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Appellate court rules contracted rates relevant in determining reasonableness

Dec 3, 2015 in Case Law Updates by

In a victory for insurers fighting against the false market created by medical and diagnostic service providers, Miami-Dade County’s Eleventh Circuit, sitting in its Appellate Capacity, issued an opinion explicitly holding that “reimbursement rates accepted by the petitioner from other insurance providers are relevant in the context of litigation over the reasonableness of the charges” but nonetheless quashed the lower court’s order for its failure to make the ever-amorphous “particularized findings” regarding the medical provider’s assertion of the trade secret privilege. In finding the reimbursement rates relevant, the panel cited to Columbia Hospital v. Hasson, 33 So. 3d 148, 150 (Fla. 4th DCA 2010) and Section (5)(a) of the PIP Statute—two sources which have consistently been argued at the trial level as supporting the relevance of such amounts. The opinion by the panel is consistent with and builds upon prior opinions from the Eleventh Circuit on this issue. The decision represents binding authority in Miami-Dade County.


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