Secrest Wardle’s Groundwork in Central Home Health Care Expands Medicare Limitations Applicable to Determining Reimbursable Amounts

Similar to the opinion in Central Home the panel reversed the trial court by holding there was no genuine question of fact that the Medicare provisions/limitations applied by the insurers were related to amounts payable under Medicare and thus were not barred by the No-Fault definition of Medicare (MCL 500-.357(15)(f)). In both opinions, the Courts held the plain language of MCL 500.3157(2) authorizes insurers to use limitations and provisions outside of Medicare fee schedules to determine the amount payable under Medicare and thus the maximum eligible reimbursement of charges.

As in Central Home, it was held that factual questions remained as to what Defendant must pay after applying each limitation. These opinions should shape future arguments on the effect of applying provisions/limitations to the amount payable under Medicare as opposed to whether they can be applied at all.