One issue that can arise in PIP claims is a denial based on an allegation that certain billed services were not actually rendered.
This often develops after the insurance company conducts an Examination Under Oath (EUO)of its insured. During the EUO, the insured may be asked to identify or describe the specific services performed by each medical provider.
The problem is that the EUO may take place months after the treatment occurred. By that point, the insured may understandably have difficulty remembering every treatment performed during every visit. Even more importantly, the average insured is generally not familiar with CPT codes, billing terminology, or which particular code corresponds to a specific treatment.
An insurer may nevertheless attempt to use the insured’s inability to remember or accurately describe a particular service as a basis to challenge or deny the corresponding charge.
That creates an important documentation lesson for medical providers.
Best practice: Have the patient review and sign a treatment acknowledgment or daily treatment sheet after each appointment identifying the services actually rendered that day.
Contemporaneous documentation can provide valuable evidence that the treatment occurred and can help address a later argument based solely on a patient’s imperfect memory during an EUO.
Months later, a patient may not remember every modality or procedure. The medical record should.
Strong documentation today can prevent unnecessary disputes tomorrow.
Disclaimer: Educational content only. This article is not legal advice and is intended for general informational purposes for Florida PIP providers.
