PIP Collections for Healthcare Professionals
Florida is one of twelve states that require Personal Injury Protection (PIP) coverage as part of all auto insurance policies. The intention of PIP insurance is to provide injured drivers immediate medical coverage, of up to $10,000. As an alternative to establishing fault through the court systems, PIP is supposed to reduce payment delays for the PIP provider. That is not always the case. For Florida’s healthcare providers, PIP payments have historically offered a predictable revenue source. Yet many medical providers find themselves not correctly reimbursed for treating Florida auto accident victims. If this is the case, an attorney versed in Florida PIP collections can drive this effort for you, collecting what you are due for services rendered.
Healthcare professionals may feel forced to accept non-payment or underpayment of benefits, even though Florida law mandates insurer responsibility for costs and attorney fees when PIP benefits have been underpaid or denied. It is therefore critical that Florida healthcare professionals quickly identify and pursue all underpaid claims via a PIP review. This South Florida Hospital News article, published on December 1, 2020, details an important decision that upholds the rights of medical providers.
On May 18th, 2011, Florida’s Fourth District Court of Appeal held that when an individual insurance policy provides for higher payment than the minimum required under Florida’s Personal Injury Protection law, the terms of the policy will dictate payment. This gives medical professionals the ability to collect the balance of PIP benefits for services rendered under insurance policies dating back as far as January 1, 2008.
Given this decision, alongside the realities Florida healthcare professionals face regarding PIP underpayments and denials, it is important that healthcare professionals speak to a knowledgeable Florida lawyer for doctors from Rosenberg Law, P.A. Our firm can evaluate your PIP billing to ensure you are paid outstanding balances for services rendered.
We will review the files in question, then send a written demand letter to the insurance carrier, advising them they have 30 days to pay the claim or we will file suit. If Rosenberg Law, P.A. files suit on your behalf for PIP collections, and we recover money, according to Florida Law, the insurance carrier will also be responsible for our fees, meaning there are no out-of-pocket attorney fees for you. We have offices in Plantation and Sarasota, for your convenience.
How Does PIP in Florida Work for Healthcare Providers?
Following a Florida accident, an insured person may assign their PIP benefits under their insurance policy to a medical provider, who then treats his or her injuries. Florida healthcare professionals work hard to improve the lives and futures of their injured patients and their reimbursement under PIP is well earned. Unfortunately, PIP claims can be complex—demanding time and resources that medical providers feel are more immediately needed in other areas of their practice. Knowing this, insurers may attempt to deny PIP claims for any number of reasons, leading to a reduction in benefits or an outright denial of benefits for the insured patient.
It can be extremely beneficial to have your past unpaid PIP files reviewed by experienced Rosenberg Law, P.A. attorneys. Since Florida PIP law requires all PIP expenses to be paid within 30 days of the date the bill is submitted to the insurance company, invoices that are unpaid or underpaid past this 30-day window are considered legally past due, providing just cause for a Florida healthcare professional to seek legal representation.
And keep in mind that the law is always changing. You may believe that you are not entitled to further payment but a court order may say otherwise.
When medical billings have no justification for denial or reduction (usually found on the Explanation of Benefits) you may have justifiable cause to file a PIP claim in court. You should be mindful of the Florida statute of limitations for recovery of PIP claims—five years from the date of filing. In many cases, a review by a knowledgeable PIP attorney can help recover underpaid or unpaid PIP claims with no out of pocket cost to the healthcare provider.
How Long Does a PIP File Review Take?
The length of your PIP file audit will, of course, depend on the number of claims involved, and therefore could take anywhere from several hours, to days. The time will also depend on whether electronic copies of the files exist. Should only hard copies remain, those in question would need to be scanned. Once a PIP claim that has been unpaid or underpaid is found, as noted above, a demand letter is sent. If the bill remains unpaid, a determination will be made regarding whether a lawsuit should be filed on behalf of the healthcare professional; if there are a significant volume of cases, the demand letters may take a bit longer to send out.
What Happens Once a PIP Collections Lawsuit is Filed?
If the insurer fails to respond to the demand letter, litigation is usually filed in County Court, and a Pre-Trial Conference date is set. The insurance company’s attorney must attend this conference if the case is not settled prior to that date. In fact, a large number of newly filed cases will settle prior to the Pre-Trial Conference; this benefits the healthcare professional in that they will receive payment fairly quickly. Of course, this is not true in every county and not always true now that the courts are dealing with COVID-19 protocols. If the case or cases continue beyond the Pre-Trial Conference, discovery will take place; depositions may be taken, interrogatories sent back and forth, and requests for production made.
How Can Rosenberg Law, P.A. Help Healthcare Professionals Obtain PIP Payments?
It is important to carefully examine all Explanations of Benefits/Reviews associated with PIP payments. If an “allowed amount” has a $0, or there is any other indication the PIP charge will be underpaid or denied, it should be marked for review by a skilled lawyer. This is because the healthcare professional may believe that they are getting paid, when in fact they are not. Rosenberg Law, P.A. has highly skilled lawyers who can submit a demand letter on your behalf that fully meets all statutory rules. If you are a healthcare professional with many denials or underpayments, we invite you to give us a call to address your PIP collections.
We will carefully review your PIP billing records to determine the strength of your claims and provide honest insight as to your likelihood of success. We understand that many healthcare professionals fail to follow up on denied or underpaid PIP claims, simply due to lack of time or concern the efforts will not be successful. Contact Rosenberg Law, P.A. today—we are committed to ensuring healthcare professionals are reimbursed for the health care they provide.
Do not let the insurance carriers wrongfully underpay and deny payment of benefits.