According to the Opinion, following the subject accident, the Plaintiff underwent a cervical spine fusion surgery which was performed in Florida.
The case eventually went to trial and, as part of the verdict, the jury awarded $150,000.00 in past medical expenses, most of which was related to the cost of the surgical treatment that took place in Florida.
During the post-trial proceedings, one of the issues raised was the trial court’s refusal to reduce the amount of the past medical expenses award any more than down to the figure of $148,000.00. This amount was the specific amount that was presented in evidence as to the actual cost of the surgery.
The defense asserted that the trial court erred in denying the defense motion to mold the jury’s $150,000.00 past medical expenses award down to $9,882.00 under an application of Act 6, 75 Pa. C.S.A. §1797(a), of the Pennsylvania Motor Vehicle Financial Responsibility Law.
Section 1797 of the Pennsylvania Motor Vehicle Financial Responsibility Law allows for a recovery of medical bills at up to 110% of what Medicare would pay a provider for the same service.
According to the Opinion, at trial, Judge Hertzberg allowed the Plaintiff to introduce medical bills into evidence before they were reduced under the MVFRL. The court noted at trial that it would allow for and consider any post-trial motions to mold any medical expenses award. The court stated that it took this approach based upon the Superior Court’s decision in the case of Pittsburgh Neurosurgery Associates v. Danner which allowed for awards involving these types of bills to be presented at trial in full, subject to being molded in a post-trial proceeding.
In this Yurek case, the court emphasized that, during trial, the treating doctor from Florida testified that he was not licensed in Pennsylvania and that he did not perform any medical work in Pennsylvania.
Section 1797 of the Pennsylvania Motor Vehicle Financial Responsibility Law allows for a recovery of medical bills at up to 110% of what Medicare would pay a provider for the same service.
According to the Opinion, at trial, Judge Hertzberg allowed the Plaintiff to introduce medical bills into evidence before they were reduced under the MVFRL. The court noted at trial that it would allow for and consider any post-trial motions to mold any medical expenses award. The court stated that it took this approach based upon the Superior Court’s decision in the case of Pittsburgh Neurosurgery Associates v. Danner which allowed for awards involving these types of bills to be presented at trial in full, subject to being molded in a post-trial proceeding.
In this Yurek case, the court emphasized that, during trial, the treating doctor from Florida testified that he was not licensed in Pennsylvania and that he did not perform any medical work in Pennsylvania.
There was testimony that there were allegedly no doctors in Pittsburgh who would do the type of cervical spine fusion surgery that the Florida doctor performed on the Plaintiff in Florida. The doctor also testified that he charged $120,000.00 for performing the surgery. An additional $28,000 was charged by the surgical center. As such, the total expenses for the treatment performed in Florida was $148,000.
At trial, the Plaintiff also testified as to her belief that no other doctors in Pennsylvania would perform the type of surgery at issue.
In his decision, Judge Hertzberg noted that his review of the evidence led him to conclude that, at least $148,000.00 of the $150,000.00 award of past medical expenses was related to the treatment provided by the Florida doctor.
The judge agreed with the Plaintiff’s argument that because the Florida doctor was not a Pennsylvania licensed provider, the expenses related to the treatment provided by that out-of-state doctor was not subject to reduction under Act 6 of the Motor Vehicle Financial Responsibility Law.
Judge Hertzberg reasoned that the express language of “cost containment” provision in the MVFRL, which is applicable to medical expenses in a motor vehicle accident case, “twice references medical bill amounts ‘applicable in this Commonwealth under the Medicare program.’"
Judge Hertzberg reasoned that the express language of “cost containment” provision in the MVFRL, which is applicable to medical expenses in a motor vehicle accident case, “twice references medical bill amounts ‘applicable in this Commonwealth under the Medicare program.’"
Judge Hertzberg noted that this language also signaled to him that the statute’s application was limited to only apply to Pennsylvania licensed providers.
In so ruling, Judge Hertzberg also reviewed a regulation regarding the act that was issued by the insurance department. Those regulations, found at 31 Pa. Code §69.11 state, in pertinent part, that the cost containment or payment limitation provisions apply to care rendered by Pennsylvania licensed providers.
As such, Judge Hertzberg used this additional analysis to find that Act 6 reductions did not apply to the care rendered by the doctor at issue in this case where the doctor at issue was not a Pennsylvania licensed provider, where the treatment did not take place in Pennsylvania, and where the treatment rendered was not available in Pennsylvania.
Anyone wishing to review a copy of this decision may click this LINK.
Source: Article – “Motor Vehicle Law Doesn’t Require Reduction of Medical Bills For Procedure That Wasn’t Available in PA., Judge Rules,” By Riley Brennan of the Pennsylvania Law Weekly (July 9, 2024).
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