Discussion: View Thread

If your head is still spinning on how to cost and costing challenges - read the attached. had to print the article because I could not post the link 

Restrictions on the Admissibility of Past and Future Medical Bills as Evidence at Trial

HB 837's language notably modifies the collateral source rule to limit the introduction of evidence for medical damages at trial. If the bill is signed into law, evidence offered to prove the amount of damages for past or future medical treatment at trial generally will be limited to evidence of the amount actually paid.

Past Medical Care
First, the proposed bill limits evidence of past paid medical bills to the amount actually paid for the services regardless of the source of the payment. Therefore, if a full medical bill for past services has been paid by an insurer, the actual amount paid by the insurer is the only amount admissible at trial. The initial billed amount presented by the provider may not be presented as evidence.

Second, the bill hinges on the admissibility of evidence to prove the amount of past unpaid medical bills on the type of health care coverage provided to a plaintiff.

• If a plaintiff has health care coverage, evidence of the amount the coverage is obligated to reimburse the health care provider for satisfaction of the medical services rendered under an insurance contract or regulation (including a plaintiff's share of medical expenses) is admissible at trial.

• If a plaintiff has health care coverage but chooses instead to fund medical care through use of a letter of protection (defined in the bill as "any arrangement by which a health care provider renders treatment in exchange for a promise of payment for the claimant's medical expenses from any judgment or settlement of a personal injury or wrongful death action), then only evidence of the amount the coverage would reimburse under an insurance contract or regulation (including plaintiff's share of expenses) had the plaintiff obtained treatment pursuant to his/her health care coverage is admissible at trial.

• If a plaintiff does not have health care coverage, then evidence of 120 percent of the Medicare reimbursement rate in effect on the date of the claimant's incurred medical treatment or services, or, if there is no applicable Medicare rate for a service, 170 percent of the applicable state Medicaid rate.

• Finally, if a plaintiff receives services pursuant to a letter of protection and the medical bill is subsequently assigned to a third party, then only evidence of the amount the third party agreed to pay the provider for the right to receive payment is admissible.

Future Medical Bills
The proposed bill also provides guidance on the admissibility of evidence relating to damages for future medical care.

• If a plaintiff has health care coverage or is eligible for health care coverage, only evidence of the amount for which the future charges could be satisfied if submitted to such health care coverage (including a plaintiffs' portion of medical expenses) is admissible at trial.

• Whereas, if a plaintiff does not have health care coverage or has health care coverage through Medicare or Medicaid, or is eligible for such health care coverage, evidence of 120 percent of the Medicare reimbursement rate in effect at the time of trial for the medical treatment or services the claimant will receive, or, if there is no applicable Medicare rate for a service, 170 percent of the applicable state Medicaid rate, is admissible.

If your head is still spinning on how to cost and costing challenges - read the attached. had to print the article because I could not post the link 

Restrictions on the Admissibility of Past and Future Medical Bills as Evidence at Trial

HB 837's language notably modifies the collateral source rule to limit the introduction of evidence for medical damages at trial. If the bill is signed into law, evidence offered to prove the amount of damages for past or future medical treatment at trial generally will be limited to evidence of the amount actually paid.

Past Medical Care
First, the proposed bill limits evidence of past paid medical bills to the amount actually paid for the services regardless of the source of the payment. Therefore, if a full medical bill for past services has been paid by an insurer, the actual amount paid by the insurer is the only amount admissible at trial. The initial billed amount presented by the provider may not be presented as evidence.

Second, the bill hinges on the admissibility of evidence to prove the amount of past unpaid medical bills on the type of health care coverage provided to a plaintiff.

• If a plaintiff has health care coverage, evidence of the amount the coverage is obligated to reimburse the health care provider for satisfaction of the medical services rendered under an insurance contract or regulation (including a plaintiff's share of medical expenses) is admissible at trial.

• If a plaintiff has health care coverage but chooses instead to fund medical care through use of a letter of protection (defined in the bill as "any arrangement by which a health care provider renders treatment in exchange for a promise of payment for the claimant's medical expenses from any judgment or settlement of a personal injury or wrongful death action), then only evidence of the amount the coverage would reimburse under an insurance contract or regulation (including plaintiff's share of expenses) had the plaintiff obtained treatment pursuant to his/her health care coverage is admissible at trial.

• If a plaintiff does not have health care coverage, then evidence of 120 percent of the Medicare reimbursement rate in effect on the date of the claimant's incurred medical treatment or services, or, if there is no applicable Medicare rate for a service, 170 percent of the applicable state Medicaid rate.

• Finally, if a plaintiff receives services pursuant to a letter of protection and the medical bill is subsequently assigned to a third party, then only evidence of the amount the third party agreed to pay the provider for the right to receive payment is admissible.

Future Medical Bills
The proposed bill also provides guidance on the admissibility of evidence relating to damages for future medical care.

• If a plaintiff has health care coverage or is eligible for health care coverage, only evidence of the amount for which the future charges could be satisfied if submitted to such health care coverage (including a plaintiffs' portion of medical expenses) is admissible at trial.

• Whereas, if a plaintiff does not have health care coverage or has health care coverage through Medicare or Medicaid, or is eligible for such health care coverage, evidence of 120 percent of the Medicare reimbursement rate in effect at the time of trial for the medical treatment or services the claimant will receive, or, if there is no applicable Medicare rate for a service, 170 percent of the applicable state Medicaid rate, is admissible.

Thank you for sending. 

This is the essence of an article published this week in Seattle Times.

Reimbursement rates appear to be driving some  hospitals out of business.

Best, 

Tony

Anthony J. Choppa, MEd, CRC, CCM, CDMS
Rehabilitation Counselor/Case Manager
OSC Vocational Systems, Inc
10132 NE 185th 
Bothell, WA 98011
425-486-4040 * 5220
425-486-8701 fax
https://doxy.me/oscbothelltony


REMINDER I will be out of the office and unavailable February 10 through 17, 2023; March 1 through 6; March 15 through 21, 2023; April 18 through 28, 2023; May 17 to 19, 2023; July 3 through 7, 2023; October 24 through 27, 2023; November 20 through 24, 2023; and December 18, 2023 through January 2, 2024.


Please be advised that I will be working remotely effective immediately and until further notice. OSC Vocational Systems, Inc. is fully operational. Instead of facilitating or attending face-to-face meetings I will be conducting virtual meetings telephonically or via video-conference, unless otherwise deemed necessary.

Disclaimer: The information transmitted is intended only for the person or entity to which it is addressed and may contain confidential and/or privileged material. Any review, retransmission, dissemination or other use of, or taking of any action in reliance upon, this information by persons or entities other than the intended recipient is prohibited. If you received this in error, please contact me immediately.

If your head is still spinning on how to cost and costing challenges - read the attached. had to print the article because I could not post the link 

Restrictions on the Admissibility of Past and Future Medical Bills as Evidence at Trial

HB 837's language notably modifies the collateral source rule to limit the introduction of evidence for medical damages at trial. If the bill is signed into law, evidence offered to prove the amount of damages for past or future medical treatment at trial generally will be limited to evidence of the amount actually paid.

Past Medical Care
First, the proposed bill limits evidence of past paid medical bills to the amount actually paid for the services regardless of the source of the payment. Therefore, if a full medical bill for past services has been paid by an insurer, the actual amount paid by the insurer is the only amount admissible at trial. The initial billed amount presented by the provider may not be presented as evidence.

Second, the bill hinges on the admissibility of evidence to prove the amount of past unpaid medical bills on the type of health care coverage provided to a plaintiff.

• If a plaintiff has health care coverage, evidence of the amount the coverage is obligated to reimburse the health care provider for satisfaction of the medical services rendered under an insurance contract or regulation (including a plaintiff's share of medical expenses) is admissible at trial.

• If a plaintiff has health care coverage but chooses instead to fund medical care through use of a letter of protection (defined in the bill as "any arrangement by which a health care provider renders treatment in exchange for a promise of payment for the claimant's medical expenses from any judgment or settlement of a personal injury or wrongful death action), then only evidence of the amount the coverage would reimburse under an insurance contract or regulation (including plaintiff's share of expenses) had the plaintiff obtained treatment pursuant to his/her health care coverage is admissible at trial.

• If a plaintiff does not have health care coverage, then evidence of 120 percent of the Medicare reimbursement rate in effect on the date of the claimant's incurred medical treatment or services, or, if there is no applicable Medicare rate for a service, 170 percent of the applicable state Medicaid rate.

• Finally, if a plaintiff receives services pursuant to a letter of protection and the medical bill is subsequently assigned to a third party, then only evidence of the amount the third party agreed to pay the provider for the right to receive payment is admissible.

Future Medical Bills
The proposed bill also provides guidance on the admissibility of evidence relating to damages for future medical care.

• If a plaintiff has health care coverage or is eligible for health care coverage, only evidence of the amount for which the future charges could be satisfied if submitted to such health care coverage (including a plaintiffs' portion of medical expenses) is admissible at trial.

• Whereas, if a plaintiff does not have health care coverage or has health care coverage through Medicare or Medicaid, or is eligible for such health care coverage, evidence of 120 percent of the Medicare reimbursement rate in effect at the time of trial for the medical treatment or services the claimant will receive, or, if there is no applicable Medicare rate for a service, 170 percent of the applicable state Medicaid rate, is admissible.

If your head is still spinning on how to cost and costing challenges - read the attached. had to print the article because I could not post the link 

Restrictions on the Admissibility of Past and Future Medical Bills as Evidence at Trial

HB 837's language notably modifies the collateral source rule to limit the introduction of evidence for medical damages at trial. If the bill is signed into law, evidence offered to prove the amount of damages for past or future medical treatment at trial generally will be limited to evidence of the amount actually paid.

