Billing Insurance Companies in No-Fault Claims
The no-fault billing process can be confusing and frustrating for medical providers. If insurance companies have an issue with when or how you submit your bills, they may deny your claim. It is crucial that your bills be submitted on-time and follow the insurance company’s procedures.
At The Tadchiev Law Firm, P.C., we have a deep knowledge of the claims process. Our firm is a “one-stop shop” for your no-fault needs. When it comes to billing insurance companies in no-fault claims, we can handle all the details, from sending bills and responding to verification requests, to filing for arbitration after a denial.
When you run into billing disputes with an insurance company, allow our aggressive negotiators and skilled no-fault attorneys to take the pressure off you.
Let us show you how we can help. Contact us today by phone or online.
Introduction to the Billing Process
Dealing with insurance companies about billing can be exasperating, particularly when insurance carriers request additional verification or deny your claims. When you begin the billing process, you must make sure your bills are detailed and have information about where and when you provided services. You must also be sure you submit your bills within 45 days of providing services.
The insurance company, which will pay your bill, may request verification or deny your claim altogether.
When you get another delay or negative response from the insurance company, an attorney at The Tadchiev Law Firm, P.C., can identify your options, advise you on your next steps and fight to get your bills paid.
Who Should a Medical Provider Send Their No-Fault Bills To?
When medical providers treat people injured in motor vehicle accidents, their claims should be filed with the insurance company that provides coverage for the vehicle in which the injured person was an occupant. If the injured person was on foot, the claim should be filed with the insurance company that covers the car that struck them.
If the injured party cannot identify who struck them, or if the vehicle was uninsured, then a no-fault claim may be filed with an insurance company that is providing coverage for a household family relative of the injured person at the time of the accident. If none of the injured person’s household family relatives have automobile coverage, the claim may be filed with the Motor Vehicle Accident Indemnification Corporation (MVAIC). Additional information on MVAIC can be obtained on its website (http://www.mvaic.com/) or by calling (646) 205-7800.
If you are unsure which insurance company provides coverage for the vehicle that struck the injured individual, check the “Ins. Code” section on the police report. To check which insurance company corresponds to the code listed, visit the New York State Department of Motor Vehicle’s website, which has a page of insurance codes and company contacts.
What does it means to have a no-fault insurance?
No-Fault insurance means that your car insurance carrier covers the costs incurred as a result of an injury sustained in an auto accident, these may include:
- Medical bills
- Wage loss
- Replacement services claims
What Is the Timeframe for Mailing No-Fault Bills to Insurance Companies (“Proof of Claim”)?
All no-fault bills should be mailed to the appropriate insurance carrier within 45 days of the date that medical services were provided. If a bill is not mailed within those 45 days, a late submission may be excused upon reasonable justification. Even if a bill is submitted late without reasonable justification, a medical provider may still receive payment for the claim if the insurance carrier fails to meet its legal obligations.
How Long Does an Insurance Company Have to Respond to a No-Fault Claim?
The insurance company can take up to 30 calendar days from the date it receives the bill to either provide payment, issue a denial, or request additional information or additional documentation (known as “additional verification”) relevant to the claim. If the carrier requests additional verification, it has up to 30 days after receiving the requested documents to either pay or deny the claim. In certain circumstances, the carrier will have less than 30 days to respond after receiving the requested verification.
What if the bill was sent to the correct carrier but not to the proper claims processing office of the carrier?
If the bill was sent to the correct insurance carrier but to a different address than the carrier’s claims processing office, the carrier is deemed to be in receipt of the claim within 10 business days after the bill arrived at the incorrect office.
What should a medical provider do if the insurance carrier denies a no-fault claim or fails to respond within 30 days of receiving the claim?
The medical provider can either file for no-fault arbitration with the American Arbitration Association (AAA) or take the insurance company to court.
If the insurance company denies a medical provider’s no-fault claim, should the medical provider continue billing the insurance carrier for that particular patient?
Yes. If you feel you were unfairly denied no-fault benefits, you can bring the carrier to arbitration or litigation. If the arbitrator or the court finds the denial was improper, the insurance company will be obligated to pay for that patient’s medical bills.
For no-fault claims, arbitration is generally more cost-effective and typically faster than litigation. However, in some cases, litigation will prove to be a better approach. In order to determine which forum is best for your no-fault claim, contact The Tadchiev Law Firm, P.C. We can review your claim and help determine which resolution will be the better one for you.
How an Attorney Can Help With Your No-Fault Claim
An attorney can help you by:
- Sending bills on time to insurance carriers
- Tracking claim payments
- Responding to verification requests from insurers
- Advising you on your rights under New York law
- Filing for arbitration and aggressively advocating on your behalf
If you are a medical provider dealing with the headache of no-fault bills, contact The Tadchiev Law Firm, P.C., today. We can handle everything your claim needs and take the pressure off you from the start. Our skilled no-fault attorneys and aggressive negotiators have a deep knowledge of no-fault claims. Whether you are just starting the billing process or facing insurance company denials, turn to us for the help you need.
To learn more, call The Tadchiev Law Firm, P.C., or reach out to us online today.