Currently before the Florida Supreme Court is the case of Progressive Select Insurance Company vs. Florida Hospital Medical Center, Etc., Case Number: SC18-278. At issue in this case is how the deductible is to be applied in paying PIP claims.
Insurance companies allege that it is proper to reduce the amount billed to the fee schedule amounts before applying the deductible. Medical providers allege that the deductible should first be subtracted from the billed amount, prior to applying the fee schedule. While this may, at first glance, appear inconsequential, it is an issue with millions of dollars at stake. Applying the deductible the insurance company’s way results in a typical savings on each case of $50-$150. This amount adds up with every patient that this methodology is used with.
The District Courts of Appeal are split on the proper methodology to use and the issue is before the Florida Supreme Court. The Florida Supreme Court is expected to rule on the issue soon. We will keep you updated once there is a ruling.
This issue illustrates the importance of having a professional double-check your files. While a medical provider may see that they have received payment on a file and assume it has been paid properly, it never hurts to have a professional double-check. Many medical providers have thousands of dollars in their files in underpayments and improper denials by insurance companies.
At the Law Offices of Lyle B. Masnikoff and Associates, P.A., we will be happy to few any files that you think the Carrier did not apply the deductible properly. If you have any questions regarding this issue or any other PIP claim, please do not hesitate to contact us at 561-598-7120.
Lyle Masnikoff & Associates, P.A.
1645 Palm Beach Lakes Blvd #550
West Palm Beach, FL 33401