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HomeBest Practices → Are Medical Providers Leaving P.I.P. Money On the Table?

Are Medical Providers Leaving P.I.P. Money On the Table? Print E-mail
Written by C. Glen Ged, Esq.   
Wednesday, 26 January 2011 00:00

Medical providers can't afford to miss out on the reimbursements they're entitled to in today's healthcare climate.  Yet many who treat automobile accident victims are routinely underpaid by insurance companies - and may not be aware of their rights to recover substantial sums through Florida's Personal Injury Protection (PIP) law.

Reimbursement under PI P, the "No Fault" insurance coverage required by law of Florida vehicle owners, has its own pre-requisites, deadlines and procedures. Understanding these requirements can mean the difference between full, timely payment and having to pursue a PIP suit.

Beginning with the patient's first visit, documentation is crucial to obtain proper reimbursement.  Even if you meet the pre-requisites and file timely (within 35 days of the service provided), it's possible that payment may fall short of the reimbursement to which you are entitled.

Under Florida law, you have five years from the date of service to pursue a claim adjustment for overdue benefits. A comprehensive five-year PIP audit by legal counsel experienced in PIP law is a sound business practice.  At no cost to you, an audit pinpoints the aggregate amount of reimbursements that you've "left on the table."  Those payments can be pursued by legal counsel without cost to you because the automobile insurance companies by law are responsible for payment and any related attorney fees.

Under PIP, medical benefits will be reimbursed for services that are lawfully provided, supervised, ordered, or prescribed by:

· Physicians

· Chiropractors

· Hospitals or Ambulatory Surgical Centers

· Qualified Healthcare Clinics

· MRI Companies

· Dentists

· Massage therapy and physical therapy ordered by a covered healthcare provider

· Any person/entity which provides emergency transportation or medical treatment

Medical providers, committed to putting their patients' best interests first, may face other challenges with PIP.  An insurance company may decline to pay for further treatment.  If that's the case, be aware that the insurer must first obtain a report from a properly licensed medical provider with the same licensing as the treating provider, documenting that further treatment is unreasonable, not medically necessary or not related to the accident.

An insurance company's requests for additional information can be another stumbling block to timely PIP payment. Under Florida law, a claim can be pursued only when overdue, and it is deemed overdue only after a provider has satisfied the insurer's information request.   

About the author:  C. Glen Ged is founding partner in the law firm of Ellis, Ged & Bodden, P.A. and can be reached for additional information at gged@ellisandged.com or 1 888 EGB-FIRM (342-3476) or 561 995-1966.

Last Updated on Saturday, 05 February 2011 15:04
 


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