Florida’s Personal Injury Protection (PIP) law was enacted to provide “swift and virtually automatic payment” of benefits. The idea behind the law was to ensure that individuals injured in motor vehicle accidents could resume their lives without any financial interruption. However, insurance companies make it very difficult for medical providers to receive payment for their essential treatment. It is as difficult for injured patients to receive the medical treatment they ultimately require.
Insurance companies have adopted “policies” or “tactics” to harass medical providers and claimants. Some of these tactics include Examinations under oath of the patient and depositions of the medical provider or corporate representative of the facility. These examinations may last hours at a time. Insurers commonly request medical providers their billing policies as well as the type of software used in the preparation of the bills. But that’s not it, unfortunately. Insurance companies also want to know how the total amount charged was formulated for each CPT code and what amounts providers accept from private insurers (HMO, PPO, health insurance) and from other PIP insurers. Most of the requested information concerning other insurance carriers should be protected by trade secret privilege as the PIP insurer is NOT a party to these contracts. A party that did not bargain for terms and is independent of the agreement as a whole should NOT be made privy to that private contract.
The discovery of these contractual agreements would also result in unfair prejudice to the provider, in that; private health companies provide a large volume of patients to the medical provider in exchange for a reduced reimbursement. In the world of PIP, the PIP insurance companies do not provide any patients at all, and thus providers rightfully expect the maximum allowed under the law. The question for you the medical provider is: what can I do to fight back?
Geozip Reports: Putting Up A Fight
Insurance companies are multibillion-dollar corporations containing hundreds of thousands of employees throughout the world. These companies produce thousands upon thousands of reports on a daily basis. PIP insurers create different documents indicating how much they reimburse medical providers for specific CPT codes over the span of weeks, months, or years. This is where you, the medical provider, use the insurance companies’ tactics against them and strike back by demanding a copy of the “Geozip report.”
What is a GEOZIP?
The “Geozip” report refers to the insurance company’s archive of providers who bill the insurance companies. This report contains: 1. the amount other medical providers have billed for the same CPT codes that YOU (THE Medical Provider) have billed, and 2.more importantly, the amount the various insurance companies reimbursed the medical providers.
Most judges require the insurance companies to compile this report whether or not they have one saved in their databases. This report could take weeks to compile! This report contains sensitive information. If the insurance company reimbursed you $5 less than the next provider for the same CPT code, the question becomes why? This is absolutely a question your PIP litigation attorney will ask the corporate representative of the insurance company at his/her deposition. Insurance companies will not voluntarily give up this information nor do they want it public record. Why? Because it gives an example of possible unfair bias toward one provider (paying an amount greater than others) and it specifies how much the insurance company truly reimburses for each CPT code at issue.
That is why it is essential to request this information:
- to use it for our case in chief
- to use it to show the jury that the insurer incorrectly reimbursed you, as the medical provider,
- to give the insurance company a taste of their own medicine.
These tactics if used correctly can lead to more money and PIP benefits for you, the medical provider. Some insurance companies do not wish to share this sensitive information while others will require an order from a judge to propound this information. Regardless, this information should lead to more money for the essential services you have provided your patients.
It is important to contact a PIP Litigation attorney who will formulate a strategy to recoup the money/PIP benefits you are to which you are entitled. GEOZIP reports help gather information insurance companies do not want the public to discover. Moreover, these reports will help your practice by:
- Keeping the insurance company busy compiling information
- Receiving key information indicating how much they reimbursed similarly situated providers
- Use insurance companies harassing tactics against them. GEOZIP reports are key in most PIP litigation suits.
We at LaBovick Law Group will help to ensure payment of PIP Benefits in a timely manner!