How Does Florida PIP Affect Pharmacies?

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How Does Florida PIP Affect Pharmacies?

How Does Florida PIP Affect Pharmacies?One little known aspect of Florida’s No Fault Law, which requires auto insurance policies to provide personal injury protection coverage of up to $10,000.00 in medical and disability benefits, is that those benefits can be used to pay pharmacies.

Oftentimes, auto accident victims will be prescribed pain medication and prosthetic devices for their injuries. What you may not have known is that pharmacists and pharmacies can submit the bills for those medical services and products to the PIP insurer. Whether it is a neck brace or back brace for an auto accident victim, or simple pain medication, the PIP insurer should be paying those bills.

For example, John Doe was injured in a car accident on I-95 in Miami. Following the accident, Mr. Doe was sure to follow Florida law and took himself in to see a doctor within 14 days of the accident. Mr. Doe knew to get into a doctor within 14 days after the accident, because otherwise his claim would likely be denied. Mr. Doe also knew that maximum amount of PIP benefits would be limited to $2500.00 instead of $10,000.00. unless it was determined that he suffered an emergency medical condition, or EMC.

Unluckily for Mr. Doe, he did in fact suffer an emergency medical condition, and so his PIP benefits were allowed for up to $10,000.00 for medically necessary services. After seeing his chiropractic physician, Mr. Doe visited his orthopedic doctor where Mr. Doe was prescribed pain medication and a neck brace.  Mr. Doe then went to his local pharmacy in Miami, and submitted the prescriptions to be filled.

What Mr. Doe and the pharmacist may not have known is that in Florida, the auto accident victim’s PIP insurance will pay for the prescriptions, so long as medically necessary and reasonable as a result of the accident. To get PIP to pay for prescriptions and prosthetics, there are two options:

  1. The pharmacy has its own Assignment of Benefits form wherein they could have the patient sign for authorization and then submit the bills for the prescription directly to the auto insurance company.
  2. The insured/accident victim can pay out of pocket for the prescription and the prosthetics, and so long as they keep their receipts, the insured/claimant can submit those bills for processing and payment by the PIP insurer.

Should either the pharmacy or the insured/patient not receive payment as required upon submission of the bills, then a PIP demand letter should be sent by an experienced Miami PIP attorney, as a PIP lawsuit could be likely should payment not be made within 30 days of the insurers receipt of the demand letter.

Yeboah Law Group, P.A., has experienced Miami and Fort Lauderdale PIP attorneys who have litigated throughout South Florida on behalf of their clients, including pharmacies, and recovered millions of dollars for their clients. Should you have questions, or if you have been denied payment, or have not been paid in full by an auto insurance company, call 1-800-TELL-SAM or contact our office today.

 

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