Government Employees Insurance v. Avanguard Medical Group, PLLC

OPINION OF THE COURT

Balkin, J.P.

This appeal presents an issue of first impression, namely, whether a no-fault insurer must pay, as a component of first-party benefits for “basic economic loss” (Insurance Law § 5102 [a]), a facility fee in connection with “office-based surgery” performed in a practice and setting accredited under Public Health Law § 230-d (1) (h). A facility fee is a charge for the use of a medical facility and its staff and equipment. It is separate from the fee to which a physician or other medical professional is entitled for performance of the medical procedure itself.

The…