Michigan Court of Appeals; Docket No. 172599; Unpublished
Judges Murphy, O'Connell, and Cashen; Unanimous; Per Curiam
Official Michigan Reporter Citation: Not Applicable; Link to Opinion 
STATUTORY INDEXING:
Allowable Expenses: Incurred Expense Requirement [§3107(1)(a)]
Coordination with Other Health and Accident Medical Insurance [§3109a]
Duplicate Recovery [§3109a]
TOPICAL INDEXING:
Not Applicable
CASE SUMMARY:
In this unanimous per curiam unpublished Opinion, the Court of Appeals reversed the trial court and held that where plaintiff is entitled to "double dip" under an uncoordinated auto insurance policy, she is, nevertheless, not entitled to receive compensation from Auto Club beyond the amount which the medical provider had agreed to accept from plaintiffs health insurance company pursuant to a previously negotiated reimbursement schedule.
Plaintiff was insured with Auto Club under a policy of no-fault insurance that provided for uncoordinated personal protection insurance medical coverage. Through her employer, plaintiff also enjoyed health care coverage through Group Health Plan of Michigan. There was no dispute that under her uncoordinated policy with Auto Club, plaintiff was entitled to "double dip," meaning she was entitled to be compensated twice, once by each insurer, for any medical expenses incurred that fell within coverage of both policies.
Plaintiff was treated at Heritage Hospital following her automobile accident. Heritage Hospital's customary charge for plaintiffs treatment would have been $29,000. However, Heritage was a "participating provider" in Group Health Care Plan of Michigan's medical plan, and pursuant to the participation agreement, Heritage had agreed to accept payment pursuant to a reimbursement schedule previously negotiated. Group Health Care paid $17,000 in full satisfaction of plaintiff s hospital bill. Auto Club agreed to pay the same amount pursuant to the uncoordinated no-fault policy provisions of its policy. However, plaintiff claimed that Auto Club was obligated to pay the full "customary" charge of $29,000. There was no dispute that the medical expenses at issue were "reasonable charges" within the meaning of §3107 of the act.
Auto Club argued that it was not required to reimburse the full $29,000 pursuant to plaintiffs claim to "double dip" because the full $20,000 was not an "incurred" expense. In ruling in favor of Auto Club, the Court of Appeals relied upon Dean v Auto Club Insurance Ass'n, 139 Mich App 266 (1984). In that case, two licensed chiropractors who were participating health care providers in a Blue Cross and Blue Shield of Michigan health care plan sought to obtain from the insured party's no-fault carrier the difference between the amount paid by Blue Cross and the amount that they customarily charged for their services. In Dean, the Court of Appeals held that to require no-fault insurance companies to compensate health care providers for the difference between the Blue Cross/Blue Shield reimbursement rate and the health provider's customary fee would contravene public policy and contribute to skyrocketing health care costs. Although Dean is not precisely on point, the Court of Appeals held that there was no reason why the reasoning set forth in Dean should not be extended to the present situation. Just as a health care provider is not entitled to reimbursement for the difference between its customary and actual charges from a second insurer, neither should an insured be so entitled. Where one insurer fully compensates a health care provider participating in its medical plan pursuant to an agreed upon reimbursement schedule, the only charge "incurred" within the meaning of §3107 is the "actual cost expended."
