Medical providers, such as chiropractors, are routinely being taken advantage of by their patients’ personal injury protection (PIP) insurers (State Farm, Progressive, Geico and USAA). For instance, many insurance companies are underpaying, paying incorrectly, or completely refusing to make payment altogether. Do not give up on making sure your bills are paid correctly. Contact an experienced Miami Personal Injury Protection (PIP) Lawyer to fight for you and retrieve what you are entitled to.
Miami Personal Injury Protection (PIP) Lawyer, Shamis & Gentile, P.A., explains the reasons for underpaying or paying the incorrect benefit amount:
- On several occasions, the insurance company will misapply the deductible. Instead of applying the deductible to the total billed, as they should, the insurance company will apply the deductible to the amount that they reduce the bill by their own misguided interpretation. In other words, the insurance company will reduce the bill for various reasons and then apply the deductible. When doing the correct process of application, the insurance carrier will apply the deductible after the total amount billed, prior to the reduction.
- The updated 2013 Personal Injury Protection (PIP) amended Medicare coding policies must be correctly applied by insurance carriers. The insurer isn’t supposed to reduce bills based on National Correct Coding Initiative’s Medicare Reduction Policies, Hospital Outpatient Payment System, etc. Therefore, if committed these are incorrect reductions. For instance, in Socc v. State Farm, the 5th DCA held that the Florida Statutes do not support a finding that the Legislature intended to incorporate all of Medicare into the Personal Injury Protection (PIP) statute. Despite clear legislative intent to not allow NCCI edits, and Courts all over the state of Florida routinely finding in favor of Plaintiff’s, insurance companies will still apply these edits in a “numbers game” approach with the strategy that enough providers wont challenge them. Don’t be one of those taking less money for no reason. Hire a Miami Personal Injury Protection (PIP) Lawyer.
- “The insurer believes that they paid a reasonable amount.” Another incorrect method, the insurer will defend as per Florida Statutes 627.736(5)(a)(2) indicating that they’ve included a permissive fee schedule into their policy, but really they have yet to amend their policies. Be aware that the insurer has to give notice to the insured before using Medicare fee schedules to limit reimbursements for medical services. This precise notice has to be found in the insurance policy, specifying that the insurer is taking advantage of the Medicare fee schedule, Workers Compensation Fee Schedules, etc. This is common with State Farm policies prior to 2013 (before the 9810A).
- The insured fails to attend an examination under oath (EUO). Missing a EUO does not and should not result in non-payment to the medical provider. It is not a condition precedent, meaning an event that must take place prior to obtaining Personal Injury Protection (PIP) benefits. There are also a litany of ways the insurance companies do not notice the insured correctly, thus making even a missed EUO not a roadblock to recovery.
- Assignment of benefits (AOB) is a mere direction to pay and is invalid. An assignment of benefits (AOB) is valid, even if it appears in the form of a direction to pay. There is no legal division between an assignment and a direction to pay. Don’t let insurance companies make up issues that don’t have legal basis be a bar to your recovery.
Why you should hire a Miami Personal Injury Protection (PIP) Lawyer
Listed above are a few “excuses” of the mass of defenses raised by Florida PIP insurance carriers. So it is critical to contact a knowledgeable Miami Personal Injury Protection (PIP) Lawyer to guarantee that the insurance company doesn’t incorrectly pay or omit to pay a medical provider for the medical services rendered. There is absolutely no out-of-pocket cost for you. If we do not collect money, then you do not pay. Call (305) 479-2299 and speak with a Miami Personal Injury Protection (PIP) lawyer at our office today about your personal injury protection (PIP) discrepancies and we will do everything in our power to make sure your bills are paid correctly. We also will happily review any old files that you have already been paid on to determine if you were paid correctly. It’s easy and painless and often results in tens of thousands of dollars of “found” money.
