Attorneys Scott Pawlak and Brian Catrinar obtained summary disposition on behalf of a no-fault insurer for medical expenses arising out of a motor vehicle accident. Following the accident, Plaintiff’s health insurer, Blue Cross Blue Shield (through an ERISA plan), reimbursed plaintiff’s healthcare providers at a reduced amount pursuant to their provider participation agreements. Plaintiff then sought the difference between the Blue Cross reimbursement rate and the amount billed by the providers.
Defendant argued – and the Court agreed – that the providers were statutorily bound to accept the reduced payments from Blue Cross as payment in full for their services. The Court held that because the providers were not entitled to pursue the differential, Plaintiff had not “incurred” those amounts and was therefore not entitled to recover the differential.