How your medical bills actually get paid in New Jersey, and what to do when they do not.
Your own insurance pays first, whoever caused the crash.
← The FifteenNew Jersey is a no fault state for medical treatment. Your own auto insurance pays your medical bills after a crash through Personal Injury Protection, called PIP, regardless of who caused it.
Not the other driver's insurance. Yours.
When you bought your auto policy you chose whether auto PIP or your health insurance pays first. Choosing health insurance as primary lowers the auto premium, so a lot of people picked it without understanding what it meant.
If you picked health primary, your health insurance pays the medical bills and you have a deductible and copays. PIP then covers some of what health insurance does not.
Almost nobody remembers which they chose. It is on the declarations page of your auto policy, usually one line.
Most people never hear about any of these, and each one can mean the difference between treatment being paid for and not.
Medicaid is generally a payer of last resort. That means it is not supposed to sit in front of your auto PIP.
If your auto policy has health insurance listed as primary and your health coverage is Medicaid, that is a problem that needs correcting. The election may need to be converted so PIP pays first. People in this situation get bills denied by both sides and assume they are stuck. They are not.
You were hurt in New Jersey but your car is insured somewhere else. People assume New Jersey PIP has nothing to do with them.
New Jersey has what is called the deemer statute. If your out of state insurer is authorised to do business in New Jersey, your policy may be treated as though it provided New Jersey PIP coverage for a crash that happens here, even if the policy itself says nothing about it.
That can open up medical coverage you did not know you had. It can also bring consequences with it, including limits on what you can recover for pain and suffering, so it matters both ways and it is worth understanding before anyone makes decisions for you.
Struck while walking, on a bike, or in a car with no insurance, and you have no auto policy of your own and no resident relative with one.
There is still a source of PIP in New Jersey for people in exactly this position, administered through the state's guaranty arrangement. There are requirements and there are deadlines, and the application is not something most people would find on their own.
If you were a pedestrian, a passenger in someone else's car, or you do not own a vehicle, you may still have PIP available.
This gets complicated quickly and the order matters. Call before you assume you have nothing. This is the single most common thing people get wrong, and the cost of being wrong is not treating at all.
New Jersey PIP policies generally require certain treatment to be approved in advance. Physical therapy past a certain point, injections, MRI, surgery. It is called decision point review or precertification.
Your provider usually handles this, but not always, and when it is missed the bill gets denied.
Ask your provider directly whether they have submitted the precertification. Do not assume.
Some providers will not take PIP. Some want payment up front. If you are hurt and you are being turned away, that is a problem worth solving rather than giving up on.
There are providers throughout New Jersey who regularly treat under PIP and who understand the precertification process. Call me and I will give you names, more than one, and you choose.
If you stop treating for a few weeks because you feel a bit better, or because the appointments are inconvenient, or because a bill scared you, that gap becomes the centre of the insurance company's argument.
They will say you must have recovered. It does not matter that you were busy, or that you could not get a ride, or that nobody called you back.
If you need to stop, tell your doctor why and have it noted. A documented reason is a very different thing from an unexplained gap.