How Long Must You Wait Before Your Insurance Company Has to Pay Medical Bills after a Pennsylvania Car Accident

Most of the time, your insurance company will be pretty quick about paying your medical bills when you send them along. But every now and again we run into a situation where the company drags its feet. When this happens, you should know that your insurance company has 30 days to pay your medical bills after a Pennsylvania car accident.

When Does the 30 Days Start to Run?

The 30 days begin to run once the insurance company has received “reasonable proof” of the cost and appropriateness of the treatment. What is reasonable proof? That isn’t defined in the law. Normally,the procedure codes, which explain for what the doctor was treating you (providers usually use the Medicare HCFA forms) or a full statement describing the procedure, will satisfy the requirement.  So, if you send in the bill and it doesn’t include enough information, the insurance company will send it back for the information it requires. Until it receives that information, the 30 days won’t begin running.

Are There Any Exceptions?

The insurance company might object to the bill if it feels that the medical treatment was not appropriate or not handled properly. In that case, the company can submit the bill to “peer review.” The insurance company has 90 days to send the bill to a “peer review organization” (also called a PRO.)  These are private companies that review bills and medical treatment to determine whether they were appropriate.  If the insurer submits the bill to PRO within 30 days of receipt of “reasonable proof,” then it does not have to pay the bill until the PRO makes a decision.  However, if the insurer submits to PRO between 31 and 90 days after receipt of “reasonable proof” then the insurer must pay the provider. However, if the PRO says the service did not conform or was not medically necessary, then the provider must reimburse the insurer.

Conclusion

If you are injured in a car accident, you should immediately contact the auto accident lawyers of Lowenthal & Abrams. We can help you manage both your claim against the driver who hurt you and any issues you are having with your insurance company about getting your medical bills paid after a Pennsylvania car accident..