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Florida Supreme Court Rules in Favor of Providers in PIP Deductible Case – The Issue Is Now Final

Just before the close of 2018, and in an unusual unanimous decision by the Florida Supreme Court, the years-old issue of how a PIP insurer should apply the deductible to medical bills was finally decided in favor of the providers!  In this case with Florida Hospital, it meant the difference of $200 on one $2,800 bill.  See Progressive Select Ins. Co. v. Florida Hospital Medical Center, 44 Fla. L. Weekly S59a (Fla. December 28, 2018)

 
This case with Progressive, coming out of the Fifth District Court of Appeal, arose in 2014 while alongside an appellate case from the Second District Court of Appeal against State Farm with the identical issue yet differing results.  Providers can now use this decision to collect any improperly calculated reimbursements from patients with PIP deductibles.  Unlike legislation with an effective date, and unlike most court decisions allowing for motions for rehearing, the Florida Supreme Court specifically stated in its order that, “NO MOTION FOR REHEARING WILL BE ALLOWED.”  Therefore, this decision should be effective upon the rendition of the order – December 28, 2018.
 
The Court best described the miscalculation by Progressive (note that under the PIP statute, hospitals are paid 75% of charges):  
 
**Hospital’s calculation:  
$2,781.00 Total hospital charge
 -1,000.00  Parent's PIP deductible
 $1,781.00
     x 75%   Applying section 627.736(5)(a)1.b.
$1,335.75
     x 80%   Applying section 627.736(5)(a)1.
$1,068.60  Amount due
 
**Progressive adjusted the charge by applying the reimbursement limitation before subtracting the deductible:
$2,781.00 Total hospital charge
    x 75%   Applying section 627.736(5)(a)1.b.
$2,085.75
 -1,000.00 Parent's PIP deductible
$1,085.75
   x 80%    Appplying section 627.736(5)(a)1.
$ 868.60   Amount due
 
Chief Justice Canady opined, “A plain reading of the statutory provisions makes clear that the deductible must be subtracted from the provider's charges before the reimbursement limitation is applied.” 
 
It is undetermined which of the Florida PIP auto carriers misapplied their insured’s deductible, but, at the very least you can check patient reimbursements with PIP deductibles from Progressive and State Farm who were named in the two lawsuits prior to filing any PIP demands.