Currently dealing with a no-fault claim (I live in NJ) in which I was not at fault but injured, I definitely agree that it can’t be saving insurance companies money. It seems that every time my doctor requests a specific test or treatment, my carrier requires an ‘evaluation’ by another doctor before they will approve it. This additional evaluation by another doctor has to cost my insurance company more money, not to mention the additional time and inconvenience it costs me!
This is just another manisfestation of our broken health care system. No-fault generally provides adequate coverage for medical expenses arising out of auto accidents. So, it has become too expensive. Now, we need to cost shift those expenses to individuals. At best, they have co-pays, deductibles and coverage limits under their personal health insurance. At worst, they have no coverage.
From my experience, no-fault insurers are the targets of the cost-shifting, not the beneficiaries.
No-fault insurers don’t get the benefit of that “Reasonable and customary” clause health insurers can use, and have less leeway to object to payment of an expense. The providers know we have to pay the bill and don’t have the agreement setting the cost of procedures like a health insurer (or Medicare).
…that gets raided by doctors and attorneys.
My wife fractured her ankle. She only needed to see her orthopedist a handful of times with limited physical therapy uner our HMO.
As a past PIP adjuster, I have seen the same injury treated with unending physical therapy, orthopedic visits, neurologist visits with a chiropractor thrown in for good measure.
Currently dealing with a no-fault claim (I live in NJ) in which I was not at fault but injured, I definitely agree that it can’t be saving insurance companies money. It seems that every time my doctor requests a specific test or treatment, my carrier requires an ‘evaluation’ by another doctor before they will approve it. This additional evaluation by another doctor has to cost my insurance company more money, not to mention the additional time and inconvenience it costs me!
This is just another manisfestation of our broken health care system. No-fault generally provides adequate coverage for medical expenses arising out of auto accidents. So, it has become too expensive. Now, we need to cost shift those expenses to individuals. At best, they have co-pays, deductibles and coverage limits under their personal health insurance. At worst, they have no coverage.
From my experience, no-fault insurers are the targets of the cost-shifting, not the beneficiaries.
No-fault insurers don’t get the benefit of that “Reasonable and customary” clause health insurers can use, and have less leeway to object to payment of an expense. The providers know we have to pay the bill and don’t have the agreement setting the cost of procedures like a health insurer (or Medicare).
The same goes for Work Comp.
…that gets raided by doctors and attorneys.
My wife fractured her ankle. She only needed to see her orthopedist a handful of times with limited physical therapy uner our HMO.
As a past PIP adjuster, I have seen the same injury treated with unending physical therapy, orthopedic visits, neurologist visits with a chiropractor thrown in for good measure.