Forrest Park Accupuncture v. Progressive Insurance Company (7/30/2010)
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Since there is no coverage under the Workers’ Compensation schedules for acupuncture services rendered by a licensed acupuncturist, the acupuncturist is permitted to charge the prevailing rate in the geographical area, but it must be consistent with existing fee schedules for similar procedures. The burden on the insurer to “at least, [come] forward with evidence that the provider’s fee is not ‘consisten[t] with charges permissible for similar procedures.” In this case, Respondent has alleged that the fees charged are in excess of those prevailing rates. Still, the provider may then present evidence to show otherwise.


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