As a Healthcare Provider, What Can You Expect from Insurance Arbitration?

New Jersey has no fault insurance laws that have a direct impact on healthcare providers. If you do not have a good understanding of how it works and of your rights, it can end up costing you dearly. The attorneys at Wallace Law can help you make sure that you get the payment that you deserve for the services you’ve provided.  We are here to provide you with experienced legal counsel, and to let you know what you as a healthcare provider can expect from insurance arbitration.

The Personal Injury Protection insurance arbitration process is designed to resolve issues of nonpayment between insurance companies and medical providers. When an insurer denies payment for services rendered, you need to prepare and file an Arbitration Demand with the National Arbitration Forum. Though this may feel like filing a lawsuit, it is actually just a request to have an arbitrator assigned to resolve your dispute. There is a $225.00 filing fee for a Demand for Arbitration.  The NAF will appoint an arbitrator to help with dispute resolution and a hearing will be scheduled, usually within four to six months’ time. Though the decision made by the arbitrator is binding, they are subject to appeal if an appeal states that the award was “incorrect as a matter of law.”

The dispute is generally a question of whether pre-certification was obtained for medical treatment for those injured in automobile accidents. In many cases the insurer will question whether a treatment that has been recommended or provided are medically necessary, or argue that diagnostic tests that were ordered were inappropriate or not needed. Though there is a right to file a lawsuit to pursue these disputes, they generally take far longer to proceed, and provide far greater fees to the attorneys then is the case with arbitration.

The PIP process was originally created as a way of lowering auto insurance costs, and since that time it has been used by the insurance companies as a way to make collection difficult for medical providers.  Every insurance company has its own specific requirements for documentation, and they can be frustrating if you are not familiar with the process. At Wallace Law, we are specifically knowledgeable about all of the PIP rules and the various obstacles that the insurance companies try to erect between you and the payment you deserve. As licensed attorneys who have successfully represented many healthcare providers in PIP arbitration, we will not only take charge of the appeals and arbitration process, but we do so in a way that ensures that you are always aware of the status of your case.  We will take care of all of the details, making sure that all of the information that is required by the individual insurance company is properly filed and take care of the entire collections process.  For more information on our services, call Wallace Law today to set up a convenient appointment.