PIP Games- What To Look Out For

PIP Insurance companies are always playing games and finding ways to reduce or deny payment. This is a brief list on what tactics to look out for in 2014.

– Emergency Medical Condition
The biggest reduction/denial to look out for is the Emergency Medical Condition cutoff at $2,500. Some companies are cutting off benefits at $2,500 and then saying “benefits exhausted” hoping you will close it out. Progressive, Liberty Mutual, Safeco are doing this often.

– 14 Day Rule
Another big one to look out for is denying claims when the patient didn’t treat within 14 days of the accident. My office is filing lawsuits on these cases claiming the 14 day rule is unconstitutional. Please send these cases if you come across this issue BUT be aware that this case will take years to resolve. Feel free to call with questions.

-Massage and Acupuncture
This is the same as the 14 day rule. I’m filing lawsuits claiming it is unconstitutional to deny massage/acupuncture care so please send these cases to my office. If you are billing massage then try updating your practice to bill/perform/notate manual therapy instead of massage to AVOID litigation.

-Manual Therapy vs Massage
So far one company, Progressive has been claiming that manual therapy (97140) is really just massage therapy (97124) and denying those codes. Don’t let them get away it. Please send those cases or call with questions.

Keep my office in mind for any PIP issues that you come across. I’ll keep you updated on what goes on this year with the Florida Legislature.

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