Tag Archives: medical bills

Work Comp Approved My Medical Care; Why Am I Still Getting Billed?

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Sometimes insurance companies do the right thing in workers’ compensation claims but medical offices don’t. A prime example of this is overly aggressive billing for medical services.

Under Nebraska law, an employer may only charge a certain amount for medical care covered by workers’ compensation care. Most importantly, the injured worker should pay nothing for medical care if it is covered by workers’ compensation. In Nebraska, workers’ compensation generally pays doctors a higher rate than private insurance.

The problem is that sometimes clinics will try to collect the balance from injured workers under the assumption that workers’ compensation works like private health insurance. Injured workers who get their care paid for by workers’ comp aren’t subject to deductibles or co-pays.

Sometimes clinics just make stupid mistakes.  I recently had a client who was billed by a surgical office for the expense of the employer’s lawyer meeting with the surgeon. Today, I had a client who was being flat out doubled billed.

Even if you are getting your medical paid, it would make sense to speak with an experienced workers’ compensation attorney in a scenario when you are being overbilled for care related to workers’ compensation. The same also goes if a medical office is aggressively trying to collect an unpaid bill from you. A knowledgeable lawyer can fight an unjustified collections case and can also advise you about your workers’ compensation.

Oftentimes, financial problems related to workers’ compensation injuries stem from an employee not getting loss-of-income benefits while they are healing. I defended a collection action for a client who was forced to use his wife’s health insurance to pay medical bills for his workers’ compensation-related medical bills. Having the ability to successfully prosecute a workers’ compensation case can relieve those financial pressures in some circumstances.

Contact a Workers’ Compensation Lawyer, Even if Your Medical Bills Are Being Paid: Here’s Why

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Nebraska is a state that has a “prompt payment rule” for medical expenses in workers’ compensation cases. This means that so long as your employer has sufficient knowledge that your medical care is necessary because of the injury, your bills should be paid. This is a huge plus because even a minor workers’ compensation injury can cause an employee to rack up thousands of dollars in medical bills.

In Nebraska, delay of medical payment is treated as a denial of a claim. That is why a delay in paying for medical bills from a work injury gives the employee the right to pick their own doctor for a work injury.

The issue of doctor choice brings up a couple of the hidden dangers of the prompt payment rule.  Many times, employers will promptly pay medical expenses for doctors who will oftentimes release employees before they are done healing and return employees back to work before they are ready. Employees need to be able to know their doctor-choice rights before they agree to an employer/insurer-oriented clinic or doctor – especially if that doctor is not their family doctor.

Secondly, employees can get lulled into contentment when an employer pays their medical bills. Medical benefits are one aspect of workers’ compensation benefits; the other is loss of income benefits. An employer/insurer may use their leverage with a doctor to minimize loss of income benefits. Also, when employees get into litigation, they are oftentimes confused by the fact that an employer will pay for medical benefits, but not loss of income benefits, or will deny that the injury is even work related. This is related to the prompt payment rule. Just because an employer pays medical bills, that doesn’t necessarily mean that they or a workers’ compensation judge will believe those medical bills are related to the work accident.

Medical Bills After an On-The-Job Injury – Do I Have to Pay Them? (PART 2)

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A few weeks ago we shared a guest post from Kit Case of the Causey Law Firm in Seattle on medical bills. Today we present part two in this series.

In our last post about dealing with medical bills after an on-the-job injury, our quick answer was that you most likely do not have to pay these bills, depending on your specific circumstances. So, let’s say that you don’t actually have to pay these bills, but you’ve already paid some of them. Here are a few more questions and answers.

What About Everything I Have Already Paid? Can I Be Reimbursed??

Question: My private insurance has covered the cost of my medical care while my workers’ compensation claim was in dispute. I