Medical necessity disputes in major medical disputes may be raised at any time

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Hercules Med., PC v Cabello, 2013 NY Slip Op 52186(U)(App. Term 1st Dept. 2013)

“A fair interpretation of the evidence supports the trial court’s determination that plaintiff, an out-of-network medical service provider, was entitled to recover for examination and testing services rendered to defendant for which defendant failed to pay, despite timely demand. Indeed, defendant did not dispute that the services billed for were rendered, or the reasonableness of the amounts charged for each particular service. Nor did defendant adduce any competent expert medical proof to support her assertion that the services here in dispute were not medically necessary (see Mount Vernon Hosp. v Brennan, 21 Misc 3d 140[A], 2008 NY Slip Op 52358[U] [App Term, 2nd Dept 2008]; see generally Viacom Intl. v Midtown Realty Co., 193 AD2d 45, 55 [1993]).”

If you read the Mount Vernon Hospital case that was cited, the Court required the hospital “[to] establish[] that the charges for the services rendered were fair and reasonable.”

Fair and reasonable seems to be an important issue in the realm of no-fault as it applies to services rendered out of state.  Compare, 11 NYCRR 68.6

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