It has come to our attention that some doctors’ offices are wary of treating persons involved in motor vehicle accidents. Perhaps there are concerns about long delays in getting the medical bills paid or not being paid at all. This article looks at legal provisions for paying the medical bills of persons injured in motor vehicle accidents. We hope this will alleviate some apprehensions.
PIP PAYS MOST BILLS PROMPTIY AND IN FULL
If either the automobile your patient was in when he or she was injured or your patient personally was covered by an Oregon private auto insurance policy, then your reasonable and necessary medical treatment resulting from that accident will be covered up to $15,000 or one year after the accident, which ever comes first. This is “Personal Injury Protection” (“PIP”). PIP is legally required on every auto policy written in Oregon. The coverage may be more than $15,000, but $15,000 is the minimum. (For more detail on exactly how PIP works, please see my articles in MEDICAL-LEGAL JOURNAL, Volumes I and 2.)
PIP is “no fault.” It covers all riders in the insured vehicle. It also extends to members of the insured’s family in the same household, including unrelated children being reared by the insured, even if they are injured in another vehicle. It also covers pedestrians struck by the insured vehicle.
So, PIP may cover your medical bills for treating a minor living at home, even if he/she was a passenger in an uninsured vehicle. Also, pedestrians struck by an insured vehicle get their medical bills paid immediately, without having to prove liability.
PIP medical bills are paid immediately. The insurer is required by law to pay all PIP benefits promptly after proof of loss (e.g., your bill) has been submitted.
What if your bill is not paid promptly by the PIP insurer? Delays may occur when the insurer is checking into whether the medical services are reasonable, necessary and/or related to the accident.
The insurer must give you notice within sixty days after receiving your bill, if they intend to deny your claim. You must provide written answers within 10 days to any questions the insurer asks you about the claim within fifty days of receiving your bill. Your delay in responding will extend the amount of time the insurer has to deny. Your services are legally presumed to be reasonable and necessary, if they are not denied within this time frame.
Disputes concerning denials are decided by arbitration or trial. If your patient is represented by counsel, your patient’s attorney is in an ideal position to obtain payment of any of your bills which were improperly denied. You should have your staff call them for help.
When billing for treatment of auto accident injuries, then, the bill should be sent first to the PIP carrier, which is usually the company insuring the vehicle in which the patient was injured.
Looking first to the PIP carrier has an advantage over billing your patient’s HMO. PIP carriers usually pay the billed amount in full, while HMOs pay a reduced amount which doctors are usually required to accept as payment in full. Thus, PIP cases are potentially more profitable to your office than most other insurance cases.
ASSIGNMENTS PROTECT DOCTORS
Some medical providers are apprehensive about treating an injured patient if an attorney is involved, which means the claim is in dispute. However, if there is no attorney involved there is not much you can do to insure that your bills are paid other than hope the PIP carrier acts responsibly!
On the other hand, if your patient has an attorney, you can get an assignment from the attorney. With an assignment, if any money at all comes to your patient out of the case, you will be paid from this money.
Doctors’ offices do not qualify for the legally required “statutory” liens which benefit hospitals. However, an assignment gives the doctor not only a legal right to part of the proceeds of the settlement or money judgment in a disputed claim, but also a legal right to look to the patient’s attorney if the injury-related medical bills are not paid through oversight or intentional disregard of the assignment.
Medical costs are an essential element of PIP claims and all disputed personal injury liability claims. The advocacy of your client’s counsel in these matters ultimately benefits you.
This article was prepared by Dennis H. Black.