Freedom Medical Supply, Inc. v. State Farm Fire & Casualty Co., 131 A.3d 977

MVFRL 1797(a) caps reimbursement at 80% of either the usual and customary charge or a Medicare-based amount where applicable; usual and customary charge is not defined in statute.
Regulations define usual and customary charge as the charge most often made by similarly trained providers in the geographic area; §69.3.
§69.43(c) permits, but does not require, an insurer to calculate the usual and customary charge using the provider’s bill or carrier/intermediary data to the extent that data is available.
Freedom provided EMS and whirlpools with large markups; sought 80% of charges as usual and customary.
State Farm conducted its own market-based calculation using various sources and began paying amounts based on that calculation in 2010.
District court held §69.43(c) is permissive; questions were certified to the Pennsylvania Supreme Court for interpretation of statutory/regulatory ambiguity.

Issue	Plaintiff's Argument	Defendant's Argument	Held
Does §69.43(c) mandate or permit calculation of usual and customary charges using specific bases?	Freedom argues §69.43(c) is exclusive and mandatory for the two bases.	State Farm argues §69.43(c) is permissive and allows other methods.	Permits but does not require calculation based on those bases.

Meyer v. Community College of Beaver County, 93 A.3d 806 (Pa. 2014) (ambiguity and interpretive framework for statutes/regulations)
Foster, 629 A.2d 1055 (Pa. Cmwlth. 1993) (Department interpretation of usual and customary charge)
Pittsburgh Neurosurgery Assocs., Inc. v. Danner, 733 A.2d 1279 (Pa. Super. 1999) (MVFRL purpose to contain medical costs; insurance costs)
Sturkie v. Erie Ins. Co., 595 A.2d 152 (Pa. Super. 1991) (MVFRL’s primary aim to provide coverage and contain costs)