FAQs

Midlige Richter specializes in recovering wrongfully withheld revenue from healthcare clients. This is all we do. Our firm has roots in representing insurance companies in payment denial so our experience on both sides of the industry affords us an unparalleled, holistic understanding of the intricacies of PIP law and insurance company tactics. We have a long, proven track record and depth of experience with both large and small providers – making us uniquely qualified to navigate the reimbursement minefield for our clients. Midlige Richter is also unlike other firms in terms of our character. Clients find us refreshingly genuine and down-to-earth, yet when there’s work at-hand, we are highly passionate, hard-hitting, results-oriented people who treat client financial interests like our own – with a sense of urgency and with their best interests at heart. Our clients are our priority and they choose to work with us because we deliver results, we provide sound advice, we have proven experience, and because we are easy to do business with. We are transparent and fee friendly.

Personal injury protection (PIP) is an extension of car insurance available in some U.S., and mandatory in New Jersey. Basically PIP covers medical expenses and, in some cases, lost wages and other damages when someone is injured in a car accident. PIP is sometimes referred to as "No-Fault" coverage, because the statutes enacting and requiring PIP coverage are designed to ensure coverage is provided without regard to "fault," Simply stated, if you have PIP or No Fault coverage, your medical bills following a car accident are covered by your automobile insurance, irrespective of whether you were at fault or not in causing the accident.

A Personal Injury Protection (PIP) arbitration is filed when either an individual or medical provider has a dispute with the insurance company over PIP benefits. New Jersey’s PIP laws created a robust private arbitration system which is administered by Forthright Solutions Inc., a private arbitration management company. This system employs in excess of 60 Dispute Resolution Professionals, also known as DRPs or arbitrators. These DRPs are experts in PIP law, and work full-time to resolve the 50,000+ arbitrations filed each year.

Given the voluminous number of PIP disputes arising each year, New Jersey created a system that requires virtually all PIP disputes to be resolved by arbitration, as opposed to filing a law suit. While there are certain limited situations where PIP disputes are heard in court, the vast amount are heard and resolved through the arbitration process.

Yes. For a host of different reasons, many medical providers don’t take advantage of their rights to recover payment for treating automobile accident victims. Whether it is hospitals, surgery centers, or physicians, all too often they accept and write off an insurer’s underpayment or denial of benefits, even though by law, they have a legitimate claim to such compensation. It is our experience that providers who rigorously pursue PIP claim recovery, including with an aggressive look-back PIP audit, find that the revenue impact can be significant.

Insurance companies’ wrongful denial of legitimate claims is a well-established nationwide problem. In New Jersey, PIP is a highly regulated industry that is constantly changing. Insurer’s implement an ever-increasing number of strategies to prevent healthcare providers from recovering the money they earn treating accident victims. This fact, coupled with the fact that PIP laws are highly technical and constantly changing, dictate that medical providers need experienced legal representation, who are on the cutting edge of industry-wide developments and willing to strongly defend the rights of providers.

Contact our office about immediately conducting a PIP Audit. PIP audits are a powerful tool to pinpoint aggregate revenues due. They do not burden hospitals’ and providers’ resources. A no-cost PIP audit by an experienced legal team may reveal many cases in which insurers have shorted the provider. With aggressive legal representation – at no cost to the provider - revenue recovery payments may begin to flow within 60 days. Once an audit updates claim files, it’s prudent to have the legal team keep the provider current by reviewing new, incoming PIP claims to identify improper denials, revenue reductions, and otherwise dubious insurer tactics that keep you from the revenue you have earned.

Medical providers and billing managers must carefully scrutinize ALL payments for reductions to your billed charges. If you see an “allowed amount” as being $0, or anything that indicates the charge will not be paid, mark it for review, as there is a potential issue. If you see services being down coded or otherwise changed by the insurer, that is a reduction ripe for demand. If your patient is sent for an IME and benefits are subsequently suspended, that is a claim ripe for demand. Essentially, anytime the EOBs/EORs indicate no payment you have a likely issue for PIP arbitration. While a small percentage are legitimate denials (i.e., no coverage), the majority are not; so when in doubt, ask us. Medical providers and billing manager should be particularly mindful of when claims are past-due. EOBs/EORs are sometimes not sent and a claim could go unpaid for months and years without explanation. Once 60 days have passed, if no payment is received and there are no EOBs/EORs explaining the nonpayment, the claim is ripe for demand.

You don’t! Insurance companies often lead medical providers to believe that charges for treatment are not justified. If any of your bills have been denied or reduced, call our office to find out how you can get the money your medical office deserves. Do not let the insurance companies attempt to intimidate you, we’ll explain how we can maximize PIP fee recovery efforts.

Insurance companies make money by refusing to pay valid bills, and part of this strategy is to refuse otherwise appropriate treatment when pre-certification is sought. This tactic is most frequently encountered when providers seek authorization to perform surgery. This places medical providers in the untenable position of having a patient who requires surgery to treat their injuries, and having the responsible insurer stating they will not reimburse the provider for the services. Midlige Richter specializes in aggressively pursuing these cases through the arbitration process, and has had remarkable success in getting prospective surgeries denials overturned and approved.

Generally, you should cooperate with the request to the best of your ability. If you believe an insurance company is asking for too much information, or if you have concerns about sharing any specific information with them, feel free to contact our office and get our opinion. There is no charge for the consult.

It costs nothing upfront to consult with Midlige Richter. Our legal team offers a free, no obligation consultation to all new clients. We’re also willing to work on a contingency fee basis, so you may not need to worry about legal costs upfront. If we are forced to arbitrate your claim to secure payment, and are successful, the insurance company will also pay your legal fees!