Billing auto insurance for medical transportation: PIP, no-fault claims, and what Michigan pays for rides

After a car crash, the injured person’s own auto policy often pays for rides to treatment. In no-fault states that coverage is called personal injury protection (PIP), and it pays regardless of who caused the accident, up to the policy’s limits. Each state writes its own rules about what PIP covers, how much it pays for a ride, and whether a transportation company can be paid directly. Get those answers before the first ride, not after the insurer cuts the bill. A rider’s health plan is a separate question, covered in does private insurance cover medical transportation.

The same ride under four state laws

The same van ride to physical therapy is treated four different ways in four no-fault states. This is the starting point for each:

Before the first ride: intake that protects the bill

Collect these details when the ride is booked. Each one is harder to get after the rides have happened.

1. The claim. Insurer name, claim number, adjuster’s name and contact, the policyholder, and the accident date.
2. The coverage level. In Michigan, policies issued or renewed after July 1, 2020, carry a chosen limit for these benefits: $50,000 (available only to Medicaid enrollees, with conditions on household members), $250,000, $500,000, or no limit. A named insured with Medicare Parts A and B may opt out of the coverage entirely (MCL 500.3107d). A rider near the limit can run out mid-course.
3. Proof the rides are needed. A physician’s order or a disability certificate stating the rider cannot drive. In the July 2025 Michigan appeal described below, the independent reviewer found the rides necessary in part because the rider’s physician had certified that driving would be difficult, impossible, and dangerous.
4. Approval from the adjuster. Ask whether rides are approved, for which appointments, and for how long. Get it in writing.
5. An assignment, where allowed. New York prescribes the NF-AOB form for assignments to health care providers. Michigan voids any assignment of benefits payable in the future (MCL 500.3143), so an assignment there should cover rides already given and be renewed as rides continue.
6. Who pays if the insurer will not. A signed agreement on what the rider owes for denied rides, where your state and any payer contract allow it. Lawyers sometimes guarantee rides through a letter of protection, which has its own rules.

Michigan: reasonable charges, not the fee schedule

Michigan’s 2019 reform capped what providers can charge auto insurers. For treatment Medicare does not pay for, the cap is 52.5 percent of the provider’s charge as of January 1, 2019, for services after July 1, 2023, under MCL 500.3157(7). That cap does not apply to non-emergency medical transportation. DIFS Bulletin 2021-38-INS, issued October 11, 2021, says services not provided by physicians, hospitals, clinics, or similar providers are not subject to section 3157. It names non-emergency medical transportation in its list of examples. Those charges fall under MCL 500.3107(1)(a), which pays “reasonable charges incurred for reasonably necessary products, services and accommodations.” Insurers that had applied the fee schedule to such services were told to reprocess the claims.

What counts as reasonable is the fight. DIFS order 25-1411, entered July 31, 2025, shows how the department decides it. A transportation company billed an insurer using T2003 for each trip and T2007 for waiting time. The insurer paid some dates at the 95th percentile of a FAIR Health fee reference and denied others after an independent medical examination. DIFS reversed both determinations. It found the denied rides necessary and priced the underpaid ones at the 80th percentile of FAIR Health charge data for the area (geozip 481), a method Michigan’s Court of Appeals approved in 2003. The order applies only to the rides it covered, but it tells you what evidence persuades the department: medical necessity records and charges in line with local norms.

Getting paid on time

Michigan’s deadlines reward fast billing:

• 30 days to pay. Benefits are overdue if not paid within 30 days after the insurer receives reasonable proof of the fact and amount of the loss (MCL 500.3142).
• Bill within 90 days. If you send the bill more than 90 days after the ride, the insurer gets 60 more days before payment is overdue.
• 12 percent interest. Overdue benefits bear simple interest of 12 percent a year.
• The one-year look-back. Once notice has been given or a payment made, a lawsuit can recover only losses incurred in the year before it is filed. The clock pauses from a specific claim for payment until the insurer formally denies it, but only if the claim is pursued with reasonable diligence (MCL 500.3145).

