As a practicing No-Fault attorney for over 10 years, I have seen a significant increase in the abuse of verification requests utilized by Insurance Carriers as tool to deny, delay and not pay viable claims submitted by legitimate healthcare practitioners. This can be extremely frustrating for a healthcare provider. Our firm is extremely knowledgeable concerning the regulations and developing case law guiding the use and limitations regarding this powerful tool. It is very important that you are represented by attorneys that have a command of this area of law and that you have an open line of communication to address new verification issues that develop.
As with most areas in No-Fault, verification requests are guided by time constraints for healthcare providers. Most importantly, last year, the New York State department of financial services implemented the fourth amendment to 11 NYCRR 65-3 (Insurance Regulation 68-c) claims for personal injury protection (PIP) benefits. In particular, according to NYCRR 65-3.5 (o), a medical provider is required to respond to a verification request from an insurance carrier within 120 calendar days from the date of the initial request for verification. You must submit all such verification under the applicant’s control or possession or written proof providing reasonable justification for the failure to comply. This subdivision applies with respect to claims for medical services, to any treatment or service rendered on or after April 1, 2013 and with respect to claims for lost earnings and reasonable and necessary expenses, to any accident occurring on or after April 1, 2013.
It is important to make sure you respond to all verification requests, no matter how unreasonable and burdensome you believe they are. If you are receiving verification requests from Insurance carriers that you believe are unreasonable or burdensome, please feel free to contact me via email at firstname.lastname@example.org or (631) 656-8180. I can assist you with responding and explaining your legal rights and options available to you as a healthcare provider.
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