High Quality Med. Supplies, Inc. v Mercury Ins. Group, 2016 NY Slip Op 51444(U)(App. Term 2d Dept. 2016)
“In SK Prime Med. Supply, Inc. v State Farm Mut. Auto. Ins. Co. (43 Misc 3d 133[A], 2014 NY Slip Op 50630[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2014]), this court noted that the “NYS Medicaid DME Services Fee Schedule” has been adopted as the Durable Medical Goods Fee Schedule for Workers’ Compensation (12 NYCRR 442.2 [a]). However, contrary to defendant’s argument on appeal, that is not a basis to hold that “the billing for durable medical equipment that is not included within the fee schedule is not compensable.” Indeed, 11 NYCRR 68.5 specifically addresses reimbursement for healthcare services not set forth in fee schedules”
I suppose I was unavailing here. 68.5 played out to the insurance carrier’s detriment.
3 Responses
I’m curious to see your arguments in support jason.
I can’t blame you for trying, but… wait, actually, I can blame you for trying and will respond in kind by creating more law that takes money from your clients.
Regardless of who pays my bills, I am always contemplating the arguments on the myriad issues that are out there. Sometimes I feel like I have solved the riddle. Other times, I feel like I am just losing it.
I respect that you are willing to be inventive to get your client’s results even if I must be an instrument of karma.