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Emergency Medical Providers Key to not being Underpaid

 

A Brief History of the Law

In 2008, Florida legislatures revised the PIP statute which created a mandatory reservation of $5,000 of the $10,000 PIP benefit for payment to a specific category of providers for within a specified period of time. Under Florida Statues, after being given notice that one of their insured has been in an accident that might be covered by PIP benefits, an Insurance Company must reserve the $5,000 portion for payment to physicians that are deemed to provide emergency services under the Statutes. This amount is reserved only for paying these physicians for 30 days after receiving the notice of the accident.

Reasons for the Law

The law reflects an effort by the Florida legislature to ensure that providers of certain emergency services are being properly compensated for their work. The law gives special recognition and protection to providers for being such a vital piece of the health care system. For a full description of what have been deemed “Emergency services and care”, See Florida Statutes 395.002(10).

Ways that Insurance Companies Underpay

Insurance companies commonly deny payment to medical providers by claiming that charges for treatment are too high. When this occurs, providers can respond by hiring PIP litigation attorneys who work to prove that the charges are reasonable by filing motions, taking depositions, hiring expert witnesses and other work. However, instead of denying charges completely, Insurance Companies routinely underpay providers without receiving any kind of penalty for it.

Insurance companies have been allowed to underpay because of their policies that that have used the law in their favor. As of 2012, Florida PIP law allows them to limit payment according to a schedule of charges. Emergency service providers are entitled to charges that are usual and customary in the community for those services or care. In emergency medical departments, providers are entitled to 80% of the usual and customary charges in the community. Insurance companies have under paid physicians that provide emergency services by paying them as if they were paying a hospital instead of properly paying them as a separate entity.

Emergency service providers have been collectively loosing out on hundreds of thousands of dollars over the years. If providers fail to understand how to address the problem of being under paid, insurance companies will move on and keep a portion of what the provider, as an independent contractor, is entitled to.

Protection from Underpayment

Many providers have avoided being under paid by hiring specialized attorneys that have experience litigating claims against insurance companies with the end goal of ensuring that providers receive what they are entitled to. Hiring the right attorney to review files and records can prevent insurance companies from moving on and filling to properly pay on claims. Failing to do so may allow insurance companies to profit by retaining a portion of providers charges that they are entitled to.