For many people seeking medical treatment after a motor vehicle accident, there is a lot of stress to go around: keeping up with appointments, excruciating discomfort, confusing insurance paperwork, escalating medical bills, Time of work, and period of time for settlement.
The average injury victim knows very little about how their insurance works in regards to paying for medical bills.
Additionally, worrying about "how much I am responsible for" can be overwhelming. It is essential to understand the PIP patient's rights regarding timely billing.
The importance of timely billing cannot be stressed enough. Medical providers have 35 days from the date of service to submit their bill to the PIP insurance carrier.
After 35 days, the insurer, per Fla. becomes free from the responsibility of the state. 627.736(5)(c). Provider's failure to submit billing on time cannot be the responsibility of the patient.
Related statutory protections for insureds are as follows:
The injured party is not liable for unpaid charges due to the provider's failure to comply with this paragraph, and the provider may not bill the injured party.
For medical providers, the deadline is measured from the date of postmark or date of electronic submission.
For example, a billing submitted on May 1 cannot include any charges prior to March 27, which is the35th day.
As a matter of practice, I recommend electronic submission if possible because you get an instant timestamp that can serve as proof of timely billing.
submitting the fee by post, certified mail is recommended. However, certified costs can be expensive and if using regular mail, the provider should keep a detailed submission log as proof of timely billing.
For patients, if you notice that your insurance company is denying your bills, verify with your medical provider that all charges were submitted on time.
Consequently, don't tell yourself that you are responsible for paying in the event that bills weren't submitted on time.
Among the plethora of paperwork patients sign, patient responsibility forms are undoubtedly one of them. The law provides protection in the event a patient unknowingly signs a form subject to liability for late payment submission.
The provision quoted above further states that, "[a]n agreement requiring the injured person or the insured to pay for such services is unenforceable."
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Medical providers who notify the insurer of the initiation of treatment within 21 days after the first examination or may be involved in the insured's treatment, but not earlier than 75 days A fee of up to Rs. Postmark statement date.
I recommend that all providers submit treatment initiation notification after the first visit as a practice to avoid the issue of timely billing.
There are likely countless situations where medical providers are told there is no insurance or have been given incorrect information, then later discover the identity of the correct insurer to deny billing on the basis of timeliness. There is a specific measure of law that must be followed and that is Fla. Found in Stat. 627.736(5)(c)1.
Once the medical provider receives the correct PIP insurer information, there is a 35-day deadline for fee submission. The insurer is not required to pay unless: The
provider does not include documentary evidence that was provided by the insured during the 35-day period, that shows the provider reasonably relied on incorrect information from the insured , and any: Denial letter from the wrong insurer; or proof of mailing, which may include an affidavit under penalty of perjury reflecting the wrong address or timely mailing to the insurer.
In other words, keep all the information that was relied upon at the time of initial billing; or any document showing that there was no insurance.
Once you have determined that the PIP exists and know the correct insurer, submit your billing immediately with the document you initially relied on as well as proof of mailing with an affidavit.
For patients, when visiting your medical provider after an accident, be sure you present all current insurance information that you believe covers you for the motor vehicle accident.
Required information will include the insurance ID card at the top. If you are represented by an attorney, make sure your attorney presents your insurance information to the medical providers providing treatment.
Being injured in a motor vehicle is already an extremely stressful and mind-numbing experience. Worrying about whether the technical aspects are being followed or not is something that should not bother patients.
As always, the experienced trial attorneys at Dolman Law Group Accident Injury Lawyers, PA are happy to be a resource if you ever have questions regarding a PIP insurance claim or denial. Please contact yourself for further clarification by calling 727-451-6900 or via email; stefan@dolmanlaw.com
Dolman Law Group Accident Injury Attorney, PA
800 North Belcher Road
Clearwater, FL 33765
727-451-6900