What makes a medical charge reasonable?

John Inserra

Attorney
(866) 735-1102 Ext 510

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The case of Reyher v. State Farm Mutual Automobile Insurance Company out of the Colorado Court of Appeals reversed the trial court's summary judgment on the issue of what a medical doctor should or should not be reimbursed by the automobile insurance company based on a submission of a Auto Injury Management database.

In October 2001, Reyher was injured in an automobile accident and required medical treatment. State Farm notified her that "[t]o determine reasonable and necessary amounts, [it would] compare [her] provider's charges to a Medicode database (the database) through the Sloans Lake AIM [Auto Injury Management] program." The database contained "charges for the same or like services in the specific geographical area where the service was performed."

The Colorado court found the question as to the reasonableness of the bill when the bill differs from the computer program created a question for fact for the fact finder.

For more information on this subject, please refer to our section on Car and Motorcycle Accidents.