Who Pays the Bills?

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When your patient who is either a bicyclist or a pedestrian has been injured by a vehicle, Oregon law states the order of which insurance is required to pay for their medical treatment. The following is the order determined by the statute:

  1. Workers’ Compensation will be the first available resource, if a pedestrian or bicyclist was injured by a vehicle while on the job;
  2. PIP through the injured person’s automobile insurance;
  3. The insurance of any family member the injured person lived with when the injury occurred;
  4. The injured person’s health insurance, whether that be private insurance or Medicaid / Oregon Health Plan;
  5. PIP coverage through insurance that covered the vehicle involved in the collision.

In the Portland Metro area, we have many folks who choose not to own a vehicle, and may have no access to PIP through a spouse or relative’s automobile policy. In these cases, it’s important to open a PIP claim through the at fault driver’s insurance, even if your patient has health coverage.

PIP coverage has more extensive coverage than most health plans. If your patient has health coverage, this will require that all bills be submitted to the health insurer first, even if it’s for a type of treatment that is not covered, or only minimally covered, by the health plan.

For treatment not covered by the health plan, or that exceeds the number of treatments allowed by the plan, the health insurer will issue a denial or an explanation of benefits (EOB). Once the denial or EOB is issued, you can submit your bill, along with a copy of the denial or EOB, to the at fault driver’s PIP for reimbursement.

An additional benefit to your patient is that the at fault driver’s PIP will cover any deductibles or co-pays that your patient would have to pay in relation to the claim.

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