Personal Injury Protection May Entitle You to Services Not Covered By Your Health Insurance Policy

It is very common to discover (especially after a recent auto accident or similar surprise trauma) alternative health treatment services such as visits to a chiropractor or acupuncture treatments are not covered by your average health insurance policy. According to health insurance expert Louise Norris, a contributor to and chiropractic visits and services are commonly excluded from many health insurance policies. “In the under-65 market, individual health insurance is not specifically required to cover massage therapy, acupuncture, or chiropractic care,” says Norris in an article at the Huffington Post addressing the things insurance companies do not cover.

Seeking alternative treatment with a chiropractor

This lapse in coverage might be deemed inessential to most; however, after experiencing trauma from an automobile accident or similar event, one may find themselves in dire need of such treatments. One such person in need of chiropractic treatments, resulting from a car accident, became a patient at Dupilka Family Chiropractic.

Taking a look at DUPILKA FAMILY CHIROPRACTIC, vs. MET LIFE AUTO & HOME we can see how personal injury protections enabled a patient of Dupilka Family Chiropractic, services that were otherwise not covered by their health insurance policy. Said patient was recommended hot and cold pack treatments which had an approximate cost of $30 dollars a treatment.

The patient’s health insurance policy Harvard Pilgrim Healthcare (HPHC), at the time, included chiropractic services, but with the specific exclusion of hot and cold pack treatments from coverage. Pursuant to G. L. c. 90A, § 34A regarding personal injury protection, MetLife paid the first $2,000 of the insured’s medical expenses leaving the patient and Dupilka Family Chiropractic in a precarious position as to how the hot cold pack treatments would be paid for.

Upon reaching $2,000 in expenses MetLife redirected DuPilka to send all treatment bills to HPHC for payment. HPHC denied reimbursement for all thirty-six hot and cold pack treatments. HPHC’s payment policy pointedly excluded hot and cold pack treatments from reimbursement. So what happened, who was responsible for providing payment?

The precedent was finely established in the case Dominguez v. Liberty Mut. Ins. Co., 429 Mass. 112, 112-113 (1999) that services not paid for by a health insurer are not subject to reimbursement from PIP benefits if the “health insurer would have covered medical services had the claimant sought treatment in accordance with the health insurer’s plan.” HPHC specifically excluded hot and cold pack treatments from the insured’s health insurance policy and only provided coverage for “care within the scope of standard chiropractic practice.” Having specifically mentioned the hot cold pack treatments as not being a treatment covered, it was determined by the judge that the treatments were not standard treatments within the chiropractic practice.

MetLife argued hot and cold packs were a standard treatment, however with the specific mention of them not being covered, it fell on MetLife under PIP benefits to pay Depulka for the services rendered to their patient from a resulting car accident.

If you, or a loved one who is seeking alternative treatments for injuries resulting from an automobile accident, you may have options for obtaining compensation. Plymouth County personal injury law attorney Michael S. Mehrmann has spent many years helping people from across Plymouth County, including in Kingston, Plymouth, Marshfield, Hanson, Carver, Pembroke, and Duxbury, deal with their legal needs. To find out more about how we can assist you, call (781) 585-3911 or contact us online.