Priority Medical Centers, LLC (a/a/o Susan Boggiardino) v. Allstate Insurance Company
In a PIP declaratory action, the Third DCA answered a certified question of great public importance about the meaning of "allowable amount under the applicable schedule of Medicare Part B for 2007" in section 627.736(5)(a)2. The court held that the 2007 floor is the higher non-facility limiting charge, not the lower non-facility participating price, because the 2012 amendment deleted "participating physician" and substituted "applicable schedule." Summary judgment for Allstate was affirmed.
Key facts
- Priority Medical Centers, LLC brought a PIP declaratory action against Allstate Insurance Company seeking to determine the correct calculation of the statutory reimbursement floor under section 627.736(5)(a)2.
- The trial court entered summary judgment in favor of Allstate, and the case was certified to the Third DCA as a question of great public importance regarding the meaning of 'allowable amount under the applicable schedule of Medicare Part B for 2007.'
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Why it matters
This is a published answer to a certified question of great public importance that resolves a recurring PIP reimbursement dispute in favor of the higher 2007 non-facility limiting charge, directly affecting how insurers… — full analysis with a trial
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