In Texas, does a person HAVE to use their PIP to be treated for injuries or can they use medical insurance first?

Asked over 1 year ago - Houston, TX

I work for a chiropractor and a patient does not want to use his PIP and wants to use his medical insurance. What is the law on this? Thank you.

Attorney answers (4)

  1. Paul Hilmon Cannon

    Contributor Level 13

    6

    Lawyers agree

    Answered . There is no "law" per se. It is often more advantageous for the client to use Heath insurance if he can because he can then use pip to cover deductibles, copays and list wages. However, many Heath ins policies will deny the claim if they find our it's an auto accident caused by someone else. If a patient requests this, you would be wide to get an agreement in writing that the patient understands the risks and that he is responsible if health ins doesn't pay. Maybe even have a backup agreement that says you can file on pip if health ins denies claim.

    All information provided here is for educational use only and does not constitute legal advice nor establish any... more
  2. Daragh John Carter

    Contributor Level 15

    3

    Lawyers agree

    Answered . I am not aware of any law that would make it mandatory that a patient use their PIP coverage before using health insurance to pay for chiropractic services. I imagine the chiropractor you work for would prefer to bill the patient's PIP because the reimbursement rate is much better than the reimbursement rate from a HMO. Perhaps if the doctor explains that to the patient, the patient may be more willing to use PIP. It is also 99% likely to be true that the patient's health insurer would be entitled to a subrogation lien against any recovery the patient gets from the car accident, but there would not be a lien if the patient uses their PIP to pay the doctor's bill. The patient may be worried that making a PIP claim will cause their auto insurance premiums to increase, which is probably not true.

    I've had conversations with clients about PIP and health insurance what feels like a million times: you're welcome to have the patient contact me with questions if you like.

  3. Christian K. Lassen II

    Pro

    Contributor Level 20

    2

    Lawyers agree

    Answered . Luckily, the above lawyer in your state has offered to discuss it with you. Good luck.

  4. Roberto Rafael Rios

    Contributor Level 1

    Answered . As the attorneys above stated, there is no law that he/she must use their PIP before their medical insurance. I advise our clients to use their medical insurance first and foremost as their carriers will have negotiated prices with providers, unlike their PIP claim. They can then use their PIP to repay the carrier at a reduced price, therefore benefiting from the fact that they carry medical coverage while paying down (or eliminating) their medical lien. Your employer chiropractor may not want this as he/she may be paid less than what PIP would pay, but it is in the best interest of the client/patient and the chiropractor, as he/she is guaranteed payment, including amounts above the PIP limits.

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