Phoenix, AZ., November 17, 2010–WorkCompWire–Last week the Arizona Court of Appeals declined to reconsider its earlier decision that affirmed a 2008 Maricopa County Superior Court ruling in SCF Arizona’s favor.
The trial court held, and the appellate court confirmed, that SCF Arizona paid a “reasonable amount” to two ambulatory surgical centers, rejecting the argument that SCF had violated state law by using a bill reviewer to recommend what to pay.
Canyon Ambulatory Surgery Center and El Dorado Surgery Center (now known as Tucson Surgery Center) asked the Appellate Court to reconsider its September decision. The Court declined to do so. The surgery centers have until Nov. 26 to file a Petition for Review with the Arizona Supreme Court.
“We are pleased the Court of Appeals left its well-reasoned and published opinion intact,” said attorney Mark Worischeck of Sanders & Parks.
Sanders & Parks is a Phoenix-based law firm that specializes in complex litigation and represents a number of insurers locally and nationally. SCF retained Worischeck and colleague Debora Verdier after the centers filed suit in 2003.
The centers had sought to force SCF, the state’s leading workers’ compensation carrier, to pay 100 percent of their billed charges, even though they presented no evidence that their billed charges were reasonable.
After the Court of Appeals’ September decision, Worischeck said, “The court’s ruling strikes a blow to health care providers who seek to impose their unreasonable charges on Arizona’s employers.”
SCF paid the two centers $3.59 million for services rendered to injured workers insured by SCF. Those payment amounts were recommended by Qmedtrix, a third-party vendor.
The workers’ compensation insurer routinely reviews medical bills for reasonableness where the reimbursement amounts are not established by a negotiated contract or by the Industrial Commission’s Medical Fee Schedule. The use of an outside vendor, such as Qmedtrix, to assist in reviewing such bills is standard within the insurance industry.
The surgical centers sued SCF seeking an additional $4.69 million, asking the court to rule that their billed charges were reasonable, even though Canyon accepts 30 percent or less of billed charges from 82 percent of its payers and El Dorado accepts 24 percent or less from 89 percent of its payers. SCF paid almost twice those amounts.
When the case was at the Superior Court level, Judge Edward Burke wrote in his decision: “This court finds that [Canyon Surgery Center and El Dorado Surgery Center] have received the reasonable value of their services from SCF, if not more.”
About SCF Arizona
SCF Arizona is the state’s largest workers’ compensation insurer, providing coverage to more than 35,000 active policyholders and some 500,000 employees statewide. SCF has operated in Arizona for 85 years, holds $3.4 billion in assets and employs more than 500 people. SCF is headquartered in Phoenix and has offices in Flagstaff, Lake Havasu City, Prescott, Show Low, Tucson and Yuma. For more information about SCF Arizona, visit www.scfaz.com
SCF Arizona Contact: Bruce Trethewy
Source: SCF Arizona Press Release 11/17/2010