Past Medical Care
First, the proposed bill limits evidence of past paid medical bills to the amount actually paid for the services regardless of the source of the payment. Therefore, if a full medical bill for past services has been paid by an insurer, the actual amount paid by the insurer is the only amount admissible at trial. The initial billed amount presented by the provider may not be presented as evidence.

Second, the bill hinges on the admissibility of evidence to prove the amount of past unpaid medical bills on the type of health care coverage provided to a plaintiff.

• If a plaintiff has health care coverage, evidence of the amount the coverage is obligated to reimburse the health care provider for satisfaction of the medical services rendered under an insurance contract or regulation (including a plaintiff's share of medical expenses) is admissible at trial.

• If a plaintiff has health care coverage but chooses instead to fund medical care through use of a letter of protection (defined in the bill as "any arrangement by which a health care provider renders treatment in exchange for a promise of payment for the claimant's medical expenses from any judgment or settlement of a personal injury or wrongful death action), then only evidence of the amount the coverage would reimburse under an insurance contract or regulation (including plaintiff's share of expenses) had the plaintiff obtained treatment pursuant to his/her health care coverage is admissible at trial.

• If a plaintiff does not have health care coverage, then evidence of 120 percent of the Medicare reimbursement rate in effect on the date of the claimant's incurred medical treatment or services, or, if there is no applicable Medicare rate for a service, 170 percent of the applicable state Medicaid rate.

• Finally, if a plaintiff receives services pursuant to a letter of protection and the medical bill is subsequently assigned to a third party, then only evidence of the amount the third party agreed to pay the provider for the right to receive payment is admissible.

Future Medical Bills
The proposed bill also provides guidance on the admissibility of evidence relating to damages for future medical care.

• If a plaintiff has health care coverage or is eligible for health care coverage, only evidence of the amount for which the future charges could be satisfied if submitted to such health care coverage (including a plaintiffs' portion of medical expenses) is admissible at trial.

• Whereas, if a plaintiff does not have health care coverage or has health care coverage through Medicare or Medicaid, or is eligible for such health care coverage, evidence of 120 percent of the Medicare reimbursement rate in effect at the time of trial for the medical treatment or services the claimant will receive, or, if there is no applicable Medicare rate for a service, 170 percent of the applicable state Medicaid rate, is admissible.

Thanks for posting. Is this bill state specific. When I looked it up, it appears to be a Florida bill. Do you know when they are voting on it and whether it is getting any traction. The implications to what we do seem to be fairly significant and it certainly places a new burden on attorneys.

If your head is still spinning on how to cost and costing challenges - read the attached. had to print the article because I could not post the link 

Restrictions on the Admissibility of Past and Future Medical Bills as Evidence at Trial

HB 837's language notably modifies the collateral source rule to limit the introduction of evidence for medical damages at trial. If the bill is signed into law, evidence offered to prove the amount of damages for past or future medical treatment at trial generally will be limited to evidence of the amount actually paid.

Past Medical Care
First, the proposed bill limits evidence of past paid medical bills to the amount actually paid for the services regardless of the source of the payment. Therefore, if a full medical bill for past services has been paid by an insurer, the actual amount paid by the insurer is the only amount admissible at trial. The initial billed amount presented by the provider may not be presented as evidence.

Second, the bill hinges on the admissibility of evidence to prove the amount of past unpaid medical bills on the type of health care coverage provided to a plaintiff.

• If a plaintiff has health care coverage, evidence of the amount the coverage is obligated to reimburse the health care provider for satisfaction of the medical services rendered under an insurance contract or regulation (including a plaintiff's share of medical expenses) is admissible at trial.

• If a plaintiff has health care coverage but chooses instead to fund medical care through use of a letter of protection (defined in the bill as "any arrangement by which a health care provider renders treatment in exchange for a promise of payment for the claimant's medical expenses from any judgment or settlement of a personal injury or wrongful death action), then only evidence of the amount the coverage would reimburse under an insurance contract or regulation (including plaintiff's share of expenses) had the plaintiff obtained treatment pursuant to his/her health care coverage is admissible at trial.

• If a plaintiff does not have health care coverage, then evidence of 120 percent of the Medicare reimbursement rate in effect on the date of the claimant's incurred medical treatment or services, or, if there is no applicable Medicare rate for a service, 170 percent of the applicable state Medicaid rate.

• Finally, if a plaintiff receives services pursuant to a letter of protection and the medical bill is subsequently assigned to a third party, then only evidence of the amount the third party agreed to pay the provider for the right to receive payment is admissible.

Future Medical Bills
The proposed bill also provides guidance on the admissibility of evidence relating to damages for future medical care.

• If a plaintiff has health care coverage or is eligible for health care coverage, only evidence of the amount for which the future charges could be satisfied if submitted to such health care coverage (including a plaintiffs' portion of medical expenses) is admissible at trial.

• Whereas, if a plaintiff does not have health care coverage or has health care coverage through Medicare or Medicaid, or is eligible for such health care coverage, evidence of 120 percent of the Medicare reimbursement rate in effect at the time of trial for the medical treatment or services the claimant will receive, or, if there is no applicable Medicare rate for a service, 170 percent of the applicable state Medicaid rate, is admissible.

Thanks for posting. Is this bill state specific. When I looked it up, it appears to be a Florida bill. Do you know when they are voting on it and whether it is getting any traction. The implications to what we do seem to be fairly significant and it certainly places a new burden on attorneys.

If your head is still spinning on how to cost and costing challenges - read the attached. had to print the article because I could not post the link 

Restrictions on the Admissibility of Past and Future Medical Bills as Evidence at Trial

HB 837's language notably modifies the collateral source rule to limit the introduction of evidence for medical damages at trial. If the bill is signed into law, evidence offered to prove the amount of damages for past or future medical treatment at trial generally will be limited to evidence of the amount actually paid.

Past Medical Care
First, the proposed bill limits evidence of past paid medical bills to the amount actually paid for the services regardless of the source of the payment. Therefore, if a full medical bill for past services has been paid by an insurer, the actual amount paid by the insurer is the only amount admissible at trial. The initial billed amount presented by the provider may not be presented as evidence.

Second, the bill hinges on the admissibility of evidence to prove the amount of past unpaid medical bills on the type of health care coverage provided to a plaintiff.

• If a plaintiff has health care coverage, evidence of the amount the coverage is obligated to reimburse the health care provider for satisfaction of the medical services rendered under an insurance contract or regulation (including a plaintiff's share of medical expenses) is admissible at trial.

• If a plaintiff has health care coverage but chooses instead to fund medical care through use of a letter of protection (defined in the bill as "any arrangement by which a health care provider renders treatment in exchange for a promise of payment for the claimant's medical expenses from any judgment or settlement of a personal injury or wrongful death action), then only evidence of the amount the coverage would reimburse under an insurance contract or regulation (including plaintiff's share of expenses) had the plaintiff obtained treatment pursuant to his/her health care coverage is admissible at trial.

• If a plaintiff does not have health care coverage, then evidence of 120 percent of the Medicare reimbursement rate in effect on the date of the claimant's incurred medical treatment or services, or, if there is no applicable Medicare rate for a service, 170 percent of the applicable state Medicaid rate.

• Finally, if a plaintiff receives services pursuant to a letter of protection and the medical bill is subsequently assigned to a third party, then only evidence of the amount the third party agreed to pay the provider for the right to receive payment is admissible.

Future Medical Bills
The proposed bill also provides guidance on the admissibility of evidence relating to damages for future medical care.

• If a plaintiff has health care coverage or is eligible for health care coverage, only evidence of the amount for which the future charges could be satisfied if submitted to such health care coverage (including a plaintiffs' portion of medical expenses) is admissible at trial.

• Whereas, if a plaintiff does not have health care coverage or has health care coverage through Medicare or Medicaid, or is eligible for such health care coverage, evidence of 120 percent of the Medicare reimbursement rate in effect at the time of trial for the medical treatment or services the claimant will receive, or, if there is no applicable Medicare rate for a service, 170 percent of the applicable state Medicaid rate, is admissible.

Thanks for posting. Is this bill state specific. When I looked it up, it appears to be a Florida bill. Do you know when they are voting on it and whether it is getting any traction. The implications to what we do seem to be fairly significant and it certainly places a new burden on attorneys.

If your head is still spinning on how to cost and costing challenges - read the attached. had to print the article because I could not post the link 

Restrictions on the Admissibility of Past and Future Medical Bills as Evidence at Trial

HB 837's language notably modifies the collateral source rule to limit the introduction of evidence for medical damages at trial. If the bill is signed into law, evidence offered to prove the amount of damages for past or future medical treatment at trial generally will be limited to evidence of the amount actually paid.

Past Medical Care
First, the proposed bill limits evidence of past paid medical bills to the amount actually paid for the services regardless of the source of the payment. Therefore, if a full medical bill for past services has been paid by an insurer, the actual amount paid by the insurer is the only amount admissible at trial. The initial billed amount presented by the provider may not be presented as evidence.

Second, the bill hinges on the admissibility of evidence to prove the amount of past unpaid medical bills on the type of health care coverage provided to a plaintiff.

• If a plaintiff has health care coverage, evidence of the amount the coverage is obligated to reimburse the health care provider for satisfaction of the medical services rendered under an insurance contract or regulation (including a plaintiff's share of medical expenses) is admissible at trial.

• If a plaintiff has health care coverage but chooses instead to fund medical care through use of a letter of protection (defined in the bill as "any arrangement by which a health care provider renders treatment in exchange for a promise of payment for the claimant's medical expenses from any judgment or settlement of a personal injury or wrongful death action), then only evidence of the amount the coverage would reimburse under an insurance contract or regulation (including plaintiff's share of expenses) had the plaintiff obtained treatment pursuant to his/her health care coverage is admissible at trial.

