Question about MedPay from the other party’s insurance
I live in Virginia, and the other driver was determined to be 100% at fault in my car accident.
I’ve completed physical therapy and submitted all the necessary documentation to the other party’s insurance. Today, I was informed that my claim is still being reviewed due to a “gap in treatment.” The accident occurred in mid-November, and I had two orthopedic appointments before starting PT in January. The insurance company claims this gap raises questions, even though I attended the appointments as they were scheduled.
What steps can I take to resolve this?
It’s frustrating to deal with insurance companies, especially when you’ve submitted all necessary documentation. Here are a few steps you can take:
Clarify the Gap: Request a written explanation from the insurance company regarding what they consider a “gap in treatment.” This will help you understand their concerns and address them more effectively.
Provide Additional Documentation: If you have any medical records or notes from your appointments that support the timeline of your treatment, be sure to submit those. Documentation that clearly outlines the progression of your condition and the reasons for any delays can be helpful.
Follow Up with Your Providers: If possible, ask your healthcare providers for a summary or statement explaining why there was a break between your ortho appointments and physical therapy. They may be able to provide information that addresses the insurer’s concerns.
Stay in Communication: Keep in regular contact with the insurance adjuster handling your claim. Politely ask for updates on the review process and let them know you are working to address their concerns.
Seek Legal Advice: If you continue to encounter obstacles or feel that your case isn’t being handled fairly, it may be worth consulting with a personal injury attorney. They can provide guidance based on the specifics of your situation and help advocate on your behalf.
Be Patient but Persistent: Insurance investigations can take time, but don’t hesitate to stay on top of the situation. Asking for a timeline or expressing the urgency of your case may help expedite the process.
Ultimately, maintaining thorough records and open communication will aid in resolving this issue. Good luck!