By: Spencer Hayes*
Published: October 11, 2023
Abstract
Despite their best efforts, Pennsylvania courts have struggled to articulate a workable standard for fixing the reasonable value of medical services. This has profound implications for breach of implied-in-fact contract and unjust enrichment actions related to medical services as both center on the reasonable value of said services. The reasonableness standards that do exist typically ask what services are “ordinarily worth in the community,” but the courts offer no guidance on how to discern this “ordinary worth.” Moreover, there is no agreed upon interpretation of the meaning of, or the boundaries associated with, the concept of “community.” Instead, the courts must engage in an agonized, case-by-case analysis of reasonable value. A bright-line rule would be helpful. Fortunately, Pennsylvania law already recognizes such a rule in the unjust enrichment context, but the rule’s applicability to breaches of implied-in-fact contract is unclear. This Article contends that the reasonable value of medical services in all cases should be the average reimbursement rate healthcare providers accept from third-party payors for the services rendered.
* Staff Attorney, Central Legal Staff, Superior Court of Pennsylvania.
Suggested Citation: Spencer Hayes, A Bright-line Rule for the Reasonable Value of Medical Services, 128 Penn St. L. Rev. Penn Statim 1 (2023).