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Labor & Employment Law

: The Law Planet Blog

Exception to Personal Injury Protection (PIP) Billing Time for Medical Providers

By Dobin & Jenks

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One question I often hear from medical providers who accept assignments of benefits from an insured is ?What do I do when my patient provided me with incorrect insurance information regarding his Personal Injury Protection (PIP) coverage, and now the insurance company is refusing to issue any payment for services I rendered because I didn?t submit the bills within the time frame set forth in the Florida No-Fault Statute??

One important change brought about by amendments to Florida?s No-Fault Statute was an exception to the billing time limits contained in F.S. 627.736(5) allowing providers who are furnished incorrect insurance information by a patient to re-bill the correct insurer upon discovery of the proper insurance information. Prior to the amendment, a provider who was furnished with incorrect insurance information from his patient was precluded from being reimbursed for services rendered by the PIP carrier if the bill was not submitted within the 30 day time frame. There was no exception to this time frame regardless of whether there were ?reasonable? delays caused by the patient or any third party.

The No-Fault Statute currently allows providers who have suffered from this scenario a second chance. All that is required is proof demonstrating that the provider reasonably relied on erroneous information from the insured and either: (1) a denial letter from the incorrect insurer; or (2) proof of mailing reflecting timely mailing to the incorrect address or insurer.

Don?t let the insurance carriers rob you from money rightfully owed to you due to delays caused by incorrect insurance information or misrepresentation by your patient!

Full post as published by The Law Planet Blog on February 08, 2012 (boomark / email).