Many previous blogs on this site have discussed New Jersey Personal Injury Protection or PIP laws. Generally they provide that when you are injured in an automobile accident your automobile insurance is primarily responsible for paying your medical expenses up to the limits you have selected. One important aspect of the PIP laws in place to protect you the injured party and all consumers of insurance and medical services are the medical fee schedules.
Pursuant to New Jersey Statute 39:6A-4.6 and New Jersey Administrative Code section 11:3-29.4. “ … the limit of liability for medically necessary expenses payable under PIP coverage is the fee set in this chapter.” As a result there is a detailed schedule of all medical procedures and the allowable charge under the law. But just because there is a set fee does not mean that is what the doctor or medical provider charges you the patient. In fact almost every time you receive a bill from a medical provider the charge listed on the bill is well in excess of the allowable fee schedule. Many times even though your insurance company has paid the doctor the required amount you as the patient continue to receive bills from the medical provider indicating an outstanding balance owed to them.
You and we as your attorney can fight back against this common occurrence. Pursuant to New Jersey Statute 39:6A- 4.6 c. and New Jersey Administrative Code section 11:3-29-5. “No health care provider may demand or request any payment from any person in excess of those permitted by the medical fee schedules established pursuant to this section, nor shall any person be liable to any health care provider for any amount of money which results from the charging of fees in excess of those permitted by the medical fee schedules established pursuant to this section.”
You as the patient must be vigilant in reviewing your bills and making sure you do not pay more then you are legally required to pay under the law. As an attorney I work together with my expertly trained staff to guard against excess medical billing and protect the rights and pockets of our clients. These laws are in place to protect you and there is no reason not to use them for exactly that purpose.