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Can a medical provider pursue arbitration for outstanding medical bills after a PIP settlement has been reached?

Bloomfield, NJ |

The PIP part of this client's case has been settled and I received a check from the atty. stating that this is the final and full payment for outstanding medical bills. Can I still arbitrate and pursue unpaid bills because the pt's copay & deductible were the the only thing covered in that payment.

Attorney Answers 5


I'm not sure I understand the question as posed. Typically, there will be an arbitration of the outstanding medical bills. If the provider loses an arbitration for reason of lack of medical necessity, as an example, the provider is prohibited from pursuing the patient personally for the outstanding bills. See NJAC 11:3-29.5. However, the PIP claimant will be responsible for his co-pay and deductible.

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Call your lawyer for an update

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You should consult with your attorney - you have one and they should be able to help you.

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It sounds like you are the medical provider, and if the PIP case was pursued by the injured person (patient's) attorney for your (the medical provider) unpaid medical bills, then it doesn't make much sense how that case could be settled without having your input.

But if the PIP case just settled, then it is possible that the patient's attorney will send you a check out of the injured person's 3rd party settlement for the co-pay and deductible (which are not recoverable in a PIP suit), and you have a separate check coming directly from the PIP carrier. That does happen occasionally.

You should contact the attorney who sent you the check to find out the details.

Going forward, if you are a medical provider, you can always file your own PIP suit.

Each case is fact senstive, so all answers should be viewed as general advice only, and should never replace a thorough and in depth consultation with an experienced attorney. Further, an answer should not be seen as establishing an attorney-client relationship.

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Thank you for your inquiry.

Short answer is yes, based on the preliminary information you have provided.

The receipt of PIP co-pay and deductible from (presumably) the personal injury settlement does not preclude you from pursuing outstanding dates of services at PIP Arbitration under an AOB from the patient.

Be sure you have pre-certified all treatment and have followed all proper levels of appeals, which are strictly enforced by DRPs at these hearings.

Good luck.

***DISCLAIMER: the providing of this information does not constitute legal advice and does not create any attorney-client relationship***

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