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Why Going To The Hospital Following a Car Crash May Cost You Big On PIP

You were just hit from behind by a driver while waiting at a red light. You get out and inspect your car and your rear bumper is damaged. You start to realize that your back is hurting, your neck is hurting. Did you hit your head on the steering wheel? What do you do next? After calling the police to fill out a police report and exchange insurance information with the person who hit your vehicle, you realize that you are hurt. So, what do you do now?

Many people would tell you to go straight to the emergency room at your local hospital to get checked out. If you are in such pain and feeling weak and feel you are in need of emergency treatment for your health, you should. However, what do you do when your neck and back are just sore and in dull pain? Should you still go straight to the emergency room? What are your other options?

In this scenario Dolman Law Group will show you how a person using their Personal Injury Protection benefits only ($10,000), based on the person who hit you having no insurance coverage, could fair in two different scenarios. Scenario 1, going to the hospital after a crash or scenario 2 reaching out to a chiropractor.

SCENARIO #1

So you chose to go to the Medical Center of Trinity after your crash. At the hospital, after waiting hours to be seen the doctor’s give you an examination and x-ray your chest and cervical spine. At the end of your visit they may prescribe you some ibuprofen. The hospital would then bill to your own insurance the following charges: (numbers taken from an actual bill submitted for PIP in 2015)

  1. CPT- 71010 Chest X Ray- Billed amount $1,294.75
  2. CPT-72125 CT Cervical Spine- Billed amount $10,723.00
  3. CPT-99284- Emergency Department visit- Billed amount $2,244.75

When you have an auto insurance policy, the policy and the No-Fault statute (Fla. Stat. 627.736) control the maximum amount medical providers have to be reimbursed from insurance companies. So what part of the statute controls how a hospital gets reimbursed?

Florida Statute 627.736(5)(a)(1)(b) states:

1. The insurer may limit reimbursement to 80 percent of the following schedule of maximum charges:

b. For emergency services and care provided by a hospital licensed under chapter 395, 75 percent of the hospital’s usual and customary charges.

Meaning each bill will be paid 80% of 75% of the charges by the hospital. So really this is how the bills from the hospital look.

    1. CPT- 71010 Chest X Ray- Billed amount $1,294.75(Adjusted because it’s a hospital bill to 75%-$971.06)
    2. CPT-72125 CT Cervical Spine- Billed amount $10,723.00 (Adjusted because it’s a hospital bill to 75%- $8,042.25)
  1. CPT-99284- Emergency Department visit- Billed amount $2,244.75 (Adjusted because it’s a hospital bill to 75%- $1,683.56)

Meaning that of your $10,000 in maximum PIP benefits, that you need to get back to health, the hospital will be paid a whopping $8,557.50. Leaving only $1,442.50 remaining in benefits for treatment.

SCENARIO #2

In the second scenario, after a car crash you call Dolman Law Group in either our Clearwater or St. Petersburg offices and you go to one of the recommended chiropractic physicians and an MRI/Imaging center for treatment. At the facility, which does not require you to wait for hours and hours to be seen you get the same 3 procedures; the doctor’s gives you an examination and x-rays your chest and cervical spine. Even though the chiropractic/imaging center would not charge nearly as close to what a hospital charges, for the purpose of this scenario let’s say that you were charged the same amounts to your insurance company.

  1. CPT- 71010 Chest X Ray-Billed amount $1,294.75
  2. CPT-72125 CT Cervical Spine- Billed amount $10,723.00
  3. CPT-99284- Emergency Dept visit- Billed amount $2,244.75

When you have an auto insurance policy, the policy and the No-Fault statute (Fla. Stat. 627.736) control the maximum amount medical providers have to be reimbursed from insurance companies. So what part of the statute controls how a chiropractic doctor, imaging center or other doctor’s gets reimbursed?

Florida Statute 627.736(5)(a)(1)(f) states:

1. The insurer may limit reimbursement to 80 percent of the following schedule of maximum charges:

f. For all other medical services, supplies, and care, 200 percent of the allowable amount under:

(I) The participating physicians fee schedule of Medicare Part B, except as provided in sub-sub-subparagraphs

(II) and (III).

(II) Medicare Part B, in the case of services, supplies, and care provided by ambulatory surgical centers and clinical laboratories.

(III) The Durable Medical Equipment Prosthetics/Orthotics and Supplies fee schedule of Medicare Part B, in the case of durable medical equipment.

For the most part what the above means is the doctor’s will get reimbursed at 80% of 200% of Medicare Part B. The Medicare Part B number is published and goes into effect March 1 of every year. It is a set number. Basically, this means no matter what doctor you go to, or the amount they charge, they can only accept a certain amount for your treatment. This is the amount the insurance company must pay for the treatment for your doctor to be paid from PIP. So really this is how the bills from the chiropractic/imaging center look.

  1. CPT- 71010 Chest X Ray-Billed amount $1,294.75 (200% Medicare Part B Amount $50.44)
  2. CPT-72125 CT Cervical Spine- Billed amount $10,723.00 (200% Medicare Part B Amount $208.37)
  3. CPT-99284- Emergency Department visit- Billed amount $2,244.75 (200% Medicare Part B Amount $242.02)

Meaning if someone went to one of our clients who is an MRI/Xray facility/Chiropractor they would pay from their PIP only $400.66. Leaving $9599.34 remaining in benefits for treatment.

Therefore, at the end of the day, for the same exact treatment you would be paying $8,156.84 MORE by choosing to go to the hospital.

So what does that mean? It means that instead of having a small amount of money to begin your treatment, you have a full amount of money ($9599.34). Therefore the doctors can get you back to the health you had before that person hit you from behind.

If you are ever in a car crash or injured while being a pedestrian by a vehicle and are wondering who you should see to help you recover from you injuries, call Dolman Law Group at 727-451-6900 or visit www.dolmanlaw.com. The wrong choice could be the difference between being healed or being broke.

Dolman Law Group
800 North Belcher Road
Clearwater, FL 33765
727-451-6900

https://www.dolmanlaw.com/legal-services/personal-injury-attorneys/pip/