In Allstate Ins. Co. v. Revival Chiropractic, LLC, 2024 WL 1776115 (Fla. April 25, 2024), Plaintiff argued that because the charge was less than 80% of 200% of the Medicare Fee schedule, Allstate was required to pay either 100% of the amount charged or 80% of 200% of the Medicare Fee Schedule, which was more than the amount billed. The court ruled in Allstate’s favor and found that Allstate’s payment of 80% of the billed amount was not prohibited by the statute and allowed by the policy. The court reiterated its ruling in MRI Associates of Tampa, Inc. v. State Farm Mutual Automobile Insurance Co., 334 So. 3d 577 (Fla. 2021), in which it found that when an insurer has a hybrid policy that both elects to pay at 80% of 200% of the Medicare Fee Schedule pursuant to §627.736 (5)(a),Fla. Stat., and also allows payment at 80% of the usual and customary amount pursuant to §627.736 (1), Fla. Stat., the insurer has the option to make payment under either method. Here, Allstate had a hybrid policy allowing both payment methods and also had added language stating: “If a provider submits a charge for an amount less than the amount determined by the fee schedule or other limitations established by Section 627.736 . . . or any other provisions of the Florida Motor Vehicle No-Fault Law . . . [Allstate] will pay eighty percent of the charge that was submitted.” Consequently, the court found the policy provides that Allstate will pay 80% of reasonable expenses and it expressly permits Allstate to pay 80% of the charges submitted. Nothing in the PIP statute invalidates the policy provisions authorizing such payments. Read more here.
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