Judge Picks Formula For Disputed Surgical Charges

The San Diego judge hearing a consolidated bill-review case decided that the insurers should pay Elite Surgical Centers the same percentage of its billed amounts that they did before the state adopted a fee schedule in 2004. Judge Susan England in her March 29 order rejected a formula calling for payment of 67% of the billed amounts to Elite Surgical Centers. The workers' compensation judge instead adopted a formula based on the historical payment levels for outpatient surgeries from 2000 to 2003. The sole issue in the case between Elite Surgery Centers and the 16 carriers was the reasonab...