80% of 200% of Medicare Part B

GEICO GENERAL INSURANCE COMPANY vs HALLANDALE BEACH ORTHOPEDICS, INC. A/A/O FRITZNIE JARBATH, 4D21-206 (Fla 4th DCA 2021)

If a fee schedule says that you are only liable for 80% of 200% of a fee and the billed amount is less than 80% of 200% of the fee, what can you do?

The Florida court said In Muransky, we held that “under the PIP statute, if the billed amounts are less than 80% of the fee schedule, the insurer may pay the billed amounts in full or pay the 80% reimbursement rate of maximum charges.”

In Muansky, the carrier paid 80% of the billed amount and got burned. Here, the Court remanded for findings as to the proper fee schedule. Play with this on certain bills and ground rules… It is messy 🙂