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What Does a Medical Provider Do When They Bill the Wrong Insurer?

What Does a Medical Provider Do When They Bill the Wrong Insurer? FL

One of the most common issues that medical providers run into is billing the wrong PIP insurer.  Many times, the patient will give the medical provider the wrong information on who their proper PIP insurer is.  This can have a profound effect on the bottom line of a small business.  If a medical provider bills the wrong insurer, there could be a complete denial of the claim.  Coverage issues are often black and white and can result in a complete denial of payment for weeks or months or treatment to a patient.  What happens when a medical provider bills an incorrect insurer, and later finds out the correct insurer?

Pursuant to Florida Statute 627.736(5)(c), “the statement of charges must be furnished to the insurer by the provider and may not include, and the insurer is not required to pay, charges for treatment or services rendered more than 35 days before the postmark date or electronic transmission date of the statement.”  Many times, the correct insurer is discovered more than 35 days after the treatment.  In that case, Florida Statute 627.736(5)(c)1 reads that “If the insured fails to furnish the provider with the correct name and address of the insured’s personal injury protection insurer, the provider has 35 days from the date the provider obtains the correct information to furnish the insurer with a statement of the charges.  The insurer is not required to pay for such charges unless the provider includes with the statement documentary evidence that was provided by the insured during the 35-day period demonstrating that the provider reasonably relied on erroneous information from the insured and either:

a. A denial letter from the incorrect insurer; or

b. Proof of mailing, which may include an affidavit under penalty of perjury, reflecting timely mailing to the incorrect address or insurer.”

As a result, the PIP statute allows the medical provider to bill charges to the correct insurer, even if it is outside of the initial 35-day period.  However, the medical provider must submit the bills to the correct insurer within 35 days of learning about the correct insurer, as long as they provide a denial letter from the correct insurer or an affidavit.  One of the services our firm provides to our clients is the drafting of these affidavits so that our client medical providers can get paid for the services rendered to their patients.  If you need an affidavit or help securing your PIP benefits, please do not hesitate to contact the Law Office of Lyle B. Masnikoff, P.A. at 561-598-7120.  Attorney Kevin Davies or Lyle Masnikoff will be happy to speak to you.

Over the past 10 years, the Law Offices of Lyle B. Masnikoff and Associates, P.A. has handled hundreds if not thousands of personal injury protection cases.If you have any questions about your personal injury protection case, please do not hesitate to contact us at 561-598-7120.

Personal Injury Protection Lawyer, West Palm Beach 

If you have questions about whether you can qualify for Security Disability Benefits or SSI, please do not hesitate to contact us at 561-598-7120.

Lyle Masnikoff & Associates, P.A.
1645 Palm Beach Lakes Blvd #550
West Palm Beach, FL 33401


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