County court rules in favor of plaintiff regarding defendant’s use of Budget Neutrality Adjustor in calculating reimbursement made for plaintiff.

This suit was for allegedly underpaid PIP benefits. ISO Diagnostic Testing billed seven units of CPT code 95851. United Auto reimbursed these codes utilizing the 2007 Limiting Charge rate. ISO Diagnostic’s contention was that United Auto was not allowed to use a 0.8994 Budget Neutrality Adjustor when calculating the reimbursement to the plaintiff and should have paid $44.60 per unit, as opposed to $43.00 a unit. 

The court ruled in favor of the plaintiff, noting that the Budget Neutrality Act (BNA) issue is analogous to the issue presented to the Fourth District Court of Appeal in Sunrise Chiropractic and Rehabilitation Center, Inc. a/a/o Buchenet Louis v. Security National Ins. Co., 321 So. 3d 786 (Fla. 4th DCA 2021). Additionally, the court adopted the analysis in Chiropractic USA of Plantation, Inc. v. United Automobile Ins. Co., 30 Fla. L. Weekly Supp. 650 (Broward Cty. Ct. 2022), in which the court concluded that the 2007 BNA issue is no different than the 2% BNA issue in Sunrise Chiropractic, thus ruling that United Automobile’s use of the Budget Neutrality Adjustment was prohibited. 

This ruling is significant as it establishes Broward County as a jurisdiction that is firmly against an insurer’s use of the Budget Neutrality Adjustments. However, it remains to be seen what affect the recent decision from the Fourth District Court of Appeals in Progressive Select Insurance Company, Appellant v. In House Diagnostic Services, Inc. a/a/o Darryl Frazier, No. 4D21-2581, will have on this issue moving forward.
 

_{Case Law Alerts, 3rd Quarter, July 2023 is prepared by Marshall Dennehey to provide information on recent developments of interest to our readers. This publication is not intended to provide legal advice for a specific situation or to create an attorney-client relationship. Copyright © 2023 Marshall Dennehey, all rights reserved. This article may not be reprinted without the express written permission of our firm.}