December 19, 2014
Health Needles Acupuncture, P.C. v GEICO Ins. Co. (2014 NY Slip Op 51864(U))
https://www.beynensonlaw.com/case-law/health-needles-acupuncture-p-c-v-geico-ins-co-2014-ny-slip-op51864u/
- Decided
- December 19, 2014
- Citation
- 2014 NY Slip Op 51864(U) · 46 Misc 3d 134(A)
- Posture
- Summary judgment
- Outcome
- Insurer prevailed
- Issues
- Fee schedule
- Legal questions
- Proving a fee schedule defense (see the maps)
Posture, outcome, issues and treatment by other decisions are Beynenson Law’s classification. Treatment labels are assigned by a language model reading the citing decision; negative and appeal-history labels are checked by a second reader.
Summary
Editorial summary by Beynenson Law, not part of the court’s decision.
Reported in New York Official Reports at Health Needles Acupuncture, P.C. v GEICO Ins. Co. (2014 NY Slip Op 51864(U))
| Health Needles Acupuncture, P.C. v GEICO Ins. Co. |
| 2014 NY Slip Op 51864(U) [46 Misc 3d 134(A)] |
| Decided on December 19, 2014 |
| Appellate Term, Second Department |
| Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431. |
| This opinion is uncorrected and will not be published in the printed Official Reports. |
Decided on December 19, 2014
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS
PRESENT: : PESCE, P.J., ALIOTTA and SOLOMON, JJ.
2012-2071 Q C
against
GEICO Ins. Co., Respondent.
Appeal from an order of the Civil Court of the City of New York, Queens County (Barry A. Schwartz, J.), entered August 15, 2012. The order, insofar as appealed from, denied plaintiff’s motion for summary judgment, except for the branch of the motion seeking summary judgment on so much of the complaint as sought to recover upon a claim for services rendered on October 7, 2009, and granted defendant’s cross motion for summary judgment dismissing the complaint except for the branch of the cross motion seeking summary judgment dismissing so much of the complaint as sought to recover upon the aforesaid claim.
ORDERED that the order, insofar as appealed from, is affirmed, with $25 costs.
In this action by a provider to recover assigned first-party no-fault benefits, plaintiff moved for summary judgment, and defendant cross-moved for summary judgment dismissing the complaint, arguing that it had properly used the workers’ compensation fee schedule applicable to chiropractors who render the same services as acupuncturists to reimburse plaintiff for the acupuncture services plaintiff had rendered. The Civil Court granted the branch of plaintiff’s motion seeking summary judgment on a claim for reimbursement for an initial evaluation on October 7, 2009, denied the remaining branches of plaintiff’s motion, denied the branch of defendant’s cross motion seeking to dismiss so much of the complaint as sought to recover for the initial evaluation on October 7, 2009, and granted the remaining branches of defendant’s cross motion for summary judgment dismissing the complaint.
On appeal, plaintiff argues that defendant failed to establish that its fee schedule reductions were proper. We disagree and find that defendant demonstrated that it had fully paid plaintiff for the services at issue in accordance with the workers’ compensation fee schedule for acupuncture services performed by chiropractors (see Great Wall Acupuncture, P.C. v Geico Ins. Co., 26 Misc 3d 23 [App Term, 2d, 11th & 13th Jud Dists 2009]).
Accordingly, the order, insofar as appealed from, is affirmed.
Pesce, P.J., Aliotta and Solomon, JJ., concur.
Decision Date: December 19, 2014
Legal questions
A question of no-fault law this decision rules on, from our Legal Questions pages. Bars count the decisions on the question by year and court, coloured by category; circles are this decision and the decisions on the question it cites or that cite it. Point at a bar or circle for details. The categories and summaries are Beynenson Law’s classification, made by a language model and checked by a second reading.
Did the insurer prove that the amount billed exceeded the applicable workers’ compensation fee schedule?
This decision: Insurer proved the billed amount exceeded the applicable fee schedule
Held the insurer demonstrated it had fully paid the licensed acupuncturist under the workers' compensation fee schedule for acupuncture performed by chiropractors, so the remaining claims were properly dismissed.
Of the 284 decisions on this question in the Second Department courts and the Court of Appeals, 146 (this one included) are in the same category.
Cited in this decision
A label shows how this decision treated the case it cites.
- Great Wall Acupuncture, P.C. v Geico Ins. Co. (2009 NY Slip Op 29467) FollowedAn insurer may use the chiropractic acupuncture fee schedule to reimburse acupuncture services performed by a licensed acupuncturist.
Similar decisions
- Gentle Care Acupuncture, P.C. v GEICO (2011 NY Slip Op 51121(U))An insurer may use the workers' compensation fee schedule for chiropractors' acupuncture services to reimburse a licensed acupuncturist.
- Point of Health Acupuncture, P.C. v GEICO Ins. Co. (2010 NY Slip Op 51724(U))The insurer proved timely denials and full payment under the chiropractor acupuncture fee schedule for the three appealed claims.
- BQE Acupuncture, P.C. v GEICO Ins. Co. (2019 NY Slip Op 50743(U))The insurer established full payment for acupuncture services under the workers' compensation fee schedule applicable to chiropractors.
- Ying E. Acupuncture, P.C. v GEICO Ins. Co. (2012 NY Slip Op 51805(U))The insurer established timely denials and proper use of the chiropractic acupuncture fee schedule, defeating the provider's summary judgment.
- Acupuncture Now, P.C. v GEICO Ins. Co. (2018 NY Slip Op 51643(U))The insurer established full payment of CPT codes 97810 and 97811 under the workers' compensation fee schedule for chiropractors' acupuncture.