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Financial Hardship Form

Table of Contents

Please see the attached Financial Hardship Form. It is to be used when a patient is treating at your office and cannot afford to pay you the full co-pay amount due to financial hardship.

Click here to see a nice PDF form that you can download for free

A couple of things to remember:

  • This form is not supposed to be signed by every patient.
  • You do not need to waive the whole co-pay; you have the option of partially waiving the co-pay
  • This form may be used to waive the deductible and/or the co-pay.

FINANCIAL HARDSHIP FORM

  1. I am over the age of 18 and I am legally competent.
  2. I was involved in a motor vehicle collision.
  3. At the present time, I request my deductible, if applicable, and my 20% responsibility of Personal Injury Protection benefits be waived or reduced due to a financial hardship.
  4. I understand that if my attorney reaches a settlement with regards to the above mentioned motor vehicle collision then this Financial Hardship Agreement shall not prevent the medical provider from receiving a portion of the settlement proceeds to cover my medical expenses.

________________________

Patient Signature

_________________________

Print Patient Name

Is Massage Reimbursable Under The New PIP Law?

Published on: Apr 17, 2018 @ 12:00

Does PIP Pay For Massages?

The Law

Statute for PIP: 627.736(1)(a) 5. Medical benefits do not include massage as defined in s.480.033 or acupuncture as defined in s.457.102, regardless of the person, entity, or licensee providing massage or acupuncture, and a licensed massage therapist or licensed acupuncturist may not be reimbursed for medical benefits under this section.

Statute for Massage Practice: 480.033 (3) Massage means the manipulation of the soft tissues of the human body with the hand, foot, arm, or elbow, whether or not such manipulation is aided by hydrotherapy, including colonic irrigation, or thermal therapy; any electrical or mechanical device; or the application to the human body of a chemical or herbal preparation.

My Interpretation

No. But I suggest chiropractors perform manual therapy instead.

There are two parts about the new law I’d like to analyze.
The first part states medical benefits do not include massage as defined by 480.033. Chapter 480 is the law that regulates massage therapists. It doesn’t regulate chiropractors. If this were the only part of the law then I would argue that chiropractors should be reimbursed for massage.

The second part of the law is a catch all. It states regardless of the person, entity or licensee providing massage. Because of this part, I think it is pretty clear that the legislators didn’t want to allow reimbursement for massage by any medical provider.

Also keep in mind that Florida Legislators could have mentioned CPT code 97124 (massage) in the law but they didn’t! Instead of just saying PIP will not reimburse 97124 they went the long route.

Based on the thousands of PIP claims I’ve handled under the old PIP law I know that insurance companies are going to deny 97124 every time they see it. I’m suggesting my clients perform manual therapy instead of massage. Avoid the headache!

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