Executive Summary

Overview

Name Charlie Farrell

Claim Number 09127397

$ 70 k
Court Case Number PX20218910

Date of Claimed Injury 11/19/2018

Case Information Start Date 11/20/2018 $ 60 k $ 57.7k

End Date July 24, 2019

Number of Treatments 206

$ 50 k
Number of Providers 9

Number of Specialties 7

$ 40 k $ 38.8k
Metadata $ 35.1k

Amount Billed $57,715.95 $ 30 k

Reasonable Value $38,793.22

Amount Paid by Third Party $0.00

$ 20 k
Amount Adjusted $2,133.51
Statistical Amount Paid by Patient $2,133.51
Observations Amount Paid $2,133.51 $ 10 k
Balance Due $55,582.44
Number of Providers Billed Less than Reasonable
Value 3 $ k
Amount Billed Reasonable Value The total lesser of the bill/reasonable
The total lesser of the bill/reasonable $35,115.24

Conclusions

A comprehensive review of the available medical and billing records was conducted to formulate my opinions. The medical and billing records reviewed are listed in Exhibit B. A summary of the
medical records is provided in the Record Review, Exhibit C.

The reasonable market value is $38,793.22 for the billed charges from 9 providers.

The past medical bills total $57,715.95 for dates of service November 20, 2018 to July 24, 2019.

There were 3 providers who charged less than the Reasonable value. The total lesser of the billed/reasonable value was determined to be $35,115.24.

The billed charges were analyzed based on billing and coding rules and the application of geographic-specific pricing data. The rules and pricing are applied within the context of the health care
Summary of structure of five distinct categories of care. Each category of care has its unique medical billing code set, modifiers, and highly defined rules. Each category also has unique charge-based pricing
Opinions databases that have been collected by the health care industry for use by both providers and payers to determine market value and make business decisions. These are the databases used to
determine reasonable value. See detailed Methodology, Exhibit D, and detailed Sources list, Exhibit E.

All pricing data is charged-based data. Reimbursements, payments, and commercial or governmental insurance reimbursement fee schedules are not considered.

The standard community charge, based on comparative research from the following facilities supports the reasonable value (see Comparative Analysis, Exhibit F):

Drill Start Date End Date Provider Organization Specialty Number of Amount Billed Reasonable Amount Paid Amount Amount Paid Amount Paid Balance Due
dow Treatments Value by Third Party Adjusted by Patient
n
(pen
ding)
11/20/2018 11/20/2018 Healing Radiology Radiology 2 $ 659 $ 936 $ - $ - $ - $ - $ 659.00

11/20/2018 11/20/2018 West City Medical Response Ambulance 3 $ 2,134 $ 1,929 $ - $ 2,133.51 $ - $ 2,133.51 $ -
Services

11/20/2018 11/20/2018 Roosevelt Regional Medical Center Emergency 15 $ 19,325 $ 9,122 $ - $ - $ - $ - $ 19,325.00
Department

11/28/2018 6/28/2019 Roosevelt Chiropractic Center Chiropractic 111 $ 5,595 $ 6,072 $ - $ - $ - $ - $ 5,595.44

12/14/2018 5/10/2019 Fallon Spine Center Pain Management 5 $ 9,200 $ 3,585 $ - $ - $ - $ - $ 9,200.00

4/5/2019 4/5/2019 Thompson Imaging Services Radiology 2 $ 3,900 $ 3,467 $ - $ - $ - $ - $ 3,900.00

6/17/2019 7/24/2019 Northwest Physical Therapy and Acupuncture 65 $ 4,413 $ 5,457 $ - $ - $ - $ - $ 4,413.00
Acupuncture

5/2/2019 5/2/2019 Franklin Surg Institute Outpatient Surgery 2 $ 10,750 $ 7,716 $ - $ - $ - $ - $ 10,750.00
Center

5/2/2019 5/2/2019 Fallon Anesthesia Anesthesiology 1 $ 1,740 $ 508 $ - $ - $ - $ - $ 1,740.00