• If a plaintiff does not have health care coverage, then evidence of 120 percent of the Medicare reimbursement rate in effect on the date of the claimant's incurred medical treatment or services, or, if there is no applicable Medicare rate for a service, 170 percent of the applicable state Medicaid rate.

• Finally, if a plaintiff receives services pursuant to a letter of protection and the medical bill is subsequently assigned to a third party, then only evidence of the amount the third party agreed to pay the provider for the right to receive payment is admissible.

Future Medical Bills
The proposed bill also provides guidance on the admissibility of evidence relating to damages for future medical care.

• If a plaintiff has health care coverage or is eligible for health care coverage, only evidence of the amount for which the future charges could be satisfied if submitted to such health care coverage (including a plaintiffs' portion of medical expenses) is admissible at trial.

• Whereas, if a plaintiff does not have health care coverage or has health care coverage through Medicare or Medicaid, or is eligible for such health care coverage, evidence of 120 percent of the Medicare reimbursement rate in effect at the time of trial for the medical treatment or services the claimant will receive, or, if there is no applicable Medicare rate for a service, 170 percent of the applicable state Medicaid rate, is admissible.

Thanks for posting. Is this bill state specific. When I looked it up, it appears to be a Florida bill. Do you know when they are voting on it and whether it is getting any traction. The implications to what we do seem to be fairly significant and it certainly places a new burden on attorneys.

If your head is still spinning on how to cost and costing challenges - read the attached. had to print the article because I could not post the link 

Restrictions on the Admissibility of Past and Future Medical Bills as Evidence at Trial

HB 837's language notably modifies the collateral source rule to limit the introduction of evidence for medical damages at trial. If the bill is signed into law, evidence offered to prove the amount of damages for past or future medical treatment at trial generally will be limited to evidence of the amount actually paid.

Past Medical Care
First, the proposed bill limits evidence of past paid medical bills to the amount actually paid for the services regardless of the source of the payment. Therefore, if a full medical bill for past services has been paid by an insurer, the actual amount paid by the insurer is the only amount admissible at trial. The initial billed amount presented by the provider may not be presented as evidence.

Second, the bill hinges on the admissibility of evidence to prove the amount of past unpaid medical bills on the type of health care coverage provided to a plaintiff.

• If a plaintiff has health care coverage, evidence of the amount the coverage is obligated to reimburse the health care provider for satisfaction of the medical services rendered under an insurance contract or regulation (including a plaintiff's share of medical expenses) is admissible at trial.

• If a plaintiff has health care coverage but chooses instead to fund medical care through use of a letter of protection (defined in the bill as "any arrangement by which a health care provider renders treatment in exchange for a promise of payment for the claimant's medical expenses from any judgment or settlement of a personal injury or wrongful death action), then only evidence of the amount the coverage would reimburse under an insurance contract or regulation (including plaintiff's share of expenses) had the plaintiff obtained treatment pursuant to his/her health care coverage is admissible at trial.

• If a plaintiff does not have health care coverage, then evidence of 120 percent of the Medicare reimbursement rate in effect on the date of the claimant's incurred medical treatment or services, or, if there is no applicable Medicare rate for a service, 170 percent of the applicable state Medicaid rate.

• Finally, if a plaintiff receives services pursuant to a letter of protection and the medical bill is subsequently assigned to a third party, then only evidence of the amount the third party agreed to pay the provider for the right to receive payment is admissible.

Future Medical Bills
The proposed bill also provides guidance on the admissibility of evidence relating to damages for future medical care.

• If a plaintiff has health care coverage or is eligible for health care coverage, only evidence of the amount for which the future charges could be satisfied if submitted to such health care coverage (including a plaintiffs' portion of medical expenses) is admissible at trial.

• Whereas, if a plaintiff does not have health care coverage or has health care coverage through Medicare or Medicaid, or is eligible for such health care coverage, evidence of 120 percent of the Medicare reimbursement rate in effect at the time of trial for the medical treatment or services the claimant will receive, or, if there is no applicable Medicare rate for a service, 170 percent of the applicable state Medicaid rate, is admissible.

Thanks for posting. Is this bill state specific. When I looked it up, it appears to be a Florida bill. Do you know when they are voting on it and whether it is getting any traction. The implications to what we do seem to be fairly significant and it certainly places a new burden on attorneys.

If your head is still spinning on how to cost and costing challenges - read the attached. had to print the article because I could not post the link 

Restrictions on the Admissibility of Past and Future Medical Bills as Evidence at Trial

HB 837's language notably modifies the collateral source rule to limit the introduction of evidence for medical damages at trial. If the bill is signed into law, evidence offered to prove the amount of damages for past or future medical treatment at trial generally will be limited to evidence of the amount actually paid.

Past Medical Care
First, the proposed bill limits evidence of past paid medical bills to the amount actually paid for the services regardless of the source of the payment. Therefore, if a full medical bill for past services has been paid by an insurer, the actual amount paid by the insurer is the only amount admissible at trial. The initial billed amount presented by the provider may not be presented as evidence.

Second, the bill hinges on the admissibility of evidence to prove the amount of past unpaid medical bills on the type of health care coverage provided to a plaintiff.

• If a plaintiff has health care coverage, evidence of the amount the coverage is obligated to reimburse the health care provider for satisfaction of the medical services rendered under an insurance contract or regulation (including a plaintiff's share of medical expenses) is admissible at trial.

• If a plaintiff has health care coverage but chooses instead to fund medical care through use of a letter of protection (defined in the bill as "any arrangement by which a health care provider renders treatment in exchange for a promise of payment for the claimant's medical expenses from any judgment or settlement of a personal injury or wrongful death action), then only evidence of the amount the coverage would reimburse under an insurance contract or regulation (including plaintiff's share of expenses) had the plaintiff obtained treatment pursuant to his/her health care coverage is admissible at trial.

• If a plaintiff does not have health care coverage, then evidence of 120 percent of the Medicare reimbursement rate in effect on the date of the claimant's incurred medical treatment or services, or, if there is no applicable Medicare rate for a service, 170 percent of the applicable state Medicaid rate.

• Finally, if a plaintiff receives services pursuant to a letter of protection and the medical bill is subsequently assigned to a third party, then only evidence of the amount the third party agreed to pay the provider for the right to receive payment is admissible.

Future Medical Bills
The proposed bill also provides guidance on the admissibility of evidence relating to damages for future medical care.

• If a plaintiff has health care coverage or is eligible for health care coverage, only evidence of the amount for which the future charges could be satisfied if submitted to such health care coverage (including a plaintiffs' portion of medical expenses) is admissible at trial.

• Whereas, if a plaintiff does not have health care coverage or has health care coverage through Medicare or Medicaid, or is eligible for such health care coverage, evidence of 120 percent of the Medicare reimbursement rate in effect at the time of trial for the medical treatment or services the claimant will receive, or, if there is no applicable Medicare rate for a service, 170 percent of the applicable state Medicaid rate, is admissible.

Thanks for posting. Is this bill state specific. When I looked it up, it appears to be a Florida bill. Do you know when they are voting on it and whether it is getting any traction. The implications to what we do seem to be fairly significant and it certainly places a new burden on attorneys.

If your head is still spinning on how to cost and costing challenges - read the attached. had to print the article because I could not post the link 

Restrictions on the Admissibility of Past and Future Medical Bills as Evidence at Trial

HB 837's language notably modifies the collateral source rule to limit the introduction of evidence for medical damages at trial. If the bill is signed into law, evidence offered to prove the amount of damages for past or future medical treatment at trial generally will be limited to evidence of the amount actually paid.

Past Medical Care
First, the proposed bill limits evidence of past paid medical bills to the amount actually paid for the services regardless of the source of the payment. Therefore, if a full medical bill for past services has been paid by an insurer, the actual amount paid by the insurer is the only amount admissible at trial. The initial billed amount presented by the provider may not be presented as evidence.

Second, the bill hinges on the admissibility of evidence to prove the amount of past unpaid medical bills on the type of health care coverage provided to a plaintiff.

• If a plaintiff has health care coverage, evidence of the amount the coverage is obligated to reimburse the health care provider for satisfaction of the medical services rendered under an insurance contract or regulation (including a plaintiff's share of medical expenses) is admissible at trial.

• If a plaintiff has health care coverage but chooses instead to fund medical care through use of a letter of protection (defined in the bill as "any arrangement by which a health care provider renders treatment in exchange for a promise of payment for the claimant's medical expenses from any judgment or settlement of a personal injury or wrongful death action), then only evidence of the amount the coverage would reimburse under an insurance contract or regulation (including plaintiff's share of expenses) had the plaintiff obtained treatment pursuant to his/her health care coverage is admissible at trial.

• If a plaintiff does not have health care coverage, then evidence of 120 percent of the Medicare reimbursement rate in effect on the date of the claimant's incurred medical treatment or services, or, if there is no applicable Medicare rate for a service, 170 percent of the applicable state Medicaid rate.

• Finally, if a plaintiff receives services pursuant to a letter of protection and the medical bill is subsequently assigned to a third party, then only evidence of the amount the third party agreed to pay the provider for the right to receive payment is admissible.

Future Medical Bills
The proposed bill also provides guidance on the admissibility of evidence relating to damages for future medical care.

• If a plaintiff has health care coverage or is eligible for health care coverage, only evidence of the amount for which the future charges could be satisfied if submitted to such health care coverage (including a plaintiffs' portion of medical expenses) is admissible at trial.

• Whereas, if a plaintiff does not have health care coverage or has health care coverage through Medicare or Medicaid, or is eligible for such health care coverage, evidence of 120 percent of the Medicare reimbursement rate in effect at the time of trial for the medical treatment or services the claimant will receive, or, if there is no applicable Medicare rate for a service, 170 percent of the applicable state Medicaid rate, is admissible.

