated on the assignor/insured, Claudia Torres, on March 13, 2000.
4. The total bills which are the subject matter of this lawsuit are $285.00 for date of service of December 11, 2000.
5. Defendant did not receive the subject medical bill until February 10, 2001. The envelope for the subject medical bill indicates a postmark of February 8, 2001, i.e., 59 days after the date of service.
6. Defendant denied payment to the Plaintiff for failure to comply with Florida Statute 627.736(5)(b), specifically, for failure to submit the medical bill within thirty (30) days from the date of treatment.
The issue for this Court’s determination is whether the Notice of Initiation of Treatment dated March 29, 2000 extends to subsequent and continued treatment by the medical provider, creating an additional thirty (30) days for the provider to submit its bills for all services rendered as opposed to only the initial treatment and bill.
Fla. Stat. 627.736(5)(b) (1998) states, in pertinent part, as follows:
With respect to any treatment of service, other than medical services billed by a hospital for services rendered at a hospital-owned facility, the statement of charges must be furnished to the insurer by the provider and may not include, and the insurer is not required to pay, charges for treatment or services rendered more than 30 days before the postmark date of the statement, except for past due amounts previously billed on a timely basis under this paragraph, and except that, if the provider submits to the insurer a notice of initiation of treatment within 21 days after its first examination or treatment of the claimant, the statement may include charges for treatment or services rendered up to, but not more than, 60 days before the postmark date of the statement.
The Court is of the opinion that the exclusion for billing for services up to 60 days prior to the postmark date only applies to charges for the first examination and treatment included in that first statement.
Accordingly, summary judgment is granted in favor of the Defendant and against the Plaintiff. The Court reserves jurisdiction on the attorney fee issue, pursuant to the Proposal for Settlement.
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