Court Backs Health Providers In Fight With Allstate

August 20, 2015

A South Florida appeals court Wednesday sided with medical providers in a series of cases filed against Allstate Insurance Co. about payments for treating patients in the state’s no-fault auto insurance system. The ruling, which involved 32 consolidated cases, dealt with whether policies were clear that Allstate would reimburse the providers under a fee schedule from the Medicare program. The fee schedule includes limits on payments for services. The providers argued that the policies were “ambiguous” on the issue, and a majority of a three-judge panel of the 4th District Court of Appeal agreed. The majority opinion, written by Chief Judge Cory Ciklin and joined by Judge Spencer Levine, said legal precedents “make clear that insurance statutes require clarity and specificity in electing fee schedules with respect to PIP (personal injury protection) medical benefits coverage.” But Judge Melanie May dissented, arguing that medical providers had led the court’s majority “down the yellow brick road.” She also pointed to the purpose of the no-fault system, which provides at least a minimum amount of health coverage for injuries suffered in car accidents. “Providers … look to get paid as much as possible, but that does not inure to the insured’s (policyholder’s) benefit,” she wrote. “The less costly the services provided, the more services the insured can receive. While some providers may choose to not treat an insured if their fee is limited to the Medicare fee schedules, that problem is one of the provider’s making, not that of the insurer.”

by The News Service of Florida


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Written by William Reynolds · Filed Under News