Relationship Between PIP and Medical Insurance

You’re involved in a motor vehicle accident. You’re injured. There’s pain, anger, anxiety and confusion.

The relationship between the personal injury protection (PIP) you paid for as part of your auto insurance policy and your health insurance isn’t the first thing on your mind. But, getting it right the first time avoids a lot of confusion and hassle later.

Between the two coverages your PIP is “primary”. That means that it needs to be used first and exhausted before your health insurance will start paying your accident in the way of medical expenses. Most people have $10,000.00 in PIP coverage.

PIP coverage – unlike health insurance – pays 100 cents on the dollar for your care. After your PIP coverage is exhausted (for most people that means PIP has paid $10,000.00 in medical expenses) your health insurance carrier needs to be provided with what’s called an "exhaustion letter" confirming that there is no more PIP coverage and it needs to start paying your bills.

It’s tough to make a seamless transition between PIP and health insurance but most providers have the ability to wait for a little bit while that transition is made. Their billing departments should be familiar with the transition that takes place between PIP and health insurance once PIP is exhausted.

Distilling all of this:

Provide your PIP information to your health care providers immediately after the accident.

Periodically request a copy of the PIP ledger from your auto carrier. This will show you how much PIP coverage remains.

Once you start getting close to your limits provide your health care providers with your health insurance information so they can bill it when PIP is exhausted.

One other thing (and this may be a topic of an entirely separate blog). Do not provide your health care providers with the other driver’s insurance information. Unless you are a pedestrian the other guy’s insurance is not going to cover your expenses at the outset of the case. There’s a big difference between PIP and liability insurance and I’d be happy to explain that to you if you have questions.