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Advanced Recovery Equip. & Supplies v. Maya Assurance Co.

Insurer Fails to Sustain Burden Demonstrating Provider Billed in Excess of Fee Schedule

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Recitation, as required by CPLR §2219 (a), of the papers considered in the review of this MotionPapers NumberedNotice of Motion and Affidavits Annexed           1Opposing Affidavits            2Replying Affidavits             3DECISION/ORDER

*1  Upon the foregoing cited papers, the Decision/Order on defendant’s motion for summary judgment, dismissing the complaint, is as follows: This is an action to recover assigned no-fault benefits for Durable Medical Equipment rented to plaintiff’s assignor for the period of June 25, 2016 through August 5, 2016. Defendant seeks an order dismissing this action based upon plaintiff’s alleged failure to submit the claims at issue pursuant to the proper fee schedule as set forth in 11 NYCRR §65-3.8(g). It appears that this specific issue is a case of first impression for the Court.In support of its motion, defendant submits the affidavits of Silas Catwell, Jr., a claims manager employed by plaintiff and Jeffrey Futoran, a Certified Professional Coder, together with supporting documentation. Mr. Catwell’s affidavit establishes as follows: On August 9, 2016, defendant received a bill from plaintiff in the amount of $1,045.50 for dates of service June 25, 2016 through July 22, 2016 for rental of a water circulating cold pad with pump under treatment code E0218. On September 15, 2016, defendant mailed a partial denial of said bill, paying a total of $613.50 and denying the remainder of $432.00 based upon the fee schedule. On August 9, 2016, defendant received a bill from plaintiff in the amount of $2,380.00 for dates of service June 25, 2016 through July 22, 2016 for rental of a CPM device under treatment code E0936. On September 15, 2016, defendant mailed a partial denial of said bill, paying a total of $85.00 and denying the remainder of $2,295.00 based upon the fee schedule. On August 9, 2016, defendant received a bill from plaintiff in the amount of $504.00 for dates of service July

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