Thanks for posting. Is this bill state specific. When I looked it up, it appears to be a Florida bill. Do you know when they are voting on it and whether it is getting any traction. The implications to what we do seem to be fairly significant and it certainly places a new burden on attorneys.

If your head is still spinning on how to cost and costing challenges - read the attached. had to print the article because I could not post the link 

Restrictions on the Admissibility of Past and Future Medical Bills as Evidence at Trial

HB 837's language notably modifies the collateral source rule to limit the introduction of evidence for medical damages at trial. If the bill is signed into law, evidence offered to prove the amount of damages for past or future medical treatment at trial generally will be limited to evidence of the amount actually paid.

Past Medical Care
First, the proposed bill limits evidence of past paid medical bills to the amount actually paid for the services regardless of the source of the payment. Therefore, if a full medical bill for past services has been paid by an insurer, the actual amount paid by the insurer is the only amount admissible at trial. The initial billed amount presented by the provider may not be presented as evidence.

Second, the bill hinges on the admissibility of evidence to prove the amount of past unpaid medical bills on the type of health care coverage provided to a plaintiff.

• If a plaintiff has health care coverage, evidence of the amount the coverage is obligated to reimburse the health care provider for satisfaction of the medical services rendered under an insurance contract or regulation (including a plaintiff's share of medical expenses) is admissible at trial.

• If a plaintiff has health care coverage but chooses instead to fund medical care through use of a letter of protection (defined in the bill as "any arrangement by which a health care provider renders treatment in exchange for a promise of payment for the claimant's medical expenses from any judgment or settlement of a personal injury or wrongful death action), then only evidence of the amount the coverage would reimburse under an insurance contract or regulation (including plaintiff's share of expenses) had the plaintiff obtained treatment pursuant to his/her health care coverage is admissible at trial.

• If a plaintiff does not have health care coverage, then evidence of 120 percent of the Medicare reimbursement rate in effect on the date of the claimant's incurred medical treatment or services, or, if there is no applicable Medicare rate for a service, 170 percent of the applicable state Medicaid rate.

• Finally, if a plaintiff receives services pursuant to a letter of protection and the medical bill is subsequently assigned to a third party, then only evidence of the amount the third party agreed to pay the provider for the right to receive payment is admissible.

Future Medical Bills
The proposed bill also provides guidance on the admissibility of evidence relating to damages for future medical care.

• If a plaintiff has health care coverage or is eligible for health care coverage, only evidence of the amount for which the future charges could be satisfied if submitted to such health care coverage (including a plaintiffs' portion of medical expenses) is admissible at trial.

• Whereas, if a plaintiff does not have health care coverage or has health care coverage through Medicare or Medicaid, or is eligible for such health care coverage, evidence of 120 percent of the Medicare reimbursement rate in effect at the time of trial for the medical treatment or services the claimant will receive, or, if there is no applicable Medicare rate for a service, 170 percent of the applicable state Medicaid rate, is admissible.

Thanks for posting. Is this bill state specific. When I looked it up, it appears to be a Florida bill. Do you know when they are voting on it and whether it is getting any traction. The implications to what we do seem to be fairly significant and it certainly places a new burden on attorneys.

If your head is still spinning on how to cost and costing challenges - read the attached. had to print the article because I could not post the link 

Restrictions on the Admissibility of Past and Future Medical Bills as Evidence at Trial

HB 837's language notably modifies the collateral source rule to limit the introduction of evidence for medical damages at trial. If the bill is signed into law, evidence offered to prove the amount of damages for past or future medical treatment at trial generally will be limited to evidence of the amount actually paid.

Past Medical Care
First, the proposed bill limits evidence of past paid medical bills to the amount actually paid for the services regardless of the source of the payment. Therefore, if a full medical bill for past services has been paid by an insurer, the actual amount paid by the insurer is the only amount admissible at trial. The initial billed amount presented by the provider may not be presented as evidence.

Second, the bill hinges on the admissibility of evidence to prove the amount of past unpaid medical bills on the type of health care coverage provided to a plaintiff.

• If a plaintiff has health care coverage, evidence of the amount the coverage is obligated to reimburse the health care provider for satisfaction of the medical services rendered under an insurance contract or regulation (including a plaintiff's share of medical expenses) is admissible at trial.

• If a plaintiff has health care coverage but chooses instead to fund medical care through use of a letter of protection (defined in the bill as "any arrangement by which a health care provider renders treatment in exchange for a promise of payment for the claimant's medical expenses from any judgment or settlement of a personal injury or wrongful death action), then only evidence of the amount the coverage would reimburse under an insurance contract or regulation (including plaintiff's share of expenses) had the plaintiff obtained treatment pursuant to his/her health care coverage is admissible at trial.

• If a plaintiff does not have health care coverage, then evidence of 120 percent of the Medicare reimbursement rate in effect on the date of the claimant's incurred medical treatment or services, or, if there is no applicable Medicare rate for a service, 170 percent of the applicable state Medicaid rate.

• Finally, if a plaintiff receives services pursuant to a letter of protection and the medical bill is subsequently assigned to a third party, then only evidence of the amount the third party agreed to pay the provider for the right to receive payment is admissible.

Future Medical Bills
The proposed bill also provides guidance on the admissibility of evidence relating to damages for future medical care.

• If a plaintiff has health care coverage or is eligible for health care coverage, only evidence of the amount for which the future charges could be satisfied if submitted to such health care coverage (including a plaintiffs' portion of medical expenses) is admissible at trial.

• Whereas, if a plaintiff does not have health care coverage or has health care coverage through Medicare or Medicaid, or is eligible for such health care coverage, evidence of 120 percent of the Medicare reimbursement rate in effect at the time of trial for the medical treatment or services the claimant will receive, or, if there is no applicable Medicare rate for a service, 170 percent of the applicable state Medicaid rate, is admissible.

Thanks for posting. Is this bill state specific. When I looked it up, it appears to be a Florida bill. Do you know when they are voting on it and whether it is getting any traction. The implications to what we do seem to be fairly significant and it certainly places a new burden on attorneys.

If your head is still spinning on how to cost and costing challenges - read the attached. had to print the article because I could not post the link 

Restrictions on the Admissibility of Past and Future Medical Bills as Evidence at Trial

HB 837's language notably modifies the collateral source rule to limit the introduction of evidence for medical damages at trial. If the bill is signed into law, evidence offered to prove the amount of damages for past or future medical treatment at trial generally will be limited to evidence of the amount actually paid.

Past Medical Care
First, the proposed bill limits evidence of past paid medical bills to the amount actually paid for the services regardless of the source of the payment. Therefore, if a full medical bill for past services has been paid by an insurer, the actual amount paid by the insurer is the only amount admissible at trial. The initial billed amount presented by the provider may not be presented as evidence.

Second, the bill hinges on the admissibility of evidence to prove the amount of past unpaid medical bills on the type of health care coverage provided to a plaintiff.

• If a plaintiff has health care coverage, evidence of the amount the coverage is obligated to reimburse the health care provider for satisfaction of the medical services rendered under an insurance contract or regulation (including a plaintiff's share of medical expenses) is admissible at trial.

• If a plaintiff has health care coverage but chooses instead to fund medical care through use of a letter of protection (defined in the bill as "any arrangement by which a health care provider renders treatment in exchange for a promise of payment for the claimant's medical expenses from any judgment or settlement of a personal injury or wrongful death action), then only evidence of the amount the coverage would reimburse under an insurance contract or regulation (including plaintiff's share of expenses) had the plaintiff obtained treatment pursuant to his/her health care coverage is admissible at trial.

• If a plaintiff does not have health care coverage, then evidence of 120 percent of the Medicare reimbursement rate in effect on the date of the claimant's incurred medical treatment or services, or, if there is no applicable Medicare rate for a service, 170 percent of the applicable state Medicaid rate.

• Finally, if a plaintiff receives services pursuant to a letter of protection and the medical bill is subsequently assigned to a third party, then only evidence of the amount the third party agreed to pay the provider for the right to receive payment is admissible.

Future Medical Bills
The proposed bill also provides guidance on the admissibility of evidence relating to damages for future medical care.

• If a plaintiff has health care coverage or is eligible for health care coverage, only evidence of the amount for which the future charges could be satisfied if submitted to such health care coverage (including a plaintiffs' portion of medical expenses) is admissible at trial.

• Whereas, if a plaintiff does not have health care coverage or has health care coverage through Medicare or Medicaid, or is eligible for such health care coverage, evidence of 120 percent of the Medicare reimbursement rate in effect at the time of trial for the medical treatment or services the claimant will receive, or, if there is no applicable Medicare rate for a service, 170 percent of the applicable state Medicaid rate, is admissible.

Thanks for posting. Is this bill state specific. When I looked it up, it appears to be a Florida bill. Do you know when they are voting on it and whether it is getting any traction. The implications to what we do seem to be fairly significant and it certainly places a new burden on attorneys.

If your head is still spinning on how to cost and costing challenges - read the attached. had to print the article because I could not post the link 

Restrictions on the Admissibility of Past and Future Medical Bills as Evidence at Trial

HB 837's language notably modifies the collateral source rule to limit the introduction of evidence for medical damages at trial. If the bill is signed into law, evidence offered to prove the amount of damages for past or future medical treatment at trial generally will be limited to evidence of the amount actually paid.

Past Medical Care
First, the proposed bill limits evidence of past paid medical bills to the amount actually paid for the services regardless of the source of the payment. Therefore, if a full medical bill for past services has been paid by an insurer, the actual amount paid by the insurer is the only amount admissible at trial. The initial billed amount presented by the provider may not be presented as evidence.

Second, the bill hinges on the admissibility of evidence to prove the amount of past unpaid medical bills on the type of health care coverage provided to a plaintiff.

