A class action has been proposed against both State Farm and Garrison. Your medical practice may have claims for which action is required or your ability to recover funds could be lost. At this time, we are awaiting the Judges who are overseeing the Class Action lawsuits to accept the two above-mentioned suits. It’s very likely that both suits will be accepted as class actions.
Subject Matter of the Class Action/ Settlement:
Any claim in which State Farm or Garrison reduced your reimbursement for Personal Injury Protection Benefits because a Physicians’ Assistant or Nurse Practitioner rendered the underlying services. Underpaid consists of a payment less than 80% of 200% of the Medicare Fee Schedule.
State Farm/Garrison and most PIP insurers are reimbursing the NP/PA at 85% of 80% of 200%. This results in a reimbursement that is approximately 15% less than what the PIP statute mandates for payment.
Why is this so important:
Your practice treats patients in connection with motor vehicle accidents on a daily basis. The insurance carriers are in the business of deception, delay and denial. If your office allows the insurance company to reduce payment, they’ll continue to do so across the board.
Can they reduce my PA/NP services?
NO! In most cases, the PIP insurer reduces reimbursement for PA/NP services below the 2007 participating physicians fee schedule of Medicare Part B.
Did you know that 2007 is the floor? Why is the floor relevant?
An insurer cannot reimburse ANY MEDICAL PROVIDER BILLING lawful charges for PIP an amount less than the 2007 Medicare Part B fee schedule. If the insurer pays you an amount less than the 2007 Medicare Part B fee schedule call us immediately whether the service was rendered by a Physician’s Assistant or Nurse Practitioner.
Check your Explanations of Benefits (“EOB”):
The reduction of a service performed by a Nurse Practitioner or Physician’s Assistant will appear on the Insurer’s EOB as follows:
State Farm Explanation:
“FL Our payment for this service is based upon a reasonable amount pursuant to both the terms and conditions of the policy of insurance under which the subject claim is being made as well as the Florida No-Fault Statute, which permits when determining a reasonable charge for a service, and insurer to consider usual and customary charges and payments accepted by the provider, reimbursement levels in the community and various federal and state fee schedules applicable to automobile and other insurance coverages, and other information relevant tot he reasonableness of the reimbursement for the service. The payment for this Nurse/Practitioner/Physician Assistant service has been evaluated using Medicare Claims Processing Manual guidelines and the applicable Medicare Part B fee schedule”
The EOB will indicate:
Nurse Practitioner/Physician’s Assistant: Per F.S.A. 627.736(5)(a)(2)(f) services, supplies and care are reimbursed at 200% of Medicare Part B fee schedule.”
- What to do if you know you have outstanding underpaid Physician’s Assistant or Nurse Practitioner Reduction:
Please “OPT-OUT” of the Class Action settlement once you receive the Notification Packet.
We have not received any at this point in time. However, we want to notify you of the impending Class Action. This is a hot topic in the “PIP WORLD.” As South Florida’s preferred PIP attorneys, LaBovick Law Group strives to keep our clients apprised of any and all issues affecting their medical practices and to . As always, if your office has any underpaid Nurse Practitioner or Physician’s Assistant bills, please send those to us immediately.