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Friday, April 11, 2014

What Does it Mean when they say PIP is Primary?

What Does it Mean when they say PIP is Primary?


Dr. Alan Himmel

PIP No-Fault Insurance is primary in Florida.  What this means is, if you are involved in a car accident in the State of Florida, and you either have your own car with insurance or are living with a resident relative (living in a house with family member who has a car with insurance) you are required by law to have all claims for injuries filed through PIP.  PIP is primary, meaning that even if you have your own health insurance, Medicare, Medicaid, or group plan, you have no choice but to use PIP first.

Most doctors who treat trauma/accident patients know this, unless they are new and have not been trained or have no experience with these types of patients.

So, what happens if you go see a doctor after a car accident, and hand them your health insurance card?  Well, if the doctor bills health insurance instead of PIP, there is actually a chance that the bill will get paid.  Why?  Because at this point, the insurance company is unaware of the fact that the patient is being treated for a car accident.  They process they claim as they do any other claim.

But, this is what I have seen over and over again over the years.  After a few weeks or months, the health insurance company will send a letter out to the policyholder and ask him a few questions, the most important one being describe the circumstances that led to your injury, and were you in a vehicle at the time of your injury?

If, through these questions, the insurance company learns that the patient was indeed in a car accident, the insurance company will usually proceed in one of two ways:  First, they can ask for the money back from the doctor.  Or second, they can wait to see if there is a legal settlement which will be paid out to the patient, and if so, they can put a lien on the settlement in order to be paid back.

If you have health insurance, you can use it for claims that are over and above the PIP payable amount (Secondary, not Primary). In other words, since PIP mainly pays 80% of the claim, health insurance can pick up the 20%.  You can also submit deductibles to them, and you can submit all claims to health insurance that exceed the $2500 or $10,000 in coverage.  If PIP denies the claim completely for reasons of failure to pay policy premium, or failure to carry, or anything, then health insurance can be billed in these circumstances.  But, remember, if you have a settlement pending that is due to this accident, you will pay the insurance company back from your settlement.

If you are one of those patients who just does not want to use your PIP car insurance for one reason or another, you will find yourself in one of the two scenarios up above.  Chances are, your health insurance will request the money back from the doctor or you will have to pay it out of any settlement you receive.

I have been treating car accident patients since 1996.

Consult with me for injuries relating to car accidents. I can be reached directly at 954-659-8600. Always consult with an attorney with issues regarding the law.  I am not an attorney.

My office address is:

Alan Himmel, DC, PA.
3161 Dykes Road
Miramar, FL.  33027