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Your Patient Has Been “Cut Off” By an IME – What Do You Do Now?

Your Patient Has Been “Cut Off” By an IME – What Do You Do Now?

So, you’ve been providing treatment to your patient who was in a motor vehicle accident. The patient’s PIP insurer sends your patient to their insurance doctor for an “independent” medical examination. As expected, the “independent” doctor finds that the treatment has been reasonable and necessary but that the client no longer needs active care. You examine the patient after the IME and find the patient to be symptomatic. What do you do now??

As a caring medical provider, you want to ensure that the patient achieves MMI before you discharge them from treatment. But, as a conscientious business person, you want to make sure that you are going to get paid for your hard work.

Have a conversation with the patient so that they understand that the PIP carrier has denied the bills. Explain that you are willing to treat them and that you will do everything you can to get paid by the PIP carrier. If you are unsuccessful in collecting the money from the PIP carrier, you’ve at least had the conversation with the patient and you can later decide how you want to proceed.

If the patient continues treatment, you should keep submitting your records and bills to the PIP carrier. Continue to do this REGARDLESS OF THE PIP CARRIER’S DENIALS. This could become important in a later dispute, where you will have to establish that you presented all of your bills the PIP carrier.

Consider sending a rebuttal to the PIP carrier. While this is not a must, you might want to consider setting forth your disagreement with the findings of the IME. This does not have to be lengthy but at least you’ve expressed your disagreement with the findings of the report and that you have not acquiesced to the denial! Remember, don’t make it personal! Just set out the facts in an objective way. A rebuttal can also help in a later dispute with the PIP carrier.

Send the file to The Law Office of PIP Collect, LLC. You might not want to wait until the patient has finished treatment. Don’t forget, there may be other medical providers’ bills eroding that limited amount of PIP money available! We can triage the file and get the case quickly filed for you even if the patient is not done with treatment.
If you have any questions about this or any other PIP issue, give us a call at (978) 745-7950 or send us an email at info@pipcollect.com.

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