PIP question

[Guest guest]

Hi all! I have a pedestrian that was struck by a car. She has Care Oregon and the driver's auto insurance as coverage. We've submitted the bills to Care Oregon (we are not providers) and received denials from them because the treatment was not pre-authorized. We sent the denials to the PIP carrier and they are refusing to pay since we did not pre-authorize the treatment with Care Oregon. We did not know of the pre-authorization since we are not providers for care Oregon. Can the PIP carrier refuse to pay? Can I put it into a PIP suit to recover payment? Thanks for all your help, Cluen, DC

[Guest guest]

If

the “driver” you refer to in your email is the at fault party (the driver

that caused the collision) then you did the correct thing by billing Care

Oregon first getting a denial then submitting the bills to the at fault party’s

PIP insurance. PIP should then pay. Their denial in my opinion is

not valid because this is precisely what I tell my client’s providers to

do if my client wants to see an “out of network doctor” or a doctor

that is not part of the MCO panel or Care Oregon list. Yes, I would

pursue a PIP lawsuit to recover. Great position for a PIP lawsuit.

Alternatively, you can get paid from them too once the case settles which may

be faster than a PIP lawsuit. Because the PIP lawsuit would be filed once

client has completed treatment. Protect yourself by obtaining a letter of

protection from your patient’s attorney and from her.

Regards,

A. Bobadilla

Aguilar & Bobadilla, PC

4915 SW Griffith Drive, Suite 220

Beaverton, OR 97005

Office: 503.372.5327

Fax: 503.715.0465

melissa@...

P Save a tree, please don't print this e-mail unless necessary

***** PLEASE NOTE *****

This E-Mail/telefax message and any documents accompanying this

transmission may contain privileged and/or confidential information and is

intended solely for the addressee(s) named above. If you are not the intended

addressee/recipient, you are hereby notified that any use of, disclosure,

copying, distribution, or reliance on the contents of this E-Mail/telefax

information is strictly prohibited and may result in legal action against you.

Please reply to the sender advising of the error in transmission and

immediately delete/destroy the message and any accompanying documents. Thank

you. If you are not the intended recipient for this email/telefax please

inform the sender and permanently delete this email.*****

From:

[mailto: ] On Behalf Of

Cluen

Sent: Monday, July 12, 2010 4:37 PM

Subject: PIP question

Hi all! I have a pedestrian that was struck by a car. She has Care

Oregon and the driver's auto insurance as coverage. We've submitted the

bills to Care Oregon (we are not providers) and received denials from them

because the treatment was not pre-authorized. We sent the denials to the

PIP carrier and they are refusing to pay since we did not pre-authorize the

treatment with Care Oregon. We did not know of the pre-authorization

since we are not providers for care Oregon. Can the PIP carrier refuse to

pay? Can I put it into a PIP suit to recover payment?

Thanks for all your help,

Cluen, DC