• If a plaintiff has health care coverage, evidence of the amount the coverage is obligated to reimburse the health care provider for satisfaction of the medical services rendered under an insurance contract or regulation (including a plaintiff's share of medical expenses) is admissible at trial.

• If a plaintiff has health care coverage but chooses instead to fund medical care through use of a letter of protection (defined in the bill as "any arrangement by which a health care provider renders treatment in exchange for a promise of payment for the claimant's medical expenses from any judgment or settlement of a personal injury or wrongful death action), then only evidence of the amount the coverage would reimburse under an insurance contract or regulation (including plaintiff's share of expenses) had the plaintiff obtained treatment pursuant to his/her health care coverage is admissible at trial.

• If a plaintiff does not have health care coverage, then evidence of 120 percent of the Medicare reimbursement rate in effect on the date of the claimant's incurred medical treatment or services, or, if there is no applicable Medicare rate for a service, 170 percent of the applicable state Medicaid rate.

• Finally, if a plaintiff receives services pursuant to a letter of protection and the medical bill is subsequently assigned to a third party, then only evidence of the amount the third party agreed to pay the provider for the right to receive payment is admissible.

Future Medical Bills
The proposed bill also provides guidance on the admissibility of evidence relating to damages for future medical care.

• If a plaintiff has health care coverage or is eligible for health care coverage, only evidence of the amount for which the future charges could be satisfied if submitted to such health care coverage (including a plaintiffs' portion of medical expenses) is admissible at trial.

• Whereas, if a plaintiff does not have health care coverage or has health care coverage through Medicare or Medicaid, or is eligible for such health care coverage, evidence of 120 percent of the Medicare reimbursement rate in effect at the time of trial for the medical treatment or services the claimant will receive, or, if there is no applicable Medicare rate for a service, 170 percent of the applicable state Medicaid rate, is admissible.

Thanks for posting. Is this bill state specific. When I looked it up, it appears to be a Florida bill. Do you know when they are voting on it and whether it is getting any traction. The implications to what we do seem to be fairly significant and it certainly places a new burden on attorneys.

If your head is still spinning on how to cost and costing challenges - read the attached. had to print the article because I could not post the link 

Restrictions on the Admissibility of Past and Future Medical Bills as Evidence at Trial

HB 837's language notably modifies the collateral source rule to limit the introduction of evidence for medical damages at trial. If the bill is signed into law, evidence offered to prove the amount of damages for past or future medical treatment at trial generally will be limited to evidence of the amount actually paid.

Past Medical Care
First, the proposed bill limits evidence of past paid medical bills to the amount actually paid for the services regardless of the source of the payment. Therefore, if a full medical bill for past services has been paid by an insurer, the actual amount paid by the insurer is the only amount admissible at trial. The initial billed amount presented by the provider may not be presented as evidence.

Second, the bill hinges on the admissibility of evidence to prove the amount of past unpaid medical bills on the type of health care coverage provided to a plaintiff.

• If a plaintiff has health care coverage, evidence of the amount the coverage is obligated to reimburse the health care provider for satisfaction of the medical services rendered under an insurance contract or regulation (including a plaintiff's share of medical expenses) is admissible at trial.

• If a plaintiff has health care coverage but chooses instead to fund medical care through use of a letter of protection (defined in the bill as "any arrangement by which a health care provider renders treatment in exchange for a promise of payment for the claimant's medical expenses from any judgment or settlement of a personal injury or wrongful death action), then only evidence of the amount the coverage would reimburse under an insurance contract or regulation (including plaintiff's share of expenses) had the plaintiff obtained treatment pursuant to his/her health care coverage is admissible at trial.

• If a plaintiff does not have health care coverage, then evidence of 120 percent of the Medicare reimbursement rate in effect on the date of the claimant's incurred medical treatment or services, or, if there is no applicable Medicare rate for a service, 170 percent of the applicable state Medicaid rate.

• Finally, if a plaintiff receives services pursuant to a letter of protection and the medical bill is subsequently assigned to a third party, then only evidence of the amount the third party agreed to pay the provider for the right to receive payment is admissible.

Future Medical Bills
The proposed bill also provides guidance on the admissibility of evidence relating to damages for future medical care.

• If a plaintiff has health care coverage or is eligible for health care coverage, only evidence of the amount for which the future charges could be satisfied if submitted to such health care coverage (including a plaintiffs' portion of medical expenses) is admissible at trial.

• Whereas, if a plaintiff does not have health care coverage or has health care coverage through Medicare or Medicaid, or is eligible for such health care coverage, evidence of 120 percent of the Medicare reimbursement rate in effect at the time of trial for the medical treatment or services the claimant will receive, or, if there is no applicable Medicare rate for a service, 170 percent of the applicable state Medicaid rate, is admissible.

Thanks for posting. Is this bill state specific. When I looked it up, it appears to be a Florida bill. Do you know when they are voting on it and whether it is getting any traction. The implications to what we do seem to be fairly significant and it certainly places a new burden on attorneys.

If your head is still spinning on how to cost and costing challenges - read the attached. had to print the article because I could not post the link 

Restrictions on the Admissibility of Past and Future Medical Bills as Evidence at Trial

HB 837's language notably modifies the collateral source rule to limit the introduction of evidence for medical damages at trial. If the bill is signed into law, evidence offered to prove the amount of damages for past or future medical treatment at trial generally will be limited to evidence of the amount actually paid.

Past Medical Care
First, the proposed bill limits evidence of past paid medical bills to the amount actually paid for the services regardless of the source of the payment. Therefore, if a full medical bill for past services has been paid by an insurer, the actual amount paid by the insurer is the only amount admissible at trial. The initial billed amount presented by the provider may not be presented as evidence.

Second, the bill hinges on the admissibility of evidence to prove the amount of past unpaid medical bills on the type of health care coverage provided to a plaintiff.

• If a plaintiff has health care coverage, evidence of the amount the coverage is obligated to reimburse the health care provider for satisfaction of the medical services rendered under an insurance contract or regulation (including a plaintiff's share of medical expenses) is admissible at trial.

• If a plaintiff has health care coverage but chooses instead to fund medical care through use of a letter of protection (defined in the bill as "any arrangement by which a health care provider renders treatment in exchange for a promise of payment for the claimant's medical expenses from any judgment or settlement of a personal injury or wrongful death action), then only evidence of the amount the coverage would reimburse under an insurance contract or regulation (including plaintiff's share of expenses) had the plaintiff obtained treatment pursuant to his/her health care coverage is admissible at trial.

• If a plaintiff does not have health care coverage, then evidence of 120 percent of the Medicare reimbursement rate in effect on the date of the claimant's incurred medical treatment or services, or, if there is no applicable Medicare rate for a service, 170 percent of the applicable state Medicaid rate.

• Finally, if a plaintiff receives services pursuant to a letter of protection and the medical bill is subsequently assigned to a third party, then only evidence of the amount the third party agreed to pay the provider for the right to receive payment is admissible.

Future Medical Bills
The proposed bill also provides guidance on the admissibility of evidence relating to damages for future medical care.

• If a plaintiff has health care coverage or is eligible for health care coverage, only evidence of the amount for which the future charges could be satisfied if submitted to such health care coverage (including a plaintiffs' portion of medical expenses) is admissible at trial.

• Whereas, if a plaintiff does not have health care coverage or has health care coverage through Medicare or Medicaid, or is eligible for such health care coverage, evidence of 120 percent of the Medicare reimbursement rate in effect at the time of trial for the medical treatment or services the claimant will receive, or, if there is no applicable Medicare rate for a service, 170 percent of the applicable state Medicaid rate, is admissible.

Happy Sunday,

I may have to segment my response to this in separate posts - unfortunately additional building block articles will take another 1-2 years to further analyze this concept of the 50th percentile and get published in the meantime i offer some food for thought. I will try to separate opinion from facts

Opinion: I think the notion of IARP members who follow the IARP standards are not intellectually honest is flawed when it comes to their selection of a percentile.  Honesty is already addressed in our ethic standards to purport that a life care planner is plaintiff biased and not intellectually honest because they don't use the 50th percentile is incorrect. In fact it is suggesting that a life care planner select a percentile without conducting any analysis is not consistent with our standards. 

Opinion: using the 50th percentile ...."produces a Life Care Plan that is ecologically valid, intellectually honest, valid, and reliable"   I still need to do research on how ecological (relating to or concerned with the relation of living organisms to one another and their physical surroundings") ties back to one of the IARP standards.  I am undecided but for now I will interpret this use of ecology to support the idea that i take a percentile data point bring in into my analysis and take into consideration  specific attributes of the individual in which i am building a life care plan. how does the individual interact as a being within their respective environment.  The use of this term further supports the position i take in that the data in these data bases are only building blocks not the final determinant.  you will have to sign up for the billing series to get the rest of this point.

Fact: 

Worker's comp statutes typically gets their data from Optum (largest provider of charge data) and per their policy they set reasonable value for their services at the 75/80th - the LCPer may conclude that in their case it is appropriate to use the basis for their case that involves injuries consistent with the reasonable value set for those injured at work. In addition, the use of this range has been supported for other reasons within IARP literature- that being said .gov reference is an appropriate foundation. OPINION i am not sure i could conclude that workers compensation fee schedules are intellectually dishonest nor ecologically invalid.

 FACT Other measures of centricity include mode, median and average.  OPINION If the of mode population is blood type O+ should one assume that the blood type of the individual is O positive? - my point is the approach of one size fits all is not appropriate in healthcare the average and the mode in certain circumstances can be really impacted by specific individual characteristics (distribution of intensity of health conditions) - for example follow up care for a mild scratch from a fall versus the follow up management of a  deep wound. The charge  data is absent of patient condition and the credential of the provider. Which if you READ the description of these data bases they always state this is not to be interpreted as UCR pricing. So what purpose can it serve ? Just the pure price of a cpt code versus the reasonable value at its core- that is the main reason why the data in those databases are building blocks not the final determinate.  Besides if you do the math for professional services - the incremental percentile increase of the total $ amount is so low that is it not worth all the drama that this is creating.  Remember facility based care does not come in percentile format.

