A closer look into No-Fault, PIP and other important information
After searching various sources, we have found many people have questions when it comes to Medical Revenue Recovery, PIP, Workers Compensation, and Commercial Insurance.. Do you have questions pertaining to reimbursement? Do you know what to do if problems arise? With articles written by Callagy Law’s law team, this blog will focus on many common questions and concerns surrounding legal matters which can arise in the field of healthcare law.
Car accidents can be overwhelming, one minute you’re on your way to work, the next minute you’re sorting through medical bills and trying to determine if you have enough insurance coverage for accident related injuries. This is why an understanding of medical benefit coverage under your New Jersey automobile insurance policy is crucial.
In the New Jersey No- Fault System, a patient’s medical claims are paid under the Patient’s First Party Policy, even if the motor vehicle collision is the patient’s own fault. All personal car insurance policies in New Jersey must contain No Fault coverage. These No- Fault Benefits are known as Personal Injury Protection or “PIP.”
The benefit of the PIP System is that the determination of liability has no bearing on the Insurance Company’s responsibility to pay the insured’s medical bills, which allows for a medical provider to receive payment prior to the underlying issue of liability being resolved. Basically, this system allows a patient to receive their necessary treatment, and a doctor to receive prompt payment.
As payment is made under the patient’s own policy, it is important that owners of private vehicles make prudent decisions when choosing their PIP Policy Coverage Limits.
The State of New Jersey allows for the election of PIP coverage in lesser amounts ($150,000.00, $75,000.00, $50,000.00 or $ 15,000.00).
Ideally, every patient would be insured under a $250,000.00 PIP Policy, meaning a patient’s medical bills would be covered up to a total of $250,000.00.
However, a patient may be enticed to select a Basic Policy, which provides only limited coverage in the amount of $15,000.00. While a limited policy may seem great at first glance, as the premiums are lower, if a patient is in a significant collision, their policy may be quickly exhausted leaving the patient on the hook for thousands in medical bills.
For example, subsequent to a motor vehicle collision, a patient may be transported to a Hospital for Emergency Room Treatment; thereafter, an extended period of chiropractic care for neck/back injuries will be recommended; and the patient may be further referred for MRIs, EMGs, pain management care and even surgery, which will easily exceed $15,000.00.
Additionally, in New Jersey, an automobile owner may choose a Health Insurance Primary Policy wherein a motor owner designates his/her health insurance policy is primary for a reduced premium.
When a patient is insured under a Health Insurance Primary policy it very important that the Medical Provider bill the Patient’s Health Insurance Provider first. After a denial is received from the Health Insurance Carrier, the Medical Provider must submit the Health Insurance Denial as well as the Providers bill to the patient’s PIP Carrier for payment.
In sum, it is important for a patient to research their options and be aware of the consequence that may follow when selecting PIP coverage for a reduced amount at a lower premium.
The Team at Callagy Law hopes the information in this article was helpful in either your personal or professional life. The legal world pertains to all walks of life and more specifically, various types of healthcare providers. Callagy Law, is a multidisciplinary law firm, headquartered in Paramus, NJ owned and operated by Sean Callagy. We are committed to providing legal representation and advice to our clients at additional law offices located across the United States. Please note that the information posted here should not be used as a legal argument of defense. If you find yourself needing legal advice pertaining to your unique situation, you can contact us at here. Feel free to search us on Facebook, Twitter or LinkedIn! Additionally you can subscribe to our daily videos on YouTube.
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