Medpay Inquiry from Other Party’s Insurance
I’m in Virginia, and the other party was deemed 100% at fault in my recent car accident.
I’ve finished my physical therapy and submitted all relevant documentation to the other party’s insurance. However, I was informed today that my claim is still under review due to a “gap in treatment.” The incident occurred mid-November, and I attended two orthopedic appointments before starting physical therapy in January. The insurance company is calling this gap into question, despite the fact that I went to my appointments as scheduled.
What steps can I take to address this issue?
It sounds frustrating to deal with delays in the claims process, especially after being found 100% at fault. Here are some steps you can take:
Clarify the “Gap”: Ask the insurance adjuster to provide more details about the specific gap in treatment they are referencing. Understanding their concerns can help you address them more effectively.
Documentation: Ensure that all your medical records, including the dates of your orthopedic appointments, physical therapy sessions, and any other relevant documentation, are organized and submitted to the insurance company. This helps demonstrate continuity of care.
Submit a Letter of Explanation: Consider writing a letter to the insurance company outlining the timeline of your treatment, including any reasons for delays, such as scheduling or recovery time.
Consult Your Provider: Speak with your physical therapist or orthopedic doctor about the situation. They may be able to provide supporting documentation or clarification about the necessity of treatment and any reasons for delays.
Follow Up Regularly: Stay in regular contact with the insurance adjuster to check on the status of your claim. This can help keep your claim moving forward and demonstrate your persistence.
Consider Legal Advice: If the situation doesn’t resolve and you feel your claims are being unjustly delayed or denied, it might be wise to consult with a personal injury attorney who can provide guidance specific to your circumstances in Virginia.
Stay proactive and keep records of all communications with the insurance company to have a clear path forward. Good luck!