FACT: not all price data bases are created equal (even when they are supplied by Optum)- some of them do not even give the user  data at the 50th percentile - OPINION: are we in a position to say which data bases are authoritative versus which ones are not?  Practical EXPERIENCE: I have audited so many payer systems - they do not even use the 50th percentile FYI<o:p></o:p>

OPINION: (Statisticians feel free to correct me on this) The use of the confidence interval..... if I want to have a 90% confidence that the individual will be able  to pay  the bill then you need to pick the 90th percentile. If you pick the 50th percentile then you are condemning 50% into a position that they will not be able to pay the bill.  This logic is close to the position that I have seen some LCPer's take to support the notion that they do not want to limit the individual from access to certain providers. 

PERSONAL note: the article you referenced mischaracterizes one of my publications and article that took facility based information and used it in the context of professional billing - that being said my spouse keeps telling me don't worry about it no one will notice.  If i ever publish an article and the substance of it is used against you in a case or deposition please call me - my only goal is to teach and i never take the position that because i had an article published that it means i am right. If you are being asked by an attorney in your dep why are you not using the 50th percentile take into consideration some of the points i listed.  The data is just a building block in your analysis be confident in the support of your foundation. 

Thanks for posting. Is this bill state specific. When I looked it up, it appears to be a Florida bill. Do you know when they are voting on it and whether it is getting any traction. The implications to what we do seem to be fairly significant and it certainly places a new burden on attorneys.

If your head is still spinning on how to cost and costing challenges - read the attached. had to print the article because I could not post the link 

Restrictions on the Admissibility of Past and Future Medical Bills as Evidence at Trial

HB 837's language notably modifies the collateral source rule to limit the introduction of evidence for medical damages at trial. If the bill is signed into law, evidence offered to prove the amount of damages for past or future medical treatment at trial generally will be limited to evidence of the amount actually paid.

Past Medical Care
First, the proposed bill limits evidence of past paid medical bills to the amount actually paid for the services regardless of the source of the payment. Therefore, if a full medical bill for past services has been paid by an insurer, the actual amount paid by the insurer is the only amount admissible at trial. The initial billed amount presented by the provider may not be presented as evidence.

Second, the bill hinges on the admissibility of evidence to prove the amount of past unpaid medical bills on the type of health care coverage provided to a plaintiff.

• If a plaintiff has health care coverage, evidence of the amount the coverage is obligated to reimburse the health care provider for satisfaction of the medical services rendered under an insurance contract or regulation (including a plaintiff's share of medical expenses) is admissible at trial.

• If a plaintiff has health care coverage but chooses instead to fund medical care through use of a letter of protection (defined in the bill as "any arrangement by which a health care provider renders treatment in exchange for a promise of payment for the claimant's medical expenses from any judgment or settlement of a personal injury or wrongful death action), then only evidence of the amount the coverage would reimburse under an insurance contract or regulation (including plaintiff's share of expenses) had the plaintiff obtained treatment pursuant to his/her health care coverage is admissible at trial.

• If a plaintiff does not have health care coverage, then evidence of 120 percent of the Medicare reimbursement rate in effect on the date of the claimant's incurred medical treatment or services, or, if there is no applicable Medicare rate for a service, 170 percent of the applicable state Medicaid rate.

• Finally, if a plaintiff receives services pursuant to a letter of protection and the medical bill is subsequently assigned to a third party, then only evidence of the amount the third party agreed to pay the provider for the right to receive payment is admissible.

Future Medical Bills
The proposed bill also provides guidance on the admissibility of evidence relating to damages for future medical care.

• If a plaintiff has health care coverage or is eligible for health care coverage, only evidence of the amount for which the future charges could be satisfied if submitted to such health care coverage (including a plaintiffs' portion of medical expenses) is admissible at trial.

• Whereas, if a plaintiff does not have health care coverage or has health care coverage through Medicare or Medicaid, or is eligible for such health care coverage, evidence of 120 percent of the Medicare reimbursement rate in effect at the time of trial for the medical treatment or services the claimant will receive, or, if there is no applicable Medicare rate for a service, 170 percent of the applicable state Medicaid rate, is admissible.

A percentile is not percents. Percents are actual numbers. Percentiles are positional statements that cannot be added, subtracted, multiplied, or divided. Percentile are football where two half-backs make a full-back. That is absurd. If you want to do math with percentiles convert the percentile location to a Z-Score, do the math, and then convert it back to the representational percentile. Weschler distributions of Z-Scores has a mean of 100 with a standard deviation of 15, GATB is mean of 100 and a standard deviation of 20, and T-Scores are a mean of 50 with a standard deviation of 10. Weschler divides standard deviations into thirds, GATB divides standard deviations into fourths, and T-Scores divide standard deviations into halves. Of course a Z-Score has a mean of 0 and a standard deviation of 1. 

I like percentiles for situations where the bell cannot be unrung. "if you line up 100 people in a room based on this variable, she would be in another room." It is not accurate because a percentile less that 1 represents placement for a thousand, 10 thousand, 100 thousand people, but it makes a very easy remembered human point. 

Saying the price of a service or product should be based on a percentile has no predictive validity. Nothing can mathematically or logically be more valid that it is reliable. A percentile ranking has not ability to determine the equality of prices for the other items or services. It only represents a position, not a value. Some prices may be from Walmart, and the outlier that pulls up the percentile could be based on a government contract. The only way to predict a price with any accuracy is to use the mean (average) and standard deviation. The mean can be still skewed (distorted) by extreme scores, but it has the advantage of balancing out the impact of 20,000 items sold for one dollar compared to 1 item sold for 20,000 dollars. 

Happy Sunday,

I may have to segment my response to this in separate posts - unfortunately additional building block articles will take another 1-2 years to further analyze this concept of the 50th percentile and get published in the meantime i offer some food for thought. I will try to separate opinion from facts

Opinion: I think the notion of IARP members who follow the IARP standards are not intellectually honest is flawed when it comes to their selection of a percentile.  Honesty is already addressed in our ethic standards to purport that a life care planner is plaintiff biased and not intellectually honest because they don't use the 50th percentile is incorrect. In fact it is suggesting that a life care planner select a percentile without conducting any analysis is not consistent with our standards. 

Opinion: using the 50th percentile ...."produces a Life Care Plan that is ecologically valid, intellectually honest, valid, and reliable"   I still need to do research on how ecological (relating to or concerned with the relation of living organisms to one another and their physical surroundings") ties back to one of the IARP standards.  I am undecided but for now I will interpret this use of ecology to support the idea that i take a percentile data point bring in into my analysis and take into consideration  specific attributes of the individual in which i am building a life care plan. how does the individual interact as a being within their respective environment.  The use of this term further supports the position i take in that the data in these data bases are only building blocks not the final determinant.  you will have to sign up for the billing series to get the rest of this point.

Fact: 

Worker's comp statutes typically gets their data from Optum (largest provider of charge data) and per their policy they set reasonable value for their services at the 75/80th - the LCPer may conclude that in their case it is appropriate to use the basis for their case that involves injuries consistent with the reasonable value set for those injured at work. In addition, the use of this range has been supported for other reasons within IARP literature- that being said .gov reference is an appropriate foundation. OPINION i am not sure i could conclude that workers compensation fee schedules are intellectually dishonest nor ecologically invalid.

 FACT Other measures of centricity include mode, median and average.  OPINION If the of mode population is blood type O+ should one assume that the blood type of the individual is O positive? - my point is the approach of one size fits all is not appropriate in healthcare the average and the mode in certain circumstances can be really impacted by specific individual characteristics (distribution of intensity of health conditions) - for example follow up care for a mild scratch from a fall versus the follow up management of a  deep wound. The charge  data is absent of patient condition and the credential of the provider. Which if you READ the description of these data bases they always state this is not to be interpreted as UCR pricing. So what purpose can it serve ? Just the pure price of a cpt code versus the reasonable value at its core- that is the main reason why the data in those databases are building blocks not the final determinate.  Besides if you do the math for professional services - the incremental percentile increase of the total $ amount is so low that is it not worth all the drama that this is creating.  Remember facility based care does not come in percentile format.

FACT: not all price data bases are created equal (even when they are supplied by Optum)- some of them do not even give the user  data at the 50th percentile - OPINION: are we in a position to say which data bases are authoritative versus which ones are not?  Practical EXPERIENCE: I have audited so many payer systems - they do not even use the 50th percentile FYI<o:p></o:p>

OPINION: (Statisticians feel free to correct me on this) The use of the confidence interval..... if I want to have a 90% confidence that the individual will be able  to pay  the bill then you need to pick the 90th percentile. If you pick the 50th percentile then you are condemning 50% into a position that they will not be able to pay the bill.  This logic is close to the position that I have seen some LCPer's take to support the notion that they do not want to limit the individual from access to certain providers. 

PERSONAL note: the article you referenced mischaracterizes one of my publications and article that took facility based information and used it in the context of professional billing - that being said my spouse keeps telling me don't worry about it no one will notice.  If i ever publish an article and the substance of it is used against you in a case or deposition please call me - my only goal is to teach and i never take the position that because i had an article published that it means i am right. If you are being asked by an attorney in your dep why are you not using the 50th percentile take into consideration some of the points i listed.  The data is just a building block in your analysis be confident in the support of your foundation. 

Thanks for posting. Is this bill state specific. When I looked it up, it appears to be a Florida bill. Do you know when they are voting on it and whether it is getting any traction. The implications to what we do seem to be fairly significant and it certainly places a new burden on attorneys.

