Progressive Express Insurance Co. v. SimonMed Imaging, a/a/o Hilleri Brown
In a PIP reimbursement dispute, the Sixth DCA held that the "applicable schedule of Medicare Part B for 2007" floor in section 627.736(5)(a)2. refers back to the three fee schedules delineated in subparagraph 1.f., so the correct benchmark for "all other medical services" is the 2007 non-facility participating physicians fee schedule, not the higher non-participating "limiting charge." The court reversed summary judgment for the provider, directed entry of judgment for the insurer, and certified conflict with the Third District's Priority Medical Centers decision.
Key facts
- Progressive Express Insurance Company disputed the appropriate Medicare Part B fee schedule to use as the reimbursement floor for personal injury protection (PIP) benefits owed to patient Hilleri Brown through provider SimonMed Imaging.
- The trial court entered summary judgment in favor of the provider, determining that the 2007 Medicare 'limiting charge' applied as the reimbursement benchmark for PIP medical services.
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Why it matters
This decision resolves, for the Sixth District, the widely litigated question of which 2007 Medicare Part B benchmark sets the PIP reimbursement floor, and it deepens an express DCA conflict with the Third District that… — full analysis with a trial
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