When a patient is in a car crash and the other person is to blame, what we find happens is when asked for the insurance information they can tend to give the insurance information of the “At-Fault” insurance provider. When dealing with Personal Injury Protection “PIP”, otherwise known as “The Florida No-Fault Law” the information you are seeking is for their own insurance. Meaning it is important to have every person in the office know the difference between a BI claim operating under a letter of protection and a claim that is being billed to PIP. So what happens when, even though the staff is educated, the patient is just not paying attention and gives you the wrong insurance company, or better yet, does not own a car and was in a friends vehicle and doesn’t know their friends insurance?
(c) With respect to any treatment or service, other than medical services billed by a hospital or other provider for emergency services and care as defined in s. 395.002 or inpatient services rendered at a hospital-owned facility, the statement of charges must be furnished to the insurer by the provider and may not include, and the insurer is not required to pay, charges for treatment or services rendered more than 35 days before the postmark date or electronic transmission date of the statement, except for past due amounts previously billed on a timely basis under this paragraph, and except that, if the provider submits to the insurer a notice of initiation of treatment within 21 days after its first examination or treatment of the claimant, the statement may include charges for treatment or services rendered up to, but not more than, 75 days before the postmark date of the statement. The injured party is not liable for, and the provider may not bill the injured party for, charges that are unpaid because of the provider’s failure to comply with this paragraph. Any agreement requiring the injured person or insured to pay for such charges is unenforceable.
You must force the issue with the patient or with their attorney to find out the insurance company or their best theory on who the insurance company is so you can bill someone. If you get back a denial and now after some time has passed you find the correct insurer then within the 35 days of the denial you can submit to the correct insurance company and it should be deemed timely. If it is not, then call Dolman Law Group at firstname.lastname@example.org or 727-222-6922.
Worst case scenario at the onset of treatment you might need to make your patient guess who the insurance company is. At least then you can bill someone. I would recommend waiting until closer to the 35th day (taking into account mailing time) to submit it to give your patient a chance to find the true insurer. Then if they are wrong it gives you more time to find the true one. In the end, it will leave you in a much better position than not billing during the first 35 days where you have zero chance of being reimbursed.