by Henry David, on Mar 16, 2020 11:17:09 AM
Florida PIP law both an acronym and a legal term. There is no doubt of the vast amount of technical concepts that revolve around the word. Additionally, in a constant changing legal environment Florida PIP law has experienced many changes in recent years.
Our goal is to dissect the term, explain the usefulness for legal purposes and how your practice by implementing best business practices can get compensated correctly for your patients benefit claims.
We strive to become a resource at the disposal of the medical practice, so they are better able to cope with Floridas ever changing no-fault laws.
We have assisted many medical providers with PIP claims, recovering additional benefits and audit to pursue overdue benefits under the No-Fault State law. I aim to provide a clearer insight for the medical practice so they know what to expect, how to pivot and in determining if the PIP demand is worth sending.
Florida PIP law provides insurance providers 30 days to pay the bill or any outstanding balance owed to the medical provider after a PIP claim has been submitted. When receiving the EOB (Explanation of Benefits form) sent by the health insurance company, if it reflects a reduced or denied amount or you simply came across an overdue bill.
If you incur any of these possible scenarios then you may have a PIP claim!
Assuming a PIP claim scenario is existent, where do we start ?
The cornerstone that can best aid anyone who believes that has a potential PIP claim is to become acquainted with Florida Statue 627.736. This clearly outlines the insurance responsibilities, such as the medical benefits they need to provide within a certain time frame, what rates need to be paid out when the bill is overdue, what instance can the claim be rejected and how to take action. This statue serves as a compass to anyone inquiring where to start. The first step in the process is the pre-suit stage, this were a letter is sent to the insurance company outlining the dispute and creating awareness that they have a time period of 30 days to pay the claim. If the insurance company fails to comply with the claim, then a lawsuit is filed and the insurance company faces the chance to incur attorneys fees along with the remaining cost associated with the process( interest & postage)
If insurance company fails to make payment after receiving pre-suit demand letter...
The underlying reasons why an insurance provider chooses to neglect payment for medical treatments that were already performed by the medical provider or perhaps claim they never received the bill and more. The bottomline is that all these this situations end up leaving the practice with accrued debt, thus the insurance provider at times pay medical providers less then they should. Therefore, if we are certain of a discrepancy in the pay when receiving the Explanation of Benefits form or just simply their unwillingness to comply after having received the Pre-Suit Demand Letter. Then we can commence with filing a litigation, were a Clerk will setup a date for a Pre -Trial conference. We understand the fast paced environment of a medical providers work-environment, therefore our team is always seeking to solve all litigation's in a swift manner.
Fees , PIP benefits , Rates and Settlements
Our firm only collects the attorneys fees, items such as the PIP benefits plus accrued interest are given to the medical provider. We never collect any portion of the client’s recovery.
In instances that settle per a lawsuit , our fees will be paid directly to the law firm by the insurance company. Most cases are all squared away and settled on demand, hence the insurance provider is trying to avoid paying attorneys fees.
What to keep a lookout for ?
Anything that is indicative of a charge that will be unpaid on behalf of the insurance company should be marked for a 2nd verification. The team/staff should review meticulously the explanation code on the EOB form which explains when a charge is denied, if you are unsure about this being the outcome, reach out to our team.
These are some of the best practices that should be implemented in the day-to-day to ensure that both the practice and the patient are compensated fairly.
