A well-known insurance company is hoping the
Florida Supreme Court will decide a dispute in its favor. The company is asking the court to
decide what information an insurance company is entitled to get from a
hospital regarding reimbursements paid under any given insurance policy.
The court is expected to hand down a decision later this year.
The dispute is over whether an insurance company can request that a hospital
provide confidential contract information about what medical procedures
cost. Of course, hospitals want to protect this information, but insurance
companies would love the chance to discover what the actual costs for
treatments are for hospitals.
First District Court of Appeals Rules in Hospital's Favor
This case originates out of the
First District Court of Appeals, where the insurance company
lost their case. In the original case, the insurance company sued a hospital to have its
contracts with third parties produced so it could know whether it was
paying too much in reimbursements. The insurance company was particularly
interested in getting contracts for discounted services. If it could determine
exactly how much the hospital was paying for the services it provided,
then the insurance company could pay less in reimbursements.
The hospital in this case was more than willing to provide the basis of
its payments. It produced several contracts that represented what the
federal and local standards are for reimbursements, but the insurance
company argued that this was not enough.
Florida Law on Documents
The insurance company based their case and appeal on
Florida Statutes 627.736. That law requires hospitals to produce information about its price models
and payment standards for hospital procedures. The reason there is a law
requiring hospitals to turn over this information is because under Florida
law, hospitals are not allowed to charge more than a reasonable amount
for procedures that are covered under a Personal Injury Protection policy.
When the court decides this case, it will have a big impact on personal
injury cases and how hospitals are allowed to bill their customers.
In a typical accident and injury case, the victim gets his or her treatment
at a hospital where either an insurance company pays the bill or the victim
is left to pay it. The hospital’s bill is whatever the hospital
can justify based on national and local standards for payment, but the
actual cost may be much less. If allowed to discover how much the actual
cost is, insurance companies would necessarily pay less to hospitals after
an accident or injury.
Panama City Accident and Injury Attorneys
At The Pittman Firm we are dedicated to fighting on behalf of victims of
accidents and injuries. We take this fight to hospitals, insurers, and
anyone else who is responsible for causing an accident or injury in the
Panama City area. If you have been in an accident, or have suffered an injury,
contact us. Our team of dedicated professionals will evaluate your case and give
you your legal options.
See related blog posts:
Rear-End Collision: A Look at Florida’s Traffic Laws;
Florida’s Dangerous Instrumentality Law.