Please understand your PIP. PIP stands for Personal Injury Protection and applies to injuries sustained in a motor vehicle accident (MVA). It is rare that car insurance policies will not have a PIP, but you can opt out for a lower premium. NEVER DO THIS! It is there to help you receive care following a car accident. Here are some things to be aware of:
- In Oregon, PIP is usually $15,000 for care that needs to be used within 2 years of the accident. Now that may seem like a lot of money, but it goes quick. For example, if you’re seeing a chiropractor 2x/week, massage 1x/week, PT 2x/week and maybe OT or speech language pathology 1x/1 week that could easily be $1,000/week. That will only afford you a few months of therapy before your PIP could be exhausted. Add in an ambulance ride or a trip to the ER or Urgent Care and/or imaging such as MRIs, CT scans or a series of x-rays and now a huge chunk has been taken out of that $15,000. Patients are often surprised when their PIP is exhausted, so it is imperative you (or your lawyer) monitor this throughout your treatment plans.
- Get a lawyer. If you have a lawyer the insurance adjuster CANNOT call you. Attorneys only receive payment once you settle your claim. It is a good idea to have a lawyer in place following an MVA. Often times insurance adjuster will call patients weekly to ask how they’re doing and if they are ready to settle up care. They are not your friends and they do not care about how you’re feeling. It is in their best interest to close your claim ASAP. Do not short change your therapy. They may also try to send you to an Independent Medical Exam (IME). Make no mistake, IMEs are anything but independent. The doctor who evaluates you is paid by the insurance company and will almost always find in the insurance company’s favor and say you do not need any more care. Even if you have more money and time left on your MVA claim, it doesn’t matter. They can cut you off and you will need to either use your own private insurance or be a self-pay patient. As a reminder, we do not bill any private insurance in this office.
- Should your PIP be exhausted, sometimes your lawyer will tell you to continue care until you’re well and discharged from care. They may tell you that a Doctor’s Lien can be signed which means the doctor waives any payment until the claim is closed. Please understand that more and more doctor’s are refusing these liens. We no longer work on Doctor’s Liens in this office. To sign a Doctor’s Lien, the office is agreeing to not being paid until after the claim is closed and settled. Claims can be open for 2 years and settlements in the court system are severely delayed due to COVID restrictions. This can delay payment for 3 years plus. It is inappropriate to ask a business to hold off on payment for such a long period of time. Please be mindful that should your PIP be exhausted you will need to settle your bill and you will become a self-pay patient. Once your claim is settled, you should receive these payments back as a part of your settlement, but that is something to discuss with your attorney.
- Once your PIP is exhausted more and more practitioners are not accepting private insurance to cover your services. We do not accept any other insurance (other than worker’s comp) in this office. That means if you have Blue Cross, Cigna, Moda, Kaiser, Medicare, etc…you will need to settle your bill with the office and should you want further care you will be a self-pay patient. Now, as mentioned before, any fees paid by you will become a part of your claim and once that claim is settled, any fees should be reimbursed to you. But again, that is a conversation to have with your lawyer so you fully understand how your PIP and claim settlement work.
And in the words of Judge Judy, “They call it an accident. Not an on-purpose.” Even if the accident was your fault, you still deserve treatment, so don’t be afraid to seek care. Just be mindful of where you are in the process so you don’t get stuck with a large bill to pay.