Kentucky Department of Insurance Issues PIP Fee Discount Clarification
On October 4, 2013 the Kentucky Department of Insurance (DOI) issued bulletin 2013-04 regarding Motor Vehicle Reparations Act commonly known as Personal Injury Protection ("PIP”) or Kentucky No-Fault Benefits. The bulletin clarifies that the law allows for negotiated payment rates for Kentucky No-Fault benefit payments; however, it does not allow for an insurer to arbitrarily and unilaterally reduce provider fees.
The current portion of the Motor Vehicle Reparations Act clarified in the October 4 bulletin reads as follows:
The October 4, 2013 DOI bulletin states that a Reparations Obligor (PIP Carrier) cannot pay a provider less than the amount the provider billed for Automobile No-Fault Benefits, unless the PIP Carrier can produce a written agreement between the insurer or third party administrator (TPA) and the provider allowing the discount. The insurer must also identify the agreement on the explanation of benefits when a reduction is made and the agreement must state that it is applicable to Kentucky No-Fault Benefits. Questions regarding the bulletin can be directed to Russ Hamblen via email: Russell.Hamblen@ky.gov at the Kentucky Department of Insurance. The bulletin can be found here: PIP Bulletin
If you have had your claim payment reduced by a PIP Carrier without an agreement with the carrier or TPA, please file a complaint with the KY DOI at: http://insurance.ky.gov/Home.aspx