State Farm's PIP Policy

Review of State Farm’s PIP Policy

PASS (page 14)- Mentions 14 days

PASS (page 4)- Mentions EMC
PASS (page 4)- Quotes statute re $2500 v $10,000 correctly

PASS (page 4)- Excludes massage and acupuncture

PASS (page 5)- Mentions OPPS, NCCI, MPPR, MSSR reductions are permissible as “Medicare coding policy”

PASS (page 16)- Mentions that it can pay at 200% of Medicare

PASS (page 14-15)- Mentions subparagraph 1 and 2 correctly

EXTRA- their insurance policy claims that they will reimburse a reasonable amount but no more than 200% of Medicare. Basically, they are claiming that they may be able to pay less than 200% of Medicare. This is contrary to the PIP statute and could become a reason for a lot of PIP suits if they end up reducing bills and paying less than 200% of Medicare.

EXTRA- their insurance policy claims that if they reduce your bill then you only have 15 days to resubmit a new bill with the corrections they requested. This is also contrary to the PIP statute and could become a reason for a lot of PIP suits if they end up reducing bills and stating that you only had 15 days to respond.

EXTRA- Their MedPay policy now divides benefits into EMC and not an EMC. It says that if a person is “determined” to have or not have an EMC. It doesn’t mention what happens when none of the treating doctors “determine” if there is an EMC.

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