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Florida Fourth DCA rules that PIP insurers must reduce a provider's charges to statutory permissive fee schedule before applying deductible, certifies conflict with Fifth DCA

On March 14, 2018, in State Farm v. Care Wellness Center, No. 4D16-2254, the Florida Fourth DCA ruled that PIP insurers must reduce a provider’s charges under the statutory permissive fee schedule, 627.736(5)(a), Florida Statutes, before applying the deductible. The provider in this case, Care Wellness Center, conceded that State Farm had put the insured on notice of its election to limit reimbursement to the permissive fee schedule rate found in the statute, but alleged that State Farm had improperly applied the fee schedule to charges that were unpaid because of the patient’s deductible. The circuit court agreed and entered judgment for the provider, but the Fourth DCA reversed the ruling on appeal, stating that “[t]o apply the deductible to the total amount billed, even if the amount exceeds the statutory fee schedule, would render portions of the legislation meaningless.” The Fourth DCA certified conflict with the Fifth DCA in Progressive Select Insurance Co. v. Florida Hospital Medical Center a/a/o Jonathan Parent, 43 Fla. L. Weekly D318 (Fla. 5th DCA Feb. 9, 2018).
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