Unpaid Bill and NJ Medical Fee Schedule for Bills

Information to Doctors and Medical Facilities that Provide Treatment to Personal Injury Victims

We attempt to make efforts to cooperate with treatment providers so they can get paid their interests. However, since this is an automobile/personal injury case, both the medical office and my office are bound by NJSA 39:6A-4.6. This sets forth medical fee schedules. Under this law which became effective on October 5, 1991, the Commissioner of Insurance shall establish medical fee schedules on a regional basis for the reimbursement of health care providers providing services and equipment for medical expense benefits for which payment is to be made by an automobile insured under personal injury coverage.

The Statute also provides that no health care provider may demand or request any payment from any person in excess of those permitted by the Medical Fee Schedule established pursuant to the section, nor should any person be liable to any health care provider for any amount of money which results in the charging of fees in excess of those permitted by the Medical Fee Schedule established pursuant to the section.

There is a possibility that a portion of a bill was unpaid because the charges are in excess of those permitted by the Medical Fee Schedule established by the Commissioner of Insurance. We recommend doctors and treatment facilities kindly recheck your figures and respond in writing. If you are not in possession of a Medical Fee Schedule or have questions on overbilling penalties, you should immediately contact the NJ Commissioner of Insurance. The general information telephone number is 609-984-3602 x50023.

Care paths in Car Accident Cases Starting in 1999, all medical providers must follow "care paths" and most non emergency treatment approved by the car insurance company. Please make sure all treatment and bills are pre-approved by the car insurance company. The treating doctor should also contact the car insurance company prior to MRI or extensive treatment.

Medical Provider Should Also Submit Bills to Major Medical and to Patient If you do not keep your patient and our office informed in writing of unpaid medical bills, we will be unable to put the defendant's attorney on notice when attempting to resolve a case. The medical provider must first submit the unpaid bills to the patient's car insurance carrier (PIP carrier), and/or any Blue Cross/Blue Shield or other related medical provider, and fill out any documents required by the insurance company.

Deductibles Under the New Jersey No Fault Act, car insurance companies are supposed to make timely payment of medical bills for the driver and passengers injured in their cars or other non-commercial vehicles. Please let your patients know there are now minimum deductibles under the PIP Law. There is an initial $250.00 deductible, and thereafter the car insurance company pays 80% of medical bills under a medical fee schedule established by the State Dept. of Insurance.

21 Day Notification to PIP A new State Law signed in January, 1996 requires automobile insurers to be notified by the claimant or medical provider in writing within 21 days following commencement of treatment of injuries sustained in an accident for which personal injury protection medical expense benefits are claimed. In addition, under this new law P.L. 1995, c 407, every bill for such treatment shall be submitted to the insurer, if submitted by the medical provider, within 30 days of the date that treatment was rendered.

Unfortunately, many insurance companies today delay payment or fail to pay medical bills. If payment is refused or not received, suit or Arbitration can be filed in order to compel car insurance companies to pay their share of medical bills. The filing fee of a Superior Court suit is $175.00. The Filing Fee for AAA Arbitration with an oral hearing is $325.00. Ordinarily, this is paid by the medical provider or patient. We will represent doctors or patients in PIP suits or Arbitration. We will not pay these filing fees. Based on the recent changes in New Jersey laws, we no longer sign form letters of protection. We ask doctors to send us copies of all medical bills and insurance attending physician reports you have not previously provided to us.

We will be contacted by the defendant's insurance company in an attempt to resolve your patient's personal injury case. The defendant's insurance company will request information as to the total amount of bills and whether or not there are any amounts that are unpaid. In New Jersey, under the "Collateral Source Rule," a defendant driver is not responsible for unpaid medical bills unless the plaintiff and the doctor have first submitted the bills to all available medical insurance. In car accident cases, this is both the car insurance company (PIP) and also major medical. Medical providers should fill out the bottom of this form and fax it back to our office. In addition to the below information, it would be helpful to our office if you could also fax or mail us a copy of the bill.

Total unpaid bill: _________________________________

Total bill: _________________________________

When last bill was sent to PIP/car insurance company: _________________________________

When bill was last submitted to major medical: _________________________________

When was last bill sent to patient: _________________________________