House Panel Eyes ‘PIP’ Medical Fees

Apr 16, 2019

Changes could be coming to a House proposal to alter rules in the personal-injury protection insurance system. 

Under an 18-page amendment to a bill (HB 1317) that will be considered Tuesday by the House Health & Human Services Committee, hospitals and physicians would be limited to the Medicare fee schedule for providing services to people who have been injured in auto accidents.

The amendment would restrict hospitals to 200 percent of the Medicare prospective fee payments for emergency services. Also, physicians and dentists providing emergency services at hospitals would be limited to 200 percent of the Medicare fee schedule.

Currently, a hospital providing emergency services and care cannot charge more than 75 percent of the “usual and customary charge.” And physicians providing emergency services are allowed to charge “the usual and customary charges in the community.”

Florida law requires motorists to carry no-fault insurance known as personal-injury protection, or PIP, coverage. The purpose of PIP coverage is to provide medical benefits without regard to who is at fault in accidents.

In exchange for the benefits, the no-fault law limits the right to file lawsuits stemming from vehicle accidents. The Legislature over the years has made attempts to eliminate fraud in the system and has redesigned benefits to try to hold down costs. Among those changes was limiting to 14 days the length of time motorists have to seek PIP medical benefits.

The proposed amendment that will be considered Tuesday would extend the length of time from 14 days to 30 days. But it would require that treatment plans be developed for motorists and that providers submit the treatment plans to insurance companies within 30 days.

Insurers would not be required to pay claims or bills for services if the providers did not submit treatment plans. A Senate version of the bill (SB 1790) has not been heard in committees as the May 3 end of the legislative session nears.