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Health providers up against Allstate on PIP fee schedule reimbursement issue

Auto insurance is a critical resource to have after an auto accident, as anybody who has been in a serious crash understands. Florida, unlike some other states, has a no-fault insurance system in which motorists are required to carry minimum levels of personal injury protection (PIP) to cover medical costs when an accident occurs.

Among consumers, it is well known that disputes can arise with insurance companies when it comes to the handling of insurance claims, even in personal injury protection systems. One aspect of the personal injury protection system that motorists may not be aware of, though, is that health care providers contract with insurance companies for the treatment of auto accident victims, and that disputes can arise in this area as well. 

For example, Allstate is currently embroiled in a dispute with numerous health care providers regarding the fees that are supposed to be paid to health care providers who treat auto accident victims under Florida’s personal injury protection system. Under Florida’s PIP statute, insurance companies are supposed to pay 80 percent of the reasonable expenses associated with medically necessary services, but insurance companies can elect to limit reimbursements by using Medicare fee schedules, provided they give adequate notice.

At issue in the case is whether Allstate satisfied the notice requirement. The appeal involves 32 consolidated cases in which providers argue that the Allstate policies did not clearly and unambiguously provide notice of the Medicare fee schedule election. The Florida Supreme Court recently agreed to hear the case because of disagreements among the lower courts on the matter.

Disputes with insurance companies can be brutal, both for individual consumers and other parties with whom they contract. Insurance companies naturally want to conserve their resources and can be expected to engage in every strategy possible to avoid unnecessary costs. When an insurance company fails to live up to its legal obligations, though, it is important to work with an experienced attorney to hold it accountable and ensure that one’s rights are protected.

Sources:

Orlando Sentinel, “Florida Supreme Court to hear PIP cases' appeal,” Jan. 20, 2016.

FL PIP Guide Blog, “1st DCA Upholds Allstate Use of Medical Fee Schedules,” Fernando L. Roig, Mar. 20, 2015.

CBS Local, “Allstate wants high court to enter ‘PIP’ dispute,” Dec. 22, 2016.

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