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What are unreimbursed medical expenses? Pursuant to Pennsylvania law, medical expenses are defined as ?annual unreimbursed medical expenses in excess of $250 per person.? These specifically include out-of-pocket expenses for surgical services, dental services, optical services, and orthodontia.
110 (Law Div. 2011) in ruling that the medical expenses not paid by PIP are recoverable in a tort action. It decided that the full amount of those bills, without any reduction to the PIP Fee Schedule, were admissible into evidence at trial. Thus, they are fully ?boardable? to the extent they were not paid by PIP.
§1797 (ACT VI), which sets forth the proper reimbursable amounts permitted for medical treatment arising out of a motor vehicle accident at 110% of what Medicare would pay a provider for the same service.
Collateral Source Rule and Exceptions Pennsylvania follows the common-law collateral source rule without general statutory modification. ?[P]ayments from a collateral source shall not diminish the damages otherwise recoverable from the wrongdoer.? Johnson v.
PA Act 6 and the Peer Review When the insurer receives a bill from the provider, the insurer has ninety (90) days to submit a challenge to the PRO. The PRO will assign a reviewer to review the medical record documentation to determine whether the services are reasonable and necessary.
IMPORTANT: In Pennsylvania, there is a four (4) year statute of limitations that applies to most kinds of non-government debt (e.g., credit cards, medical bills, utility bills, etc.) The 4 years usually runs from the last payment made on the account.
"Limited Tort" Option--The laws of the Commonwealth of Pennsylvania give you the right to choose a form of insurance that limits your right and the right of members of your household to seek financial compensation for injuries caused by other drivers.