How the PIP Reform Bill Will Impact 411-PAIN

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Will accident clinics still find a way to profit?
The Broward-based 1-800-411-PAIN Referral Service and other companies that solicit clients who have been in car accidents got a legislative kick in the knees Friday, but they are still standing.

A bill designed to cut down on personal injury protection (PIP) insurance fraud passed the state Senate with the enthusiastic backing of Gov. Rick Scott. Yet how much the bill will actually change the booming business of car accident treatments remains unclear.

House Bill 119 does not outlaw accident clinics. Accident victims can still call 1-800-411-PAIN and go directly to one of the many chiropractic clinics in the company's network. However, the clinic can only charge a patient's PIP insurance $2,500 unless a doctor, dentist, nurse practitioner, or physician's assistant determines that the patient has an "emergency medical condition." If the condition is an "emergency," more PIP costs can be billed.

All Florida drivers are required to carry $10,000 in PIP insurance, which covers most  of their medical bills and lost wages if they are in an accident. Unscrupulous chiropractors and physicians throughout the state have become adept at burning through that entire $10,000 with multiple clinic visits and questionable treatments. 411-PAIN is currently under investigation by the Florida Attorney General's Office for "deceptive and misleading advertising" and for allegedly allowing doctors and lawyers to use up all $10,000 of a patient's PIP insurance.

One might assume this new bill would stop the chiropractors in the 411-PAIN network from running up the bills. But some of the clinics, such as the Broward Rehab Center on West Oakland Park Boulevard, have a physician on staff. What's to stop that doctor from deciding all the patients have a medical emergency and need $10,000 worth of treatment?

The Pulp called one of the bill's biggest advocates, Sen. Joe Negron (R-Stuart), and the state Department of Financial Services, for comment. We'll update when they respond.

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14 comments
ztech79
ztech79

This law, it looks like fraudsters will try to get EMC , just by saying holding their neck and crying 'pain', though technically it says symptom(s) , which suggest pain itself, will not suffice for an EMC

Lance Cucumber
Lance Cucumber

As a medical provider who see's both sides of the spectrum, both clinics and patients can be a little shady...however the insurance companies have their games that they like to play(like one dr doing every single IME/Peer Review). Easy fix...change the state to an "at-fault" state, still offer PIP as an option, kinda like u/m is now, and make people who are prone to at-fault accidents carry more BI. As a consumer i can offer these suggestions: get uninsured motorist and whatever you do make sure all your treating providers take and BILL your health insurance if applicable. In addition to the consent forms that they make you sign, as a patient i would make them sign a waiver that they have to bill all applicable forms of insurance available. I see clinics that flat out refuse the health insuance info and lump it all on an LOP. Dont hold your breath on your insurance premiums going down!

Get Medical Records
Get Medical Records

It's extremely rather interesting obtain, that i enjoyed reading browsing it all.

PPI Claims
PPI Claims

Personal injury protection (PIP) insurance is necessary for all the people especially for the drivers because their lives are always in danger. Thanks for sharing such useful things.

Tiredpipadjuster
Tiredpipadjuster

We need to cap atty fees...attys make a living on only pip suits.

Help will with his bills
Help will with his bills

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Houston Injury Lawyer
Houston Injury Lawyer

The people are creating their own Fraud. The Bill has nothing to do with the Fraud. A bill designed to cut down on personal injury protection (PIP) insurance fraud.  It will be hard for the insurers to defend themselves int he Court of a simple pain was not an emergency. 

Pmarcus
Pmarcus

What a joke. the hospitals are the biggest fraudsters eating the 10,000 pip in two hours in unnecessary CT scans..   Further..now a patient has to go to the doctor within 14 days or they lose pip. A lot of patients dont go to the doctor right away and they will be left with a lifetime of pain.  This is a victory for pill mills that will happily provide for the "cut out" patients for their lifetime of symptom treating.

Alberto
Alberto

Lisa, you hit it right on the nail. There is no way thatinsurers will be able to defend in Court that a patient pain in the neck wasnot an emergency. PIP attorneys will have a feast like always. Enjoy the rideand keep your pockets open for the billion dollar PIP tax on drivers. Alberto

marc
marc

Exactly this reform has nothing to do with fraud, the people creating the fraud will just go around the system and bill for something else.  Plus there will be so many law suits regarding this ridiculous emergency medical condition they conjured up.  We should pay less if the piip is just for 2500..

gimmesamore
gimmesamore

Whatever... the PIP debate continues in Florida.  Now, there just simply be another level of money making; i.e. the "emergency" label will come at a price, but will not stop continued treatment up to 10k.  The other side to this debate is what insurance companies will actually do to their own insureds once the insurance companies get the opportunity --- pay less claims and deny even more claims.  While there are certainly many unscrupulous clinics, this law will just create more lawsuits, which will address the "emergency" issue, instead of one of the other issues wrapped up in Florida Statute 627.736.  This is not the solution, but just the beginning of a longer process to eliminate any claimant rights and take away PIP attorneys' desires to prosecute these claims. 

Le
Le

Im assuming that you will need to go to the emergency room , in a hospital to get that classification , of course they will give you at that time the $10000 .00, because at the emergency room 2500 will be not enough .

Lisa Rab
Lisa Rab

 That's a really interesting point. I wonder if the lawsuits will now focus on whether the patient had a medical "emergency." If so, how does one prove or disprove that?

Briancd54
Briancd54

A "medical emergency" is not listed anywhere in the AMA so will be hard to disprove when the insurance company classifies an accident as non-emergency. You better believe they will label almost all car accidents as non-emergency, capping PIP at $2500. But you will still be paying for $10000 in coverage.

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