Lawsuit: Infinity Auto Insurance Improperly Applied Medicare Rule Under FL’s No-Fault Law
Last Updated on May 8, 2018
Central Palm Beach Physicians & Urgent Care, Inc. v. Infinity Auto Insurance Company
Filed: November 9, 2017 ◆§ 0:17-cv-62201-WPD
Infinity Auto Insurance supposedly misapplied a Medicare rule with which it's been deducting payments for certain medical services in Florida.
Central Palm Beach Physicians & Urgent Care, Inc. has, on an individual patient’s behalf, filed a proposed class action against Infinity Auto Insurance Company over the insurer’s supposed practice of reducing by two percent payments made on medical services billed under certain Current Procedural Terminology (CPT) codes. The complaint charges that instead of adhering to Florida’s Personal Injury Protection (PIP) Statute, which allows insurers to limit reimbursement of medical services to 80 percent of 200 percent of the allowable amount specified by a participating physician’s fee schedule of Medicare Part B, the defendant has systematically and improperly been paying 80 percent of 200 percent of 98 percent of the allowable amount of proposed class members’ claims governed by the aforementioned Medicare rule. From the lawsuit:
“Included in the treatment provided to [the plaintiff] were services billed under CPT code 98941. The plaintiff charged $90.00 for services attributed to CPT code 989941 10 times. While the correct reimbursement rate for each CPT code 989941 charge was $68.93, [Infinity Auto Insurance Company] only paid [the plaintiff] $67.55 for each.
For each of these payments the defendant sent [the plaintiff] an Explanation of Benefits setting forth that payment had been made pursuant to the allowable rates prescribed at two hundred percent of the 2014 Medicare Part B Participating Physician Fee Schedule consistent with its insurance policy and [Florida law].”
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