Archive for category: Informational / How To

It is a new year and it is a good time to reflect on what’s been working and what hasn’t been working in your practice. Are you getting your bills fully paid by auto insurers or are they still chipping away at your invoices? Are you getting criticized by “independent” insurance company doctors who claim that you are over treating your patients or providing them with bad advice? Are your bills being cut by some arbitrary computer program? If not, then you have nothing to change about your practice. But, if you’re like most medical providers trying to provide good medicine to their patients but are being stymied by insurance companies’ cutting their bills, now is the time to take action! Push back! Ask questions! Review your billing practices to ensure that you are doing everything that you should be doing. Whatever you do, don’t quit fighting! Don’t stop providing good treatment to your patients. Don’t relent on seeking to be paid fairly for your hard work! Once you back down, the, insurance companies will keep chipping, cutting, and denying your bills.

****Our Triage Department is ready to review your files TODAY. Send them over and we will do our best to have a response to you within FOURTEEN days.****

In the fog of litigation an advocate can sometimes lose sight of the real issues at hand. Overzealous insurance defense lawyers and hard ball insurance company tactics recently turned a simple PIP claim into a multi-year battle. The result should deter them from such tactics in the future.

A local chiropractor treated a patient who had been injured in a car accident. The PIP insurance company paid the first $2,000 of benefits, and the chiropractor then submitted additional bills to the patient’s health insurance. The health insurer declined to pay for hot and cold pack treatments, using a billing code indicating that the payment was included in the allowance of another service. The chiropractor then submitted the bills and health insurance EOBs to the PIP insurer for payment of 26 units of that service at $30.00 each for a total of $780.00.

The PIP insurer denied payment stating that the health insurer covered the service. However, the chiropractor still remained unpaid for the hot and cold pack treatments which were clearly not paid by the health insurer. The chiropractor hired a lawyer and filed a small claims PIP suit.

The PIP insurer removed the matter from the small claims court, up to the district court and then promptly, lost at trial. The insurance company then appealed their loss to a higher court.

According to the appellate court the PIP insurer undertook a “contentious litigation strategy on a matter that the plaintiff had commenced as a small claim” which caused the plaintiff’s counsel to devote a significant amount of time to prosecute. The Appellate Division said further: “where the defendant and its counsel litigated this matter with little sense of proportion, they must now reap what they have sown.”

In June 2016, The Appellate Division affirmed an award over $24,000 in fees on a claim that could have resolved for $780.00 had rational minds prevailed.

The insurance company and its attorneys lost sight of the purpose of the statute and engaged in a wasteful, time consuming and very expensive course of litigation. This is the very antithesis of the PIP statute, and PIP insurers ought to think twice before engaging in such defensive measures.

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.