The Florida Supreme Court set a precedent on July 3rd which directly affects PIP payments for hospitals. This affects all PIP bills from January 1, 2008 to December 31, 2012 where the amount allowed for services was reduced to 200% of Medicare fee schedule. If you are a hospital administrator, then you should contact an attorney that handles PIP cases to see if money can be collected from PIP insurance. Background: On January 1, 2008, the PIP law was changed to give PIP insurance companies the option of reducing medical bills to 200% of Medicare fee schedules. Naturally, PIP insurance companies began to apply the Medicare fee schedule to all bills because it gave them the ability to slash payments to hospitals. The problem was that most insurance companies never changed the language that was in their policy – a legally binding contract – which continued to state that they would pay “80% of reasonable medical expenses.” The policies were never amended to state that they could pay at 200% of Medicare fee schedules.
The question before the Court was whether GEICO could limit the amount that they paid for medical services to 200% of Medicare when GEICO didn’t notify its insured vis a vis the insurance policy. The Florida Supreme Court stated that a PIP insurance company could not limit payment based on the Medicare fee schedule identified in F.S. 627.736(5)(a) without providing notice to its insured that it would be using the Medicare fee schedule as the basis for reducing payment.
GEICO has the same policy language as most of the other auto insurance companies in Florida so even though this case only involved GEICO, it directly affects many other insurance companies as well.
