What steps do I need to take to submit additional medical bills for PIP reimbursement?
What steps do I need to take to submit additional medical bills for PIP reimbursement? - North Carolina
Short Answer
In North Carolina, first-party medical coverage is usually called Medical Payments coverage (MedPay); some policies label it PIP. To seek reimbursement, promptly send your insurer a written claim package with your claim number, itemized bills, and proof the treatment relates to the crash. Use the insurer’s preferred submission method (fax, portal, or mail), keep transmission proof, and respond quickly to any document requests. Deadlines and documentation requirements are set by your policy.
Understanding the Problem
You were in a North Carolina car wreck and your insurer already paid the first ER bill. You want to know how to send the rest of your treatment bills for payment under your MedPay/PIP benefits. The decision point is: what you must submit, to whom, and by when, so your insurer can reimburse additional accident-related medical expenses.
Apply the Law
Under North Carolina auto policies, MedPay (sometimes labeled PIP) pays reasonable, necessary medical expenses caused by a covered auto crash, up to your policy limit, regardless of fault. You must give timely notice, provide a proof of loss, and submit itemized bills and related medical documentation the insurer reasonably needs to verify the charges and their connection to the accident. Claims are made to your insurer’s claims department, not the court. Policies often require you to send bills within a set timeframe (frequently within 6–12 months of service), and insurers must handle claims fairly and promptly under state law.
Key Requirements
Covered person and event: You were an insured under the policy and the treatment stems from the covered motor vehicle accident.
Reasonable, necessary, accident-related care: Bills must reflect treatment tied to the crash and medically necessary.
Timely proof of loss: Submit a written claim package with itemized bills, dates of service, providers, and your claim number within policy deadlines.
Supporting documentation: Include medical records, diagnostic codes (ICD-10/CPT), and any insurer forms or medical authorizations they request.
Proper delivery and tracking: Use the insurer’s stated method (fax, portal, or mail) and keep proof of submission.
Apply the Rule to the Facts: You have remaining MedPay/PIP benefits and new treatment bills. You meet the “covered person/event” element because your policy applies to this crash. Next, gather itemized bills showing dates of service and charges to show “reasonable, necessary, accident-related care.” Finally, submit a written proof-of-loss package via your insurer’s approved channel within your policy’s time limits to satisfy the “timely proof of loss” and “proper delivery” elements.
Process & Timing
Who files: You (or your attorney). Where: Your auto insurer’s claims department in North Carolina (use your adjuster’s fax, upload portal, or mailing address). What: A cover letter referencing your claim number; completed insurer “proof of loss” or PIP/MedPay form (if required); itemized bills (CMS-1500 or UB-04) and related records; HIPAA/medical authorization if requested. When: Submit as soon as you receive bills; many policies require submission within 6–12 months of each service.
Insurer review: The insurer typically acknowledges receipt, may request additional records or authorizations, and then evaluates whether the charges are reasonable, necessary, and accident-related. Timeframes can vary by insurer; respond promptly to any requests.
Outcome: If approved, the insurer issues payment to you or directly to the provider (depending on assignments or policy terms) and provides an explanation of benefits; if denied in whole or part, you should receive a written explanation and information on how to appeal or submit more documentation.
Exceptions & Pitfalls
Missing or non-itemized bills: Balance statements or screenshots are rarely enough; submit itemized bills with CPT/ICD codes.
Medical nexus: If the records don’t tie treatment to the crash, reimbursement may be reduced or denied—ask your provider to document causation.
Coordination of benefits: If health insurance paid first, include the explanation of benefits; avoid duplicate payments and follow any required assignments.
Timing traps: Policies often impose “as soon as practicable” notice and specific deadlines for each bill; don’t wait until treatment ends to submit.
Communication gaps: Faxed claims can get misrouted—use a clear cover sheet with your claim number and keep the transmission confirmation.
Disputes or delays: If you receive a denial or unexplained delay, request the reasons in writing; you may also contact the N.C. Department of Insurance for assistance and consider legal options.
Conclusion
To submit additional PIP/MedPay bills in North Carolina, send a timely, written claim package to your insurer’s claims department that includes your claim number, itemized accident-related bills, and supporting records. Use the insurer’s preferred channel, keep proof of delivery, and respond quickly to any requests. The key threshold is that charges are reasonable, necessary, and caused by the crash. Next step: file your proof-of-loss package with your insurer and track deadlines in your policy.
Talk to a Personal Injury Attorney
If you’re dealing with unpaid accident-related medical bills and MedPay/PIP questions, our firm has experienced attorneys who can help you understand your options and timelines. Call us today at 919-341-7055.
Disclaimer: This article provides general information about North Carolina law based on the single question stated above. It is not legal advice for your specific situation and does not create an attorney-client relationship. Laws, procedures, and local practice can change and may vary by county. If you have a deadline, act promptly and speak with a licensed North Carolina attorney.
