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Home > Medical Services Coverages and Exclusions

Medical Services Coverages and Exclusions (providers and services)

Personal Injury Protection (PIP) is no-fault auto accident insurance that covers 80% of a covered individual’s medical treatment up to $10,000,00. Doctors who treat patients with PIP claims can bill the insurers directly and receive reimbursement for services provided. But Florida PIP law doesn’t cover every type of medical provider, nor does it cover every type of service.

Read on to learn more about medical services coverages and exclusions under Florida PIP law. If you believe your PIP law claim is being unreasonably delayed, denied or underpaid, call the Florida PIP law attorneys at Shuster Saben Estevez. Our law firm is a leader in helping doctors statewide get fully reimbursed for the treatment they provided. We stand up to the insurance companies and make sure they treat you fairly. We fight. We win.

Which Medical Providers Are Covered, and Which Are Excluded, Under Florida PIP Law?

Florida’s PIP law statute specifically includes the following medical providers as eligible for reimbursement:

  • Licensed physicians, including Medical Doctors (MDs) and Doctors of Osteopathic Medicine (DOs)
  • Licensed dentists
  • Licensed chiropractic physicians
  • Advanced practice registered nurses
  • Hospitals or facilities owned by a hospital
  • Licensed emergency medical technicians (EMTs)

The following health care providers are specifically excluded from receiving reimbursement for medical treatment:

  • Licensed massage therapists
  • Licensed acupuncturists

What Services Are Covered and Excluded?

Initial services and care provided by the covered providers listed above are eligible for reimbursement. In addition, PIP law allows for reimbursement of follow-up services and care consistent with the underlying medical diagnosis by the providers listed above. PIP law also allows for referrals to those listed above or to a DO, physician assistant (PA), ambulatory surgical center, licensed physical therapist, or accredited health care clinic.

Massage therapy and acupuncture are not reimbursable services, regardless of who is providing them.

Who Can Determine an Emergency Medical Condition?

As noted above, PIP benefits are limited to $2,500 unless the patient had an emergency medical condition (EMC). Florida PIP law authorizes the following types of providers to make an EMC determination:

  • MD
  • DO
  • PA
  • Dentist
  • APRN

Get Help Today With Your Florida PIP Law Claim for Reimbursement

If you are having trouble getting reimbursement for services provided under a PIP claim because the insurer says the provider or service is excluded, because they are challenging the EMC determination, or for any other reason, call Shuster Saben Estevez at 877-511-7829 or any one of our several offices located throughout the state. Our firm is a leader when it comes to helping doctors collect reimbursement under Florida PIP law. Call us today, and we’ll go to bat for you when the insurance company isn’t playing ball.

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