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What are a PIP Patient’s Rights with Respect to Timely Billing?

For many individuals seeking medical treatment following a motor vehicle accident, there’s plenty of stress to go around: keeping up with appointments, nagging discomfort, confusing insurance paperwork, rising medical bills, time off work, and the length of time for settlement to happen. The average injury victim knows very little about how their insurance works regarding payment of medical bills. Additionally, the worry about “how much am I responsible for” can be highly stressful. For both providers and claimants, it’s necessary to understand proper billing requirements.

The importance of timely billing cannot be stressed enough. Medical providers have 35 days from the date of service to submit their bills to the PIP Insurance carrier. After 35 days, the insurer is relieved of responsibility per Fla. Stat. 627.736(5)(c). The provider’s failure to submit timely billing CANNOT BECOME THE PATIENT’S RESPONSIBILITY. The respective statutory protection for insureds is as follows:

The injured party is not liable for, and the provider may not bill the injured party for, charges that are unpaid because of the provider’s failure to comply with this paragraph.

For medical providers, the time limit is measured by the date of the postmark date or electronic submission. As an example, billing submitted on May 1 cannot include any charges rendered prior to March 27, which is the 35th day. As a matter of practice, I recommend electronic submission if possible because you get an immediate timestamp that can serve as proof of timely billing. If submitting charges by mail, certified mail is recommended. However, certified costs can be pricey and if using regular post, the provider should keep a detailed submission log as proof of timely billing.

For patients, if you notice your bills being denied by your insurance company, verify with your medical provider that all charges were timely submitted. Consequently, do not let yourself be told that you are responsible for payment in the event bills were not timely submitted. In the plethora of paperwork patients sign, patient responsibility forms are undoubtedly one of them. The statute affords protection in the event a patient unknowingly signs a form subjecting themselves to responsibility for late payment submission. The above-quoted provision goes on to say that, “[a]ny agreement requiring the injured person or insured to pay for such services is unenforceable.”

Medical providers that submit to the insurer a notice of initiation of treatment within 21 days after first examination or treatment of the insured may include charges rendered up to but not more than 75 days before the postmark date of the statement. I recommend all providers submit a notice of initiation of treatment after the first visit as a matter of practice to avert timely billing issues. There have likely been countless situations where medical providers are told there is no insurance or are given incorrect information, then subsequently discover the identity of the correct insurer only to have billing denied based on timeliness. The statute has a specific remedy that must be followed and it is found at Fla. Stat. 627.736(5)(c)1.

Once the medical provider obtains the correct PIP insurer information, there is a 35 day deadline to submit the charges. The insurer is not required to pay unless:

The provider includes documentary evidence that was provided by the insured during the 35-day period demonstrating the provider reasonably relied on erroneous information from the insured, and EITHER: A denial letter from the incorrect insurer; or Proof of mailing, which may include an affidavit under penalty of perjury, reflecting timely mailing to the incorrect address or insurer.

In other words, keep all information that was relied upon at the time initial billing was submitted; or any documentation showing there was no insurance. Once you have determined that PIP exists and know the correct insurer, submit your billing immediately WITH the documentation you initial relied upon as well as proof of mailing along with an affidavit.

For patients, when visiting your medical provider following an accident, make sure you present all current insurance information that you believe covers you for the motor vehicle accident. The necessary information would include insurance ID cards above all. If you are represented an attorney, make sure your attorney presents your insurance information to the medical providers rendering treatment.

Being injured in a motor vehicle is already an extremely stressful and mind-numbing experience. Worrying about whether or not technical aspects are being followed is something patients should not have to fret over.

As always if there are ever questions relating to a PIP Insurance Claim or denial, the experience Trial Lawyers at Sibley Dolman Gipe Accident Injury Lawyers, PA are happy to be a resource. Please contact myself for further explanation by calling 727-451-6900 or via email; [email protected]

Sibley Dolman Gipe Accident Injury Lawyers, PA
800 North Belcher Road
Clearwater, FL 33765
727-451-6900

https://www.dolmanlaw.com/pip-personal-injury-protection-attorney/