Volume 26

26 Fla. L. Weekly Supp. 430a

Online Reference: FLWSUPP 2605LASKInsurance — Personal injury protection — Coverage — Medical expenses — Where PIP policy providing that charge submitted for amount less than amount allowed above shall be paid in amount of charge submitted is ambiguous as to whether “amount allowed above” is 200% of allowable amount under Medicare Part B fee schedule or 80% of that amount, insurer was required to pay entire amount of charges that were less than 200% of allowable amount under fee schedule, not 80% of those charges

26 Fla. L. Weekly Supp. 429a

Online Reference: FLWSUPP 2605BORRInsurance — Personal injury protection — Coverage — Medical expenses — Where PIP policy provides that charge submitted for amount less than 200% of allowable amount under Medicare Part B fee schedule shall be paid in amount of charge submitted, insurer was required to pay entire amount of charges that were less than 200% of allowable amount under fee schedule, not 80% of those charges

26 Fla. L. Weekly Supp. 409a

Online Reference: FLWSUPP 2605COLEInsurance — Personal injury protection — Coverage — Medical expenses — Statutory fee schedules — Clear and unambiguous election by insurer — PIP policy that states that statutory fee schedules may be used in determining how charges are paid clearly and unambiguously elects to limit reimbursement to statutory fee schedules — Multiple Procedure Payment Reductions is payment methodology, not utilization limit prohibited by PIP statute — Where medical provider billed charge at less than 200% of allowable amount under fee schedule, insurer properly paid 80% of amount billed

26 Fla. L. Weekly Supp. 407a

Online Reference: FLWSUPP 2605CAMPInsurance — Personal injury protection — Coverage — Medical expenses — Where PIP policy provides that charge submitted for amount less than 200% of allowable amount under Medicare Part B fee schedule shall be paid in amount of charge submitted, insurer was required to pay entire amount of charges that were less than 200% of allowable amount under fee schedule, not 80% of those charges

26 Fla. L. Weekly Supp. 311b

Online Reference: FLWSUPP 2604BRUCInsurance — Personal injury protection — Coverage — Medical expenses — Statutory fee schedules — Clear and unambiguous election by insurer — PIP policy that provides that insurer will determine to be unreasonable any charges that exceed the maximum charges set forth in the PIP statute and will limit reimbursement to 80% of schedule of maximum charges provides clear and unambiguous notice of incorporation of permissive statutory fee schedule limitation into policy — Multiple Procedure Payment Reductions is payment methodology that may be relied upon in reimbursing medical provider, not utilization limit — Where provider charged less than 200% of allowable amount under Medicare Part B fee schedule for two CPT codes, insurer properly reimbursed for those codes at 80% of amount billed — Outpatient Prospective Payment Systems — No merit to provider’s claim that insurer did not reimburse its bills in accordance with PIP policy because it did not apply OPPS to bills where provider failed to present any admissible evidence that OPPS would apply to it or to CPT codes billed

26 Fla. L. Weekly Supp. 908a

Online Reference: FLWSUPP 2611CHERInsurance — Personal injury protection — Coverage — Medical expenses — Statutory fee schedules — Because 2% reduction applied by Centers for Medicaid and Medicare Services to physician fee schedule payment amounts for CPT codes for chiropractic manipulation is explicit part of formula for calculating fee schedule payment amounts for those CPT codes, PIP insurer is entitled to use fee schedule amounts that reflect 2% reduction when reimbursing for chiropractic services under PIP policy that adopts statutory fee schedules, and is not required to calculate reimbursement using formula that would add 2% back into fee schedule payment amounts

26 Fla. L. Weekly Supp. 901a

Online Reference: FLWSUPP 2611LINTInsurance — Personal injury protection — Coverage — Medical expenses — Multiple Procedure Payment Reduction does not apply to chiropractic services that were not performed by physician or non-physician practitioner under written “therapy plan of care” but, rather, by unsupervised chiropractor — Question certified

26 Fla. L. Weekly Supp. 840a

Online Reference: FLWSUPP 2610WILLInsurance — Personal injury protection — Coverage — Medical expenses — Amount paid by insurer for CPT Code 98941 on dates of service at issue for services falling under locality “99,” or “Rest of Florida,” was calculated in accordance with controlling statute and policy language

26 Fla. L. Weekly Supp. 478a

Online Reference: FLWSUPP 2606ASHFInsurance — Personal injury protection — Trial court erred in entering summary judgment ruling that medical provider’s claim for PIP benefits is barred by class action settlement where insurer failed to show that there were no genuine issues of material fact as to whether provider was member of settlement class

26 Fla. L. Weekly Supp. 999a

Online Reference: FLWSUPP 2612KIMInsurance — Personal injury protection — Coverage — Medical expenses — Where PIP policy provides that charge submitted for amount less than 200% of allowable amount under Medicare Part B fee schedule shall be paid in amount of charge submitted, insurer was required to pay entire amount of charges that were less than 200% of allowable amount under fee schedule, not 80% of those charges