When the insurer cuts or denies a bill

By providing services to people covered by PIP after July 1, 2020, a provider is considered to have agreed to submit records for utilization review and to comply with DIFS decisions (MCL 500.3157a). If the insurer decides a ride was not needed or cost too much, you can appeal to DIFS within 90 days of the date on its determination or bill denial. Late appeals are refused. Email form FIS 2356 to DIFS-URAppeals@michigan.gov with:

• A narrative explaining why the ride was appropriate and the amount you believe you are owed.
• Every page of each denial or explanation of review.
• The billing form for the rides at issue.
• Supporting records, such as the physician’s order and the trip logs.
• In a dispute over the amount for an accident on or after June 11, 2019, your charge list as of January 1, 2019, or a note that your company or the service did not exist then, plus attestation form FIS 2376.

DIFS will not accept documents after the appeal is filed, so send everything at once.

New York: a $25 daily limit

New York’s basic no-fault coverage pays up to $50,000 per person in basic economic loss. Transportation by van falls in a small corner of it. Insurance Law 5102(a)(3) pays “all other reasonable and necessary expenses” up to $25 a day for one year from the accident, and the policyholder notice in New York’s no-fault regulation gives transportation to and from a health service provider as an example. Ambulance service is listed separately as a medical expense, under 5102(a)(1).

That classification sets the billing route:

• The limit is per day. A $120 round trip to physical therapy is reimbursed up to $25 for that day.
• The deadline is 90 days. The mandatory PIP endorsement requires written proof of claim for other necessary expenses within 90 days after the service, compared with 45 days for health service bills.
• The money goes to the rider. The regulation pays benefits to the injured person, and pays by assignment only to providers of health care services covered under 5102(a)(1) (11 NYCRR 65-3.11). For van rides, give the rider an itemized receipt and trip log to submit, and collect your fare from the rider.

Once proof of claim is complete, benefits are overdue after 30 calendar days and carry interest of 2 percent a month.

New Jersey and Florida

New Jersey’s PIP rule defines medical expense to include “reasonable and necessary expenses for ambulance services or other transportation” (N.J.A.C. 11:3-4.2). Rides are covered, subject to the policy and to the insurer’s approved decision point review plan, so ask the insurer whether rides need precertification. Where the PIP fee schedule lists no amount for a service, the insurer owes a reasonable amount based on the schedule’s amounts for similar services in the region. If there is nothing similar, it owes no more than the usual, customary, and reasonable fee (N.J.A.C. 11:3-29.4(e)). That rule is the one a van ride falls under. The schedule’s ambulance exhibit (Exhibit 4) lists only ambulance codes, A0425 through A0436, and no wheelchair van or other non-ambulance transportation code.

Florida is narrower. Its PIP statute pays 80 percent of reasonable expenses for medically necessary medical, surgical, X-ray, dental, and rehabilitative services, “including prosthetic devices and medically necessary ambulance, hospital, and nursing services,” up to the $10,000 limit for medical and disability benefits. It pays only if the injured person gets initial care within 14 days after the crash (Fla. Stat. 627.736). The only transportation the statute names is ambulance service and emergency transportation by a provider licensed for it. A wheelchair van ride appears nowhere in the list. Plan to bill the rider, a health plan, or the rider’s lawyer, and check whether the policy carries medical payments coverage.

When the rider also has Medicaid

Medicaid pays after any liable third party. Under 42 CFR 433.139, when a state has established the probable existence of third-party liability at the time a claim is filed, it rejects the claim and returns it to the provider to determine the amount the third party owes. It then pays whatever its schedule allows above the third party’s payment. If the state learns of the coverage after it has paid, it seeks recovery from the insurer. For broker trips, tell the broker about the auto claim when you learn of it. The third-party liability entry explains how states find other coverage.

Records an adjuster or reviewer will ask for

Auto insurers review transportation bills line by line, and the records you keep at the time decide the outcome. Keep, for every ride:

• The date, pickup and drop-off addresses, and the appointment the ride served.
• Pickup and drop-off times, and waiting time if you bill it.
• Miles driven, and the rider’s signature.
• The physician’s order or disability certificate in force on that date.
• Your rate sheet and an itemized bill, with the codes the insurer asked for.

NEMT documentation requirements covers the same records for Medicaid trips.

Keeping the trip record in HealthRide

HealthRide records each trip’s GPS-recorded miles, pickup and drop-off times, and the rider’s signature, captured in the driver app as the ride happens. The trip log exports to CSV or PDF, which gives an adjuster or a DIFS reviewer the ride-by-ride record without retyping anything. See reports.