If your head is still spinning on how to cost and costing challenges - read the attached. had to print the article because I could not post the link 

Restrictions on the Admissibility of Past and Future Medical Bills as Evidence at Trial

HB 837's language notably modifies the collateral source rule to limit the introduction of evidence for medical damages at trial. If the bill is signed into law, evidence offered to prove the amount of damages for past or future medical treatment at trial generally will be limited to evidence of the amount actually paid.

Past Medical Care
First, the proposed bill limits evidence of past paid medical bills to the amount actually paid for the services regardless of the source of the payment. Therefore, if a full medical bill for past services has been paid by an insurer, the actual amount paid by the insurer is the only amount admissible at trial. The initial billed amount presented by the provider may not be presented as evidence.

Second, the bill hinges on the admissibility of evidence to prove the amount of past unpaid medical bills on the type of health care coverage provided to a plaintiff.

• If a plaintiff has health care coverage, evidence of the amount the coverage is obligated to reimburse the health care provider for satisfaction of the medical services rendered under an insurance contract or regulation (including a plaintiff's share of medical expenses) is admissible at trial.

• If a plaintiff has health care coverage but chooses instead to fund medical care through use of a letter of protection (defined in the bill as "any arrangement by which a health care provider renders treatment in exchange for a promise of payment for the claimant's medical expenses from any judgment or settlement of a personal injury or wrongful death action), then only evidence of the amount the coverage would reimburse under an insurance contract or regulation (including plaintiff's share of expenses) had the plaintiff obtained treatment pursuant to his/her health care coverage is admissible at trial.

• If a plaintiff does not have health care coverage, then evidence of 120 percent of the Medicare reimbursement rate in effect on the date of the claimant's incurred medical treatment or services, or, if there is no applicable Medicare rate for a service, 170 percent of the applicable state Medicaid rate.

• Finally, if a plaintiff receives services pursuant to a letter of protection and the medical bill is subsequently assigned to a third party, then only evidence of the amount the third party agreed to pay the provider for the right to receive payment is admissible.

Future Medical Bills
The proposed bill also provides guidance on the admissibility of evidence relating to damages for future medical care.

• If a plaintiff has health care coverage or is eligible for health care coverage, only evidence of the amount for which the future charges could be satisfied if submitted to such health care coverage (including a plaintiffs' portion of medical expenses) is admissible at trial.

• Whereas, if a plaintiff does not have health care coverage or has health care coverage through Medicare or Medicaid, or is eligible for such health care coverage, evidence of 120 percent of the Medicare reimbursement rate in effect at the time of trial for the medical treatment or services the claimant will receive, or, if there is no applicable Medicare rate for a service, 170 percent of the applicable state Medicaid rate, is admissible.

A percentile is not percents. Percents are actual numbers. Percentiles are positional statements that cannot be added, subtracted, multiplied, or divided. Percentile are football where two half-backs make a full-back. That is absurd. If you want to do math with percentiles convert the percentile location to a Z-Score, do the math, and then convert it back to the representational percentile. Weschler distributions of Z-Scores has a mean of 100 with a standard deviation of 15, GATB is mean of 100 and a standard deviation of 20, and T-Scores are a mean of 50 with a standard deviation of 10. Weschler divides standard deviations into thirds, GATB divides standard deviations into fourths, and T-Scores divide standard deviations into halves. Of course a Z-Score has a mean of 0 and a standard deviation of 1. 

I like percentiles for situations where the bell cannot be unrung. "if you line up 100 people in a room based on this variable, she would be in another room." It is not accurate because a percentile less that 1 represents placement for a thousand, 10 thousand, 100 thousand people, but it makes a very easy remembered human point. 

Saying the price of a service or product should be based on a percentile has no predictive validity. Nothing can mathematically or logically be more valid that it is reliable. A percentile ranking has not ability to determine the equality of prices for the other items or services. It only represents a position, not a value. Some prices may be from Walmart, and the outlier that pulls up the percentile could be based on a government contract. The only way to predict a price with any accuracy is to use the mean (average) and standard deviation. The mean can be still skewed (distorted) by extreme scores, but it has the advantage of balancing out the impact of 20,000 items sold for one dollar compared to 1 item sold for 20,000 dollars. 

Happy Sunday,

I may have to segment my response to this in separate posts - unfortunately additional building block articles will take another 1-2 years to further analyze this concept of the 50th percentile and get published in the meantime i offer some food for thought. I will try to separate opinion from facts

Opinion: I think the notion of IARP members who follow the IARP standards are not intellectually honest is flawed when it comes to their selection of a percentile.  Honesty is already addressed in our ethic standards to purport that a life care planner is plaintiff biased and not intellectually honest because they don't use the 50th percentile is incorrect. In fact it is suggesting that a life care planner select a percentile without conducting any analysis is not consistent with our standards. 

Opinion: using the 50th percentile ...."produces a Life Care Plan that is ecologically valid, intellectually honest, valid, and reliable"   I still need to do research on how ecological (relating to or concerned with the relation of living organisms to one another and their physical surroundings") ties back to one of the IARP standards.  I am undecided but for now I will interpret this use of ecology to support the idea that i take a percentile data point bring in into my analysis and take into consideration  specific attributes of the individual in which i am building a life care plan. how does the individual interact as a being within their respective environment.  The use of this term further supports the position i take in that the data in these data bases are only building blocks not the final determinant.  you will have to sign up for the billing series to get the rest of this point.

Fact: 

Worker's comp statutes typically gets their data from Optum (largest provider of charge data) and per their policy they set reasonable value for their services at the 75/80th - the LCPer may conclude that in their case it is appropriate to use the basis for their case that involves injuries consistent with the reasonable value set for those injured at work. In addition, the use of this range has been supported for other reasons within IARP literature- that being said .gov reference is an appropriate foundation. OPINION i am not sure i could conclude that workers compensation fee schedules are intellectually dishonest nor ecologically invalid.

 FACT Other measures of centricity include mode, median and average.  OPINION If the of mode population is blood type O+ should one assume that the blood type of the individual is O positive? - my point is the approach of one size fits all is not appropriate in healthcare the average and the mode in certain circumstances can be really impacted by specific individual characteristics (distribution of intensity of health conditions) - for example follow up care for a mild scratch from a fall versus the follow up management of a  deep wound. The charge  data is absent of patient condition and the credential of the provider. Which if you READ the description of these data bases they always state this is not to be interpreted as UCR pricing. So what purpose can it serve ? Just the pure price of a cpt code versus the reasonable value at its core- that is the main reason why the data in those databases are building blocks not the final determinate.  Besides if you do the math for professional services - the incremental percentile increase of the total $ amount is so low that is it not worth all the drama that this is creating.  Remember facility based care does not come in percentile format.

FACT: not all price data bases are created equal (even when they are supplied by Optum)- some of them do not even give the user  data at the 50th percentile - OPINION: are we in a position to say which data bases are authoritative versus which ones are not?  Practical EXPERIENCE: I have audited so many payer systems - they do not even use the 50th percentile FYI<o:p></o:p>

OPINION: (Statisticians feel free to correct me on this) The use of the confidence interval..... if I want to have a 90% confidence that the individual will be able  to pay  the bill then you need to pick the 90th percentile. If you pick the 50th percentile then you are condemning 50% into a position that they will not be able to pay the bill.  This logic is close to the position that I have seen some LCPer's take to support the notion that they do not want to limit the individual from access to certain providers. 

PERSONAL note: the article you referenced mischaracterizes one of my publications and article that took facility based information and used it in the context of professional billing - that being said my spouse keeps telling me don't worry about it no one will notice.  If i ever publish an article and the substance of it is used against you in a case or deposition please call me - my only goal is to teach and i never take the position that because i had an article published that it means i am right. If you are being asked by an attorney in your dep why are you not using the 50th percentile take into consideration some of the points i listed.  The data is just a building block in your analysis be confident in the support of your foundation. 

Thanks for posting. Is this bill state specific. When I looked it up, it appears to be a Florida bill. Do you know when they are voting on it and whether it is getting any traction. The implications to what we do seem to be fairly significant and it certainly places a new burden on attorneys.

If your head is still spinning on how to cost and costing challenges - read the attached. had to print the article because I could not post the link 

Restrictions on the Admissibility of Past and Future Medical Bills as Evidence at Trial

HB 837's language notably modifies the collateral source rule to limit the introduction of evidence for medical damages at trial. If the bill is signed into law, evidence offered to prove the amount of damages for past or future medical treatment at trial generally will be limited to evidence of the amount actually paid.

Past Medical Care
First, the proposed bill limits evidence of past paid medical bills to the amount actually paid for the services regardless of the source of the payment. Therefore, if a full medical bill for past services has been paid by an insurer, the actual amount paid by the insurer is the only amount admissible at trial. The initial billed amount presented by the provider may not be presented as evidence.

Second, the bill hinges on the admissibility of evidence to prove the amount of past unpaid medical bills on the type of health care coverage provided to a plaintiff.

• If a plaintiff has health care coverage, evidence of the amount the coverage is obligated to reimburse the health care provider for satisfaction of the medical services rendered under an insurance contract or regulation (including a plaintiff's share of medical expenses) is admissible at trial.

• If a plaintiff has health care coverage but chooses instead to fund medical care through use of a letter of protection (defined in the bill as "any arrangement by which a health care provider renders treatment in exchange for a promise of payment for the claimant's medical expenses from any judgment or settlement of a personal injury or wrongful death action), then only evidence of the amount the coverage would reimburse under an insurance contract or regulation (including plaintiff's share of expenses) had the plaintiff obtained treatment pursuant to his/her health care coverage is admissible at trial.

