PIP question

[Guest guest]

Hi All

PIP insurers frequently tell patients they can get medical coverage

for their injuries for two years after their accident. I recently had

a guy whose accident was about 13 months ago. He has been in constant

contact with the claim rep, telling her that he was still sore and he

finally decided to get treatment.

So, is the process the same as a normal PI case or are there special

circumstances I need to be aware of?

Thanks

Don , DC

Corvallis

[Guest guest]

So here's the deal as I experience/understand it:

Year One--The injured patient's PIP covers all appropriate and necessary care. Including supplements, I might add. You bill the primary PIP company and get paid as you go along.

Year Two--New Rules of the Game:

Starting on Day 366: It becomes a "Third Party" claim with the offending driver's auto insurance company.

The rub is this: You are able to provide treatment and the 3rd party insurance company will cover your costs.

HOWEVER, you will NOT be paid as you go along. Payment will be provided only whenl the claim is completely finished and "Settlement" occurs. At that time, the patient signs a final agreement with them, bills are paid and settlement is provided and the claim gets closed permanently.

Soooo, that said, you MUST protect yourself with an "Irrevocable Lien" signed by your patient and submitted to the Third Party insurance company. Send it CERTIFIED MAIL

This lien says that the patient understands that they are responsible for all cost, regardless of whether or not there is a final settlement and that THE THIRD PARTY INSURANCE COMPANY MUST PAY YOU BEFORE FINAL FUNDS ARE DISBURSED TO YOUR PATIENT.

I explain to my patients that I am essentially making them a LOAN IN GOOD FAITH. Since I am not a bank, I ask them to sign the lien in order not to put myself in financial risk. I have never had a patient balk or complain. They understand that I am providing a necessary service and that I should be paid at the end. I would be happy to share the lien document I use. It's a hybrid lien based on parts of other liens I 'stole' from several docs. LOL

I'm submitting this to you AND to the list serve in the event that there is anything in my explanation that is incorrect or if there are any 'rules of engagement' that might have changed while I was having so much fun treating patients!

Hope this helps.

Ann , DC

PIP question

Hi All

PIP insurers frequently tell patients they can get medical coverage

for their injuries for two years after their accident. I recently had

a guy whose accident was about 13 months ago. He has been in constant

contact with the claim rep, telling her that he was still sore and he

finally decided to get treatment.

So, is the process the same as a normal PI case or are there special

circumstances I need to be aware of?

Thanks

Don , DC

Corvallis

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[Guest guest]

Do you mean PIP arbitration? I thought that was quicker than most settlement suits. Are there any Doctor lien provisions in it?ELliott MantellSent via BlackBerry by AT&TFrom: " Bobadilla" <melissa@...>Sender: Date: Mon, 12 Jul 2010 16:54:52 -0700' Cluen'<gcluen2002@...>; < >Subject: RE: PIP question Ifthe “driver” you refer to in your email is the at fault party (the driverthat caused the collision) then you did the correct thing by billing CareOregon first getting a denial then submitting the bills to the at fault party’sPIP insurance. PIP should then pay. Their denial in my opinion isnot valid because this is precisely what I tell my client’s providers todo if my client wants to see an “out of network doctor” or a doctorthat is not part of the MCO panel or Care Oregon list. Yes, I wouldpursue a PIP lawsuit to recover. Great position for a PIP lawsuit. Alternatively, you can get paid from them too once the case settles which maybe faster than a PIP lawsuit. Because the PIP lawsuit would be filed onceclient has completed treatment. Protect yourself by obtaining a letter ofprotection from your patient’s attorney and from her. Regards, A. BobadillaAguilar & Bobadilla, PC4915 SW Griffith Drive, Suite 220Beaverton, OR 97005Office: 503.372.5327Fax: 503.715.0465melissaanbattorneys P Save a tree, please don't print this e-mail unless necessary***** PLEASE NOTE ***** This E-Mail/telefax message and any documents accompanying thistransmission may contain privileged and/or confidential information and isintended solely for the addressee(s) named above. If you are not the intendedaddressee/recipient, you are hereby notified that any use of, disclosure,copying, distribution, or reliance on the contents of this E-Mail/telefaxinformation is strictly prohibited and may result in legal action against you.Please reply to the sender advising of the error in transmission andimmediately delete/destroy the message and any accompanying documents. Thankyou. If you are not the intended recipient for this email/telefax pleaseinform the sender and permanently delete this email.***** From: [mailto: ] On Behalf Of CluenSent: Monday, July 12, 2010 4:37 PM Subject: PIP question Hi all! I have a pedestrian that was struck by a car. She has CareOregon and the driver's auto insurance as coverage. We've submitted thebills to Care Oregon (we are not providers) and received denials from thembecause the treatment was not pre-authorized. We sent the denials to thePIP carrier and they are refusing to pay since we did not pre-authorize thetreatment with Care Oregon. We did not know of the pre-authorizationsince we are not providers for care Oregon. Can the PIP carrier refuse topay? Can I put it into a PIP suit to recover payment? Thanks for all your help, Cluen, DC