What Happens if you Billed The Wrong Insurer: A Guide to Making Sure the Insurance Company Pays You

June 26, 2015 in

The Florida PIP statute requires that all bills be sent to the insurer no more than 35 days past treatment. However, if you send a Notice of Initiation of Treatment within 21 days after the first examination of the patient, you’re entitled to bill up to 75 days after the date of treatment.

Situations arise when the patient supplies you with the wrong PIP insurer. A patient may be unsure who a family member purchased PIP insurance through. If you billed the wrong insurer because you received the wrong information from the patient you potentially can still get reimbursed. You may get reimbursed even if your bills are more than 35 days past treatment, or more than 75 days if you executed a Notice of Initiation of Treatment! There is a specific process that you should follow to ensure reimbursement from the carrier.

Steps to Remedy Bills to the Wrong PIP Insurer

  1. Get the Correct Insurance Information

If you received a letter or telephone call from the wrong insurer explaining the situation, simply document the conversation and write down the correct insurance information. If you’re unable to determine who the correct insurer is, give us a call immediately and our firm will conduct an investigation to find the correct information.

  1. Provide Proof that the patient gave you the wrong information

Simply include the intake sheet that the patient filled out indicating the wrong PIP insurer. Alternatively, you can fill out an affidavit attesting to the fact the patient supplied you with the wrong information. Be sure to include all documents when re-submitting the bills.

  1. Provide a copy of the Denial Letter from the wrong insurance company

If you have a denial letter provide it. If not, simply include a synopsis of the person you spoke to at the wrong insurance company and provide specific information such as the claim number and reason for the denial.

  1. Provide proof you billed the incorrect PIP insurer in a timely fashion

Simply mail the bills (HICFAS-CMS 1500 forms) that you initially sent to the wrong insurer within either 35 days or 75 days (if applicable) of the date of the treatment.

  1. Mail all of this information to the correct insurer within 35 days of learning about the correct insurer. 

This provides you an additional 35 days to mail your bills to the correct insurer. Make sure to include the bills sent to the wrong insurer, the denial letter from the wrong insurance company, or your sworn affidavit as mentioned above. Remember, if you do not have proof of mailing you can use an affidavit, under penalty of perjury, that you mailed the bills in a timely.

It is essential to contact an experienced PIP Litigation attorney. Our PIP team can assist you from pre-suit to post-litigation. We will provide the tools to ensure your bills are paid in a timely fashion. Do not write-off bills because the insurer denies incorrect billing. Simply follow the above steps and allow us to assist you throughout the process.