• If a plaintiff does not have health care coverage, then evidence of 120 percent of the Medicare reimbursement rate in effect on the date of the claimant's incurred medical treatment or services, or, if there is no applicable Medicare rate for a service, 170 percent of the applicable state Medicaid rate.

• Finally, if a plaintiff receives services pursuant to a letter of protection and the medical bill is subsequently assigned to a third party, then only evidence of the amount the third party agreed to pay the provider for the right to receive payment is admissible.

Future Medical Bills
The proposed bill also provides guidance on the admissibility of evidence relating to damages for future medical care.

• If a plaintiff has health care coverage or is eligible for health care coverage, only evidence of the amount for which the future charges could be satisfied if submitted to such health care coverage (including a plaintiffs' portion of medical expenses) is admissible at trial.

• Whereas, if a plaintiff does not have health care coverage or has health care coverage through Medicare or Medicaid, or is eligible for such health care coverage, evidence of 120 percent of the Medicare reimbursement rate in effect at the time of trial for the medical treatment or services the claimant will receive, or, if there is no applicable Medicare rate for a service, 170 percent of the applicable state Medicaid rate, is admissible.

Thanks for posting. Is this bill state specific. When I looked it up, it appears to be a Florida bill. Do you know when they are voting on it and whether it is getting any traction. The implications to what we do seem to be fairly significant and it certainly places a new burden on attorneys.

If your head is still spinning on how to cost and costing challenges - read the attached. had to print the article because I could not post the link 

Restrictions on the Admissibility of Past and Future Medical Bills as Evidence at Trial

HB 837's language notably modifies the collateral source rule to limit the introduction of evidence for medical damages at trial. If the bill is signed into law, evidence offered to prove the amount of damages for past or future medical treatment at trial generally will be limited to evidence of the amount actually paid.

Past Medical Care
First, the proposed bill limits evidence of past paid medical bills to the amount actually paid for the services regardless of the source of the payment. Therefore, if a full medical bill for past services has been paid by an insurer, the actual amount paid by the insurer is the only amount admissible at trial. The initial billed amount presented by the provider may not be presented as evidence.

Second, the bill hinges on the admissibility of evidence to prove the amount of past unpaid medical bills on the type of health care coverage provided to a plaintiff.

• If a plaintiff has health care coverage, evidence of the amount the coverage is obligated to reimburse the health care provider for satisfaction of the medical services rendered under an insurance contract or regulation (including a plaintiff's share of medical expenses) is admissible at trial.

• If a plaintiff has health care coverage but chooses instead to fund medical care through use of a letter of protection (defined in the bill as "any arrangement by which a health care provider renders treatment in exchange for a promise of payment for the claimant's medical expenses from any judgment or settlement of a personal injury or wrongful death action), then only evidence of the amount the coverage would reimburse under an insurance contract or regulation (including plaintiff's share of expenses) had the plaintiff obtained treatment pursuant to his/her health care coverage is admissible at trial.

• If a plaintiff does not have health care coverage, then evidence of 120 percent of the Medicare reimbursement rate in effect on the date of the claimant's incurred medical treatment or services, or, if there is no applicable Medicare rate for a service, 170 percent of the applicable state Medicaid rate.

• Finally, if a plaintiff receives services pursuant to a letter of protection and the medical bill is subsequently assigned to a third party, then only evidence of the amount the third party agreed to pay the provider for the right to receive payment is admissible.

Future Medical Bills
The proposed bill also provides guidance on the admissibility of evidence relating to damages for future medical care.

• If a plaintiff has health care coverage or is eligible for health care coverage, only evidence of the amount for which the future charges could be satisfied if submitted to such health care coverage (including a plaintiffs' portion of medical expenses) is admissible at trial.

• Whereas, if a plaintiff does not have health care coverage or has health care coverage through Medicare or Medicaid, or is eligible for such health care coverage, evidence of 120 percent of the Medicare reimbursement rate in effect at the time of trial for the medical treatment or services the claimant will receive, or, if there is no applicable Medicare rate for a service, 170 percent of the applicable state Medicaid rate, is admissible.

Thanks for posting. Is this bill state specific. When I looked it up, it appears to be a Florida bill. Do you know when they are voting on it and whether it is getting any traction. The implications to what we do seem to be fairly significant and it certainly places a new burden on attorneys.

If your head is still spinning on how to cost and costing challenges - read the attached. had to print the article because I could not post the link 

Restrictions on the Admissibility of Past and Future Medical Bills as Evidence at Trial

HB 837's language notably modifies the collateral source rule to limit the introduction of evidence for medical damages at trial. If the bill is signed into law, evidence offered to prove the amount of damages for past or future medical treatment at trial generally will be limited to evidence of the amount actually paid.

Past Medical Care
First, the proposed bill limits evidence of past paid medical bills to the amount actually paid for the services regardless of the source of the payment. Therefore, if a full medical bill for past services has been paid by an insurer, the actual amount paid by the insurer is the only amount admissible at trial. The initial billed amount presented by the provider may not be presented as evidence.

Second, the bill hinges on the admissibility of evidence to prove the amount of past unpaid medical bills on the type of health care coverage provided to a plaintiff.

• If a plaintiff has health care coverage, evidence of the amount the coverage is obligated to reimburse the health care provider for satisfaction of the medical services rendered under an insurance contract or regulation (including a plaintiff's share of medical expenses) is admissible at trial.

• If a plaintiff has health care coverage but chooses instead to fund medical care through use of a letter of protection (defined in the bill as "any arrangement by which a health care provider renders treatment in exchange for a promise of payment for the claimant's medical expenses from any judgment or settlement of a personal injury or wrongful death action), then only evidence of the amount the coverage would reimburse under an insurance contract or regulation (including plaintiff's share of expenses) had the plaintiff obtained treatment pursuant to his/her health care coverage is admissible at trial.

• If a plaintiff does not have health care coverage, then evidence of 120 percent of the Medicare reimbursement rate in effect on the date of the claimant's incurred medical treatment or services, or, if there is no applicable Medicare rate for a service, 170 percent of the applicable state Medicaid rate.

• Finally, if a plaintiff receives services pursuant to a letter of protection and the medical bill is subsequently assigned to a third party, then only evidence of the amount the third party agreed to pay the provider for the right to receive payment is admissible.

Future Medical Bills
The proposed bill also provides guidance on the admissibility of evidence relating to damages for future medical care.

• If a plaintiff has health care coverage or is eligible for health care coverage, only evidence of the amount for which the future charges could be satisfied if submitted to such health care coverage (including a plaintiffs' portion of medical expenses) is admissible at trial.

• Whereas, if a plaintiff does not have health care coverage or has health care coverage through Medicare or Medicaid, or is eligible for such health care coverage, evidence of 120 percent of the Medicare reimbursement rate in effect at the time of trial for the medical treatment or services the claimant will receive, or, if there is no applicable Medicare rate for a service, 170 percent of the applicable state Medicaid rate, is admissible.

Thanks for posting. Is this bill state specific. When I looked it up, it appears to be a Florida bill. Do you know when they are voting on it and whether it is getting any traction. The implications to what we do seem to be fairly significant and it certainly places a new burden on attorneys.

If your head is still spinning on how to cost and costing challenges - read the attached. had to print the article because I could not post the link 

Restrictions on the Admissibility of Past and Future Medical Bills as Evidence at Trial

HB 837's language notably modifies the collateral source rule to limit the introduction of evidence for medical damages at trial. If the bill is signed into law, evidence offered to prove the amount of damages for past or future medical treatment at trial generally will be limited to evidence of the amount actually paid.

Past Medical Care
First, the proposed bill limits evidence of past paid medical bills to the amount actually paid for the services regardless of the source of the payment. Therefore, if a full medical bill for past services has been paid by an insurer, the actual amount paid by the insurer is the only amount admissible at trial. The initial billed amount presented by the provider may not be presented as evidence.

Second, the bill hinges on the admissibility of evidence to prove the amount of past unpaid medical bills on the type of health care coverage provided to a plaintiff.

• If a plaintiff has health care coverage, evidence of the amount the coverage is obligated to reimburse the health care provider for satisfaction of the medical services rendered under an insurance contract or regulation (including a plaintiff's share of medical expenses) is admissible at trial.

• If a plaintiff has health care coverage but chooses instead to fund medical care through use of a letter of protection (defined in the bill as "any arrangement by which a health care provider renders treatment in exchange for a promise of payment for the claimant's medical expenses from any judgment or settlement of a personal injury or wrongful death action), then only evidence of the amount the coverage would reimburse under an insurance contract or regulation (including plaintiff's share of expenses) had the plaintiff obtained treatment pursuant to his/her health care coverage is admissible at trial.

• If a plaintiff does not have health care coverage, then evidence of 120 percent of the Medicare reimbursement rate in effect on the date of the claimant's incurred medical treatment or services, or, if there is no applicable Medicare rate for a service, 170 percent of the applicable state Medicaid rate.

• Finally, if a plaintiff receives services pursuant to a letter of protection and the medical bill is subsequently assigned to a third party, then only evidence of the amount the third party agreed to pay the provider for the right to receive payment is admissible.

Future Medical Bills
The proposed bill also provides guidance on the admissibility of evidence relating to damages for future medical care.

• If a plaintiff has health care coverage or is eligible for health care coverage, only evidence of the amount for which the future charges could be satisfied if submitted to such health care coverage (including a plaintiffs' portion of medical expenses) is admissible at trial.

• Whereas, if a plaintiff does not have health care coverage or has health care coverage through Medicare or Medicaid, or is eligible for such health care coverage, evidence of 120 percent of the Medicare reimbursement rate in effect at the time of trial for the medical treatment or services the claimant will receive, or, if there is no applicable Medicare rate for a service, 170 percent of the applicable state Medicaid rate, is admissible.