Medical expenses - billed or amount recieved by the provider

When totaling medical expenses in an injury case, is the amount billed or the amount accepted by the provider as payment in full the relevant number?

(thanks to the popular forensic economist bulletin board for this posting idea...)

While most of the legal opinions out there say the billed amount is correct, there is at least one state court case allowing testimony for the amount accepted.

In at least on instance in Federal District Court case the trial court judge, allowed the defense to present testimony about the amount the defendant (the government) would pay through its various health insurance programs and how much the plaintiff would actually pay as copay. The defense's reasoning was that the US was ultimately paying for everything, assuming the plaintiff won the case and received all his expected copays.

As such, the defense reasoned it was not collateral source as it didn’t come from some third party. Since, under the defenses theory, it was not a collateral source, the amount paid by the defendant could be considered as an offset in th damages calculation. In the trial, the court allowed the US to bring in a claims adjuster from Medicare and from Tricare to explain just how much they would pay and which procedures would be covered. They allowed me to use those estimates in determining the loss.