Medical Providers – PIP SUITS

Medical Providers – PIP SUITS

Are you a medical provider that treats patients injured in car accidents? If so, many of your bills are getting denied or reduced by insurance carriers. At Bottari & Doyle, our attorneys work hard to get you paid. There is no upfront cost to you. We file PIP suits on behalf of medical providers throughout the state of Florida. We make this process as easy as possible for you, and we are able to audit your files to see which claims have been denied by the insurance carriers. Our goal is to get you paid every penny. Please call us at (561)588-2781 for a free consultation. Even though our physical address is in South Florida, we are able to travel to you for a consultation. Please read below for more information about the PIP demand and PIP suit process.

PIP Demands

After your bill gets denied, reduced or remains unpaid, we send a demand letter to the patient’s insurance carrier. The demand letter gives the insurance carrier one last opportunity to pay your bill. If the carrier does not pay your bill within 30 days, then we will file a lawsuit against the insurance company. This is at no cost to you. We are able to get the majority of your bills paid through this demand process.

PIP Suits

If the insurance carrier chooses to not pay your bill, then we will file a lawsuit against the carrier. Most of the time, we are able to resolve these claims within a few months.

Common Denials

Insurance carriers typically deny bills for the following reasons:

  1. The patient didn’t receive medical treatment within 14 days after the accident. Florida’s 14 day rule requires the patient to treat within 14 days after the accident to be entitled to benefits. Many times, insurance carriers are unaware that the patient received EMS treatment, or that the patient treated at the hospital.
  2. Material Misrepresentation: Carries frequently denies claims alleging thatthe named insured failed to disclose all of their household members when submitting their policy application. If disclosed, the premium would have been higher. There are many issues with material misrepresentations. Please call us for more information.
  3. IME Cutoff: This occurs when the insurance company requests an “independent” medical examination for the patient. The insurancecompany’s doctor then evaluates the patient and opines that the patient doesn’t require any further medical treatment. Any bills submitted after the IME doctor’s determination are denied. As you are well aware, insurance companies frequently use the IME defense to deny bills. We have been very successful in recovering benefits owed to medical providers after the IME cutoff.
  4. No Emergency Medical Condition – Benefits Capped at $2500.00. Without an EMC, insurance carriers routinely deny bills after $2500 has been disbursed to the patient’s medical providers. It is important for the patient to have a documented EMC.
  5. Missed CPT codes or downcoding: Adjusters are human beings. They make mistakes by missing CPT codes and incorrectly downcoding bills (i.e. Reimbursing you for 99203 when you bill 99204). We find these mistakes and put the insurance company on notice through the demand and pip suit process.

Contact Us
These are just some of the issues that frequently arise in PIP cases. Please call us at (561)588-2781 to speak to an attorney about your PIP claims. There is no cost you, and we are able to travel to your location.