AccuMed Blog

What is the Reasonable Value of Medical Care?

May 19, 2017


A plaintiff in a personal injury case deserves compensation for both past and future medical services required to treat their injuries. That much is clear. The problem is discovering (and demonstrating) what, exactly, the reasonable value of medical care is.

Determining Reasonable Value is Elusive

Only medical billed charges that are reasonable are acceptable for determining economic damages. And most providers would say whatever their Charge master says is reasonable is in fact reasonable. In the past, plaintiff attorneys have largely relied on these providers to testify to reasonableness, but courts are now requiring more unbiased analysis to prove this. Given that charges vary by region and type of provider, among other factors, it can be difficult to demonstrate what’s reasonable in a case.

Determining the Reasonable Value of Medical Care

At AccuMed HealthCare Research, we help law firms get full credit for their clients’ medical damages, especially medical care down the road like a series of facet injections, a joint replacement or ongoing medications. We do this by carefully wading through our nationwide database of 40+ million medical records to find what providers’ charge in your local area.

We distill this database down to the necessary procedures from certain providers then apply the standards of “usual” and “customary” to arrive at a reasonable value:

Usual – We only use data from our database if it represents a minimum of eleven patients for a specific procedure. Not only does this establish a large enough sample size for a usual charge for a procedure but it ensures patients’ protected health information in our database remains protected.

Customary – A charge is considered customary if it would include a significant percentage of procedures performed by providers within a reasonable distance from your client. AccuMed has determined “a significant percentage” to include 8 out of 10 procedures (or the 80th percentile using the nearest rank method).

We provide assessments of reasonable value for medical services that have already happened and for those that have yet to happen:

  • FutureNeeds

With FutureNeeds, we provide detailed reports of surgical estimates for hundreds of medical procedures. We regularly find that doctors’ estimates for surgeries and hospital stays are three to five times lower than the reasonable value.

  • BillValue

With BillValue, we review the patient’s prior medical bills and arrive at the reasonable value for these services in their area, often putting money back in your clients’ pockets.

To learn more about how our services can help your firm spend less time trying to determine the reasonable value of medical care and more time focusing on what matters in your case, visit our homepage or contact us today!

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