How Medical Providers can Maximize Profits from PIP Carriers
How Medical Providers Can Maximize Collection From Florida PIP Carriers
All auto insurance policies in the state of Florida are legally required to include a minimum of $10,000 in Personal Injury Protection (PIP) coverage to cover medical bills and lost earnings. The purpose of this law is to provide prompt financial assistance to persons injured in accidents regardless of who is at fault. Insurance companies are always looking for ways to delay, undervalue or deny claims in order to boost their profits, including claims by hospitals and doctors that provide emergency and follow-up treatment to accident victims. If you are a medical provider that is not being paid what you're entitled to for treatment covered by PIP, then it is necessary to bring in an experienced Florida PIP reimbursement attorney can help you maximize what you collect from the carrier. Your PIP attorney can audit your files to get the most money from the insurance company.
Who’s Covered Under Florida PIP?
Title XXXVII of the Florida Insurance Statutes, Section 627.736 requires insurers to pay out medical and/or lost earnings benefits to the following classes of persons when they are injured as a result of a motor vehicle accident arising from the “ownership, maintenance or use” of the vehicle:
● Named Insured;
● Relatives of Insured Residing In Same Household;
● Operator of Vehicle;
● Passengers in Vehicle and
● Persons Struck By Vehicle (pedestrians, bicyclists, etc.)
This straightforward provision can be exploited by insurance companies to delay and deny payments. For example, the insurer may claim that there was no contact between the insured and a pedestrian, a household member is not an eligible relative or that the driver did not have permission to use the vehicle. If any of these situations arise that is when a medical provider should call an experienced Florida PIP reimbursement attorney to help them collect what they’re entitled to. Insurance companies are in the business of making money and looking out for their best interest. Let your PIP attorney take over to get your claims paid.
Time Limits Under Florida PIP
Florida insurance law only requires insurance companies to pay medical providers for treating motor vehicle accident-related injuries if treatment is sought by a victim within fourteen (14) days of an accident. It is important to understand that insurers are responsible for payment for follow-up treatment weeks and even months after an accident, but only if initial treatment is sought during that 14 day window for a specific injury. For example, if a person goes to the emergency room from the scene of the accident and complains about their neck, back and right knee right, that individual is eligible for follow-up treatment for those areas of their body after the 14-day window closes. If they went to the doctor 12 days after the accident and added a complaint of pain in their right shoulder, they would be eligible for follow-up treatment for that additional area of their body as well. Even if the car accident victim goes to a dentist within the 14-day window, PIP billing may be processed among other medical providers. Medical providers should timely file the CMS 1500 to the insurance company for the work completed within a reasonable time. There is no rigid time limit for medical providers submitting their bills, but they are required to submit a written request for payment that includes the basis of eligibility and the amount of the bill to the insurer as soon as practicable. The insurance company has 30 days from the date the written notice was furnished by the provider to issue payment, but this is rarely the case because most insurance companies will either ignore this quick deadline or find an excuse for a delay.
What Constitutes Medically Necessary Treatment?
Disputing whether treatment is medically necessary is the most common ploy used by insurance companies to avoid paying medical providers what they are entitled to under PIP claims. Section 627.732(2) broadly defines what’s medically necessary as care for the purpose of diagnosing, preventing or treating an injury in accordance with generally accepted standards of care and clinically appropriate as to type, extent, duration and frequency. Insurers will often deny expensive tests and surgical procedures claiming that they are not medically necessary, but experienced PIP reimbursement attorneys are often able to get the insurance companies to pay out on these claims. Insurance carriers have a right to have injured people claiming benefits after being examined by a doctor that they hire, referring to these examinations as “independent medical exams.” These exams are usually very brief and intended to rubber stamp the insurance company’s position that treatment is not medically necessary or has reached maximum results. Experienced Florida PIP reimbursement attorneys are often able to get the insurance company to pay out by showing a deficit in billing and/or lack of interest on the late payments being made to the medical provider.
Reimbursement for Reasonable Charges
According to Section 627.736(5)(a) of Florida’s PIP statute, defines a “reasonable charge” as one that does not exceed the amount that the provider usually charges for their treatment or supplies. The law provides for entering evidence of what’s usual and customary in the form of documentation and testimony that supports the reimbursement levels in the community and fee schedules for other types of insurance for the same or similar services, procedures, and supplies. Acupuncture and massages are not covered under the PIP statute. Courts have required insurers to pay additional sums to medical providers after Florida PIP reimbursement attorneys have proven that they calculated payments to providers in a manner that’s improper and self-serving.
Florida PIP Reimbursement Attorney
Medical providers do not have the time or expertise to handle disputes with insurance companies. That’s why the best way to collect what you’re entitled to is to hire an experienced Florida PIP reimbursement attorney that knows how to get insurance companies to pay out what you’re owed for services covered by PIP. Contact us to help you collect your full benefits from the Insurance Company.
