What is PIP coverage?

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What is PIP coverage?

Personal Injury Protection (also called “PIP”) is a type of auto insurance coverage for medical care following injuries from a motor vehicle accident. The great thing about PIP is that it covers immediate medical care regardless of fault in the accident. Even if you were at fault in the accident, if you have PIP coverage, then you can get healthcare paid for following a car accident. PIP coverage is mandated by law to be offered in Washington State, and can ONLY be declined if the insurance company has gotten a signed written waiver declining PIP coverage. If this waiver was never obtained by the insurance company, then they are obligated to offer PIP coverage to you, even after you have been involved in an accident (you would have to pay for the PIP coverage, but this is a small amount in comparison to the medical expenses that you will get covered).

 Another great thing about PIP coverage is that there is no “network” of medical providers. If you have health insurance through your employer or some other source of coverage, then you may be restricted to a certain group of healthcare providers that are “in-network”. With PIP, however, there is no “network”, you are free to choose any doctor you want and it will be covered (as long as it is for care that is reasonable and related to the accident).

My doctor does not accept my PIP: What can I do?

Unfortunately, there are a number of doctors/clinics who do not accept patients who are treating using PIP coverage. This is often based on a misconception by those doctors, who often do not have experience working with PIP coverage and think that they will not be paid if they provide care for someone treating with PIP coverage. In fact, it is quite the opposite. Most healthcare providers enter into contractual agreements with health insurance companies, and agree to reduce the amount they get paid for types of treatment in exchange for being an “in-network” provider (the idea is that these doctors, by being “in-network” will get more patients, which will offset the charges that they agree to reduce in the contract). So, if you go for a check-up through your health insurance to an “in-network” provider, the charge for that check-up may be $100. But, the doctor has contractually agreed with the health insurance company to get paid $45 for that check-up. If that same patient was treating with PIP, the doctor would not have to take a write-off and would get paid the full $100 charge for that same check-up. It is common that healthcare providers who are unfamiliar with PIP, think that they will not get paid for treatment, when in fact, they often get paid more than if the patient used their health insurance to pay for the visit.

 If you call a doctor’s office and request an appointment, and the office tells you that they do not accept PIP coverage, then you can contact your attorney who can call and talk to the billing coordinator about PIP coverage and its benefits for healthcare providers. If that does not work, then you can use your health insurance to pay for the visit, and worry later about which insurance should be paying the healthcare provider. You can call other providers and find an office that does accept your coverage, and/or work with your attorney to find a provider who can help you. It is important to note that it is typically a bad idea to stop getting treatment or have a long delay in your treatment (a “treatment gap” is the term typically used). This can happen frequently because navigating insurance coverage can be intimidating, which can cause some people to forego treatment for a long period of time altogether.

If you find yourself intimidated, it is important to contact your attorney (or find an attorney to help you if you do not have one) to help you find a provider to get the treatment you need.
At Premier Law Group we offer FREE Consultation to talk with our attorneys for any Personal Injury Case: Car Accident, MotorcycleAccident, Bike Accident….

CALL our office ar 206-285-1743