Premier Open MRI, a Jacksonville, FL, imaging center, has been named as the lead plaintiff in a class action suit alleging insurance coverage abuse in the Sunshine State.
The lawsuit, filed by the Forizs & Dogali law firm, charges that Allstate Indemnity Company and Deerbrook Insurance Company systematically denied payments for MRI exams.
The plaintiffs are insurance holders who received physician-referred MRI exams after being involved in automobile accidents. The lawsuit asserts that denying payment is contrary to the plaintiffs? personal injury protection (PIP) policies and to Florida law.
?For a span of about a year, each and every request for reimbursement sent to Allstate Indemnity or Deerbrook Insurance, which are both subsidiaries of Allstate Insurance, was denied for the same stated reason: lack of medical necessity,? said Andy Dogali, attorney for the lead plaintiff. Allstate Insurance did not respond to a request for comment.
?To the best of our knowledge, Allstate has generated a large number of denials for MRIs. We don?t directly track it, but our inquiries to groups in Florida have noted that this practice appears to be more common in recent months,? said Thomas Hoffman, associate general counsel for the American College of Radiology.
According to Hoffman, the reason given for denied claims was either that the services were not medically necessary or that the claim was suspended during investigation of the underlying reasons for the injuries.
?Talk among the imaging community throughout Florida establishes that Allstate?s approach has been routine statewide,? Dogali said.
The plaintiffs are seeking payment or reimbursement of all MRI costs incurred by Florida-based imaging centers or Allstate?s Florida policyholders during 2002 and 2003, he said.
