The No-Fault Act; Attendant care charges; MCL 500.3107(a)(1); Reasonableness; Spectrum Health Hosps v Farm Bureau Mut Ins Co of MI

Concluding that no genuine issue of material fact existed as to the reasonableness of plaintiff-provider’s charges for attendant-care services, the court affirmed summary disposition for defendant-insurer. Plaintiff provided the services to defendant’s insured (N). The court noted that the relevant statute, MCL 500.3107(1), does not define what “constitutes a ‘reasonable charge’ for such services.” But the court and the Michigan “Supreme Court have explained that determining the reasonableness of charges is a fact-specific inquiry, which requires evidence of the actual costs incurred and whether the charges align with marketplace rates.” Plaintiff in this case “pointed to a number of costs that no doubt had some bearing on the $58.80 per hour rate charged to clients for attendant-care services. However, plaintiff’s burden was to show why $58.80 was a reasonable rate to charge for [N’s] attendant-care services in particular.” It failed to do so, relying solely on the deposition testimony of one of its owners (M) about “the rates that plaintiff charges its clients in general, which lacked supporting documentation or evidence to substantiate the reasonableness of the $58.80 hourly rate charged for attendant care services.” The court noted that M “admitted that the charged rate was not based on market comparisons or profit margin calculations, and was instead determined subjectively as a ‘fair’ rate.” But the court ruled in Spectrum that a “‘medical provider’s typical price cannot be deemed reasonable unless it reflects an amount that is actually being charged in the marketplace[.]’” M testimony, in the absence of corroborating evidence, did “not meet the evidentiary standard required to create a genuine issue of material fact as to the reasonableness of plaintiff’s rate for attendant-care services.”