8 Fla. L. Weekly Supp. 839a
Hospitals — Health Maintenance Organizations — Insurance — Hospital claim of lien — Action by hospital to pursue liens against patient’s personal injury protection and uninsured motorist coverage rather than submitting bills to patient’s health insurance carrier where express terms of participating provider agreement between hospital and carrier provide that hospital will accept payment from carrier as payment in full for covered services — Coordination of benefits provision of health insurance policy operates as between health insurance carrier and insured only, not as vehicle for hospital to circumvent express terms of contract to accept payment from carrier as payment in full — Hospital waived statutory right to pursue its liens by entering into participating provider agreement with health insurance carrier — Medicare and Medicaid statutes, which provide that payment may not be made for any item or service to the extent that payment is made or can reasonably be expected to be made by automobile, liability or no fault insurance, are inapplicable — No merit to claim that because participating provider contract does not contain express language modifying or limiting hospitals’ statutory hospital lien rights, silence must result in upholding lien claims as if there were no health insurance coverage — Contract read in pari materia with Florida HMO Act provision that HMO subscriber is not liable to medical provider for any services for which the HMO is liable supports conclusion that hospital has no right to recourse against patient except for applicable co-payments and deductibles for covered services or fees for services not covered by health insurance policy — Liens invalidated by HMO Act
See 9 Fla. L. Weekly Supp. 380a