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PIP Deductible Ruling

December 11, 2017 1:29 pm | Categorised in:

Geico Billed Amount Class Action and What it Means to You

We here at LaBovick Law Group would like to report another victory for Medical Providers in the great State of Florida!  The Fifth District Court of Appeals recently ruled on a crucial issue impacting all Medical Providers billing Florida Personal Injury Protection policies and their respective insurers.  The issue concerns the application of the Personal Injury Protection Deductible. The Court ruled in favor of the Plaintiff’s interpretation that the deductible should be applied to the total amount billed by the Medical Provider.  This landmark decision is a call for all Medical Providers to send your files to LaBovick LaBovick and Diaz Law Group’s PIP team for demand and eventual filing to ensure maximum reimbursement.  That’s right, we ensure every penny is paid!

OUR ADVICE:

SEND US ANY FILE in which the patient’s deductible was applied to the bill.  The PIP insurer most likely APPLIED THE DEDUCTIBLE INCORRECTLY!  If you would like us to submit your Deductible PIP Suits/Files/Bills, please contact Liliana Davidson, Business Development and Client Relations Manager at (561) 625-8323.  We are here to help.

The 4th District Court of Appeals is hearing a case involving the identical deductible issue in January of 2018. If the 4th DCA agrees with the 5th DCA the issue is resolved in your favor. If the 4th disagrees with the 5th, the Supreme Court of Florida will most likely have the last say in this matter.

Regardless, prepare in advance and get ahead of the pack!

WHAT IS AT ISSUE?

PIP insurers have incorrectly paid your bills since 2013.  HOW?  They have applied the deductible to the percentage limitations prior to calculating the amount due and owing. For example:

The total bill is $1,000.00 (Medicare Fee Schedule is $750), and the deductible is $500. The insurance carrier is applying the deductible to the MFS allowable amount as shown in this equation, $750-500=$250 as the amount due and owing.  However, what they should do is apply the deduction to the billed amount like this: $1000-$500=$500.00 and pay $400-$250=$150.00. With the deductible correctly applied you would be owed $150.00.

WHAT PROVIDERS SHOULD DO NOW AND WHEN IS A RULING EXPECTED?

Send us your deductible files. We will determine what bills were correctly v. incorrectly paid.  We anticipate the 4th DCA to rule on this matter by Summer of 2018 therefor by getting out in front of the issue you ensure payments will be forthcoming as soon as the ruling is made. Do not allow the insurer to get away with underpaying your necessary medical services.

LaBovick Law Group will ensure maximum recovery when the 4th DCA rules.  Do not let the insurers keep your money, $150.00 a pop at 1000 files starts to add up very quickly! The sooner we file the better situated your claims. The insurers have refused to pay until we get an ultimate decision.  Right now, the law of the land supports our deductible calculations.