How do I pay the Medical Bills incurred for injuries related to an auto accident in New Jersey?

In New Jersey, the Legislature has provided coverage for auto-related medical services. This is known as Personal Injury Protection (PIP for short) and is part of your auto insurance premium.

 

How much coverage do I have?

The amount of coverage provided by your policy depends on the option you selected at the time your coverage was issued. The standard policy in New Jersey provides $250,000 in medical expenses per accident with a $250.00 deductible and a co-payment of 20% of the first $5,000 in expenses. However, there are many other options now available which provide no coverage for medical and limited coverage for medical expenses from $15,000.00. You may also choose a higher deductible up to $2,500.

 

There is also another option where you can choose to use your Health Insurance coverage as primary in an auto accident. Prior to selecting this option, you should check with your Health Insurance Plan to make sure that they allow you to use their coverage first. If you have been in an accident, and they deny this option, you may be subject to an additional deductible of $750.00 to convert your auto policy to primary coverage.

 

Can I be treated by any doctor under my auto insurance?

For most medical expenses, the answer is yes. Under PIP, all medical treatment is subject to pre-certification, the approval of the insurance carrier prior to having the treatment. Your medical provider will submit a treatment plan, outlining what care he believes is medically necessary for your injuries, and seek the carrier’s approval. However, certain diagnostic testing, like MRI’s and EMG’s are required to be performed by an in-network provider, or are subject to an additional 30% co-pay. Check to see if the facility you are using is in-network.

 

What happens if the Insurance Company denies treatment that my doctor thinks is necessary?

There is a mechanism for appealing denied treatment which your provider should be familiar with. When choosing a medical provider, make sure that they understand that your treatment will be covered under PIP and that they know the appropriate steps to get your treatment approved.

 

If, after filing appeals, your treatment is still denied, your provider can choose to go ahead with the treatment and file an arbitration against the carrier to get reimbursed for the treatment after the fact. You would not be responsible for the payment of any medical bills which were disputed by your provider through arbitration and lost.

 

Are there any other benefits under this coverage that I should be aware of?

Again, depending on what options you choose at the time your policy is issued, you may have coverage for lost wages, essential services (liking having someone to assist with taking care of you at home). Check your policy, or speak with your agent to determine what coverage you have.

 

Also, expenses for prescription drugs and durable medical equipment are including in PIP, as well as dental care for injuries related to your accident.

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When injury occurs, it is often unexpected. You now have the task of dealing with life’s routine as well as the pain and injury. At Sall Myers Medical Associates, our experienced bilingual staff is mindful of this. From the instant you walk through our doors, until the moment you leave, a trained and qualified medical assistant will assist you every step of the way.

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