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Indiana Court of Appeals holds government reimbursement rates are not accurate value of health care services

By Doug Small | January, 05, 2016
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 The Indiana Court of Appeals recently affirmed a ruling in Patchett v. Lee,29A04-1501-CT-1 (Ind. Ct. App. Nov. 19, 2015), which held that government reimbursement rates are not an accurate reflection of the value of health care services, and thus are inadmissible as evidence of the reasonable value of medical services in personal-injury cases. The Patchett ruling signified a major shift in Indiana law on the determination of medical specials damages.

Ms. Lee was injured in an admitted-fault accident in 2012. Her medical specials were billed at $87,706.36. She was insured under Healthy Indiana Plan, a state-funded insurance program. HIP paid $12,051.48 as full satisfaction of Ms. Lee’s medical bills to her providers. Patchett sought to introduce the paid amount as evidence of the reasonable value of her medical specials. The trial court declined Patchett’s request to introduce this evidence, holding that the paid amount did not reflect the reasonable value of her medical services.

With Patchett, Indiana now has multiple classes of personal-injury plaintiffs being treated differently based upon how they are insured or what type of claim they file. Plaintiffs with private insurance are subject to Stanley v. Walker, 906 N.E.2d 852 (Ind. 2009), which permits evidence of the lower paid amount of their medical bills. As such, theStanley case plaintiffs may see their medical specials awarded anywhere along the billed, something in between, or paid spectrum. Next, the government-insured Patchett plaintiffs are able to recover the much higher billed total of their medical specials with little or no room for anything less. Not to be left out, the Butler v. Ind. Dep’t of Ins., 904 N.E.2d 198 (Ind. 2009), plaintiffs in statutory claims may only recover the lower paid amount of their medical specials.

For more information and discussion, see the article in the Indiana Lawyer: Does Patchett v. Lee make patchwork of medical specials? - http://www.theindianalawyer.com/column-does-patchett-v-lee-make-patchwork-of-medical-specials/PARAMS/article/39088

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