I got treated one week after a rear end collision which I am not the at fault party. First, can the doctor's office charge me the 20 percent that I am responsible for along with any extra monies that the no fault policy would not pay for? For example and to keep it simple: If a particular service cost $100.00, then no fault would pay $80.00 and I would pay $20.00. If No Fault decides to only pay $40.00 of that $80.00, would I be responsible for the remaining $40.00 plus the $20.00? Can I collect the difference from the at fault driver's insurance. Also, the doctors office told me that the services that they have provided are completely covered under my insurance plan, however, massage therapy is not as I just learned from my carrier. Why do they do this?
80% of the allowed PIP fee, and you pay 20% of that allowed PIP fee.
The 20% you pay would be collectible from the at-fault driver's insurance (depending on the liability facts of your case, of course).
Candidly, I would be concerned if you are racking up big bills for massage therapy and similar/related treatment. Big bills for massages do not mean you'll get a big offer from the other side. Soft tissue injuries treated with massage don't have much compensatory value, regardless of how big the bills might become.
If you are not careful, your massage bills might eat up anything you get offered to resolve your claim.
Consult a local injury attorney (if you don't already have one).
Generally, yes your PIP will pay 80% of allowed treatment. Under the new rules, massage therapists are not authorized providers. If your doctor bills the therapy he is giving you, even though it may partially involve massage modalities, I have seen this covered by PIP. It depends on what type of doctor you are seeing and his experience in dealing with PIP. As you were injured and the accident wasn't your fault, your injury attorney should be overseeing this and would also be able to explain this. I assume you have representation? You will have a difficult time collecting from the other driver's insurance on your own.
You only owe the remaining 20%.
Unless you have entered into a letter of protection with the doctor, then you owe him for that remaining 20% when the bill comes due unless you two have made other arrangements.
A bill is a bill, and your doctor has no way of knowing of the at-fault party has liability coverage or if the at-fault party's insurance company will pay. Sometimes, doctors will reduce the remaining 20% if your attorney negotiates well.
I have handled personal injury claims as an adjuster, and now, as an attorney, and I find that PIP confuses more people than any other issue.
Your question has multiple parts. The long and short of is that your Personal Injury Protection will pay bills up to $10,000.00 in medical expenses that your insurance carrier considers reasonable and necessary. You may have a deductible which reduces the $10,000.00. You may have Medical Payment coverage as well although most Florida policies do not include Med Pay. Additionally you may also have Underinsured Motorist coverage which may be applicable. Assuming the other person has insurance the party that injured you will be entitled to what is called a set off in the amount that your Personal Injury Protection paid. Meaning if they evaluate the claim at $20,000.00 they would reduce that amount by whatever your company paid. You should probably hire an attorney. Good Luck.
The answer to a big part of your question depends on the specific language of your insurance policy. The explanation of benefits should tell you why the insurance company is paying the way it is paying. Why did the insurance company not pay 80% of the charge? Did they reduce the bill based on a fee schedule? Did a deductible apply? Your best bet would be to consult with an attorney that handles personal injury protection lawsuits.
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