Part of signing up for medical insurance or seeing a new medical provider is navigating the sometimes daunting amount of paperwork and finding answers to questions you may have.
Many patients have questions about arbitration – what it is and when it comes into play.
Arbitration in general is a process for settling differences without going to court over them. In a medical context, many differences requiring arbitration are over who will pay for a patient’s care.
An arbitration agreement is a legal contract between a patient and medical provider or insurance company stipulating that any such disputes will be resolved through arbitration rather than legal action. The outcome is decided by an arbitrator whose final determination is binding.
Arbitration is typically more beneficial to the provider or insurance company than to the patient, but it isn’t uncommon for the patient to benefit from such proceedings.
Does Advanced Care Engage in Arbitration?
Advanced Care Physical Therapy engages in arbitration in the case of no-fault insurance claims but not workers compensation claims or major medical or Medicare or Medicaid claims.
No-fault insurance, also called personal injury protection, pays for medical bills incurred as a result of an accident regardless of who was at fault. If you’re hurt in a car wreck and want insurance to cover your medical expenses, you make a no-fault claim with your own insurance company, not the other driver’s.
There are several reasons why an insurance provider might deny no-fault benefits for physical therapy. Here’s one: An orthopedist refers a patient for PT but an independent medical examination determines that the patient no longer needs orthopedic care.
Denials are common because they save insurance companies money. When Advanced Care provides physical therapy to a patient who then is denied New York no-fault benefits, no-fault arbitration is needed.
We Fight for You While Treating You
For no-fault arbitration to occur, we require the client to be in compliance with his or her medical plan.
While an arbitration case is playing out, we continue treating the affected patient and billing the no-fault insurance, hoping that the denial ultimately is overturned and the insurer pays for services rendered to the patient. By completing these actions, we are ensuring that the patient gets the care they need, even as we also continue to work to get denials overturned for the purpose of receiving payment for services rendered.
If the patient has standard car insurance, has a PIP fund of $50,000, and all of the funds are spent, we are unable to arbitrate because there are no funds to fight to recover.
Additional PIP policies, known as APIP and OBEL, can be purchased, which can be billed and arbitrated for once the PIP is exhausted and spent. Therefore, for arbitration to occur, funds have to be available through the patient's insurance.
How is the arbitration process completed?
We complete the arbitration process using the Morris Law Firm PC. But however the process plays out, we at ACPT help to get you the treatment you need. We also help you handle arbitration proceedings. Our goal is to serve you, providing necessary treatment while working to get a denial overturned on your behalf.
This is to help relieve your pain and suffering during your recovery process. To ask about this or anything else, please contact us today.