If you are in a Motor Vehicle Accident, your primary concern AND ours is that your healthcare needs are addressed. In the midst of this experience however, you will hear a lot of terminology that may or may not apply to your specific set of circumstances. And whether we are billing your car insurance, health insurance, or you have hired an attorney, it is your responsibility, as the patient, to make sure your medical bills are paid. Please don’t hesitate to inquire about your balance or any other questions you may have. We want you as the patient to be armed with information necessary to have the most peace of mind possible during your care and recovery. Here are some of those terms and what the mean for you.
P I P – Personal Injury Protection
PIP is coverage you pay for on your insurance policy to help pay for medical expenses due to an accident. The minimum policy is $10,000 and can be up to $50,000. This is the first route to go, even if you are not at fault. If not at fault, it will not make your policy increase. It can still be used if at fault in an accident. The only reason you would not have PIP is if you waived your PIP coverage. Your insurance must have a signed waiver on file.
PIP Coverage is paid once on a first come first serve basis with claims. It is important to get this information as soon as possible.
Once PIP is exhausted, you can elect to bill your health insurance, hire an attorney, or pay out of pocket.
PIP will also cover passengers in the vehicle that were involved in the accident. Each will have a separate benefit of at least $10,000.
PIP DOES NOT cover supplements/supplies etc. or treatments unrelated to your accident.
Car insurance companies will not release details about PIP funds. We, as providers, only find out when we receive a PIP exhaustion letter. Auto insurance companies will release this information to you as the patient.
Third Party Claim/Liability
In the event that someone else is at fault, it is easy to be under the impression that the third party insurance is paying for everything. However, payment is not made to us until all treatment is concluded and you reach a settlement agreement with the at-fault party. This option would require Total Care Clinic to hold the balance until settlement is reached, which can take months. Then you, as the patient, are responsible to make sure that your bills are paid with that settlement money. If you do not have PIP, you will have to choose health insurance, attorney lien, or pay out of pocket. The provider may choose to file a lien with the county clerk in the event they want to hold the balance. This protects financial interest for the provider and ensures they get paid from the settlement. They will also have to file a satisfaction of lien on the settlement as well.
If you are the at fault party, you can access your PIP policy for medical coverage, bill health insurance (payment for balances would be due upon receipt of statement as there is no settlement to hold balance for), or if you believe you are not at fault, you can retain an attorney to dispute the decision. If needed, we can set up a payment plan.
If you decide to bill your personal health insurance you will need to set up subrogation. This means you will need to contact your health insurance and let them know treatment is related to an auto accident. The insurance company will then send out a packet for you to fill out and send back as soon as possible. You will have to live within the limits of your insurance coverage as far as appointments and will owe either your copays/deductible/co-insurance amounts. Balances are expected to be paid once accrued after insurance processes unless you retain an attorney. If there is an attorney handling the case, we will hold any balances until settlement. Attorneys, from what we have seen, will still have you bill health insurance and include treatment costs into your settlement.
Regardless of whether you have PIP or not, you can always hire an attorney. In difficult cases, attorneys are the best to help facilitate the settlement process. If you are at fault, you can’t hire an attorney unless you are disputing, as there is no case to make.
On the initial date of service with Total Care Clinic, you will sign a financial lien. This renders you liable for medical treatment costs in the event that insurance does not pay. This helps you understand your financial obligation and responsibility.
Total Care Clinics is privileged to work with an exceptional network of Healthcare providers and legal professionals to insure your care and your peace of mind are both managed with excellence.