Florida Supreme Court Will Decide Case Over Insurance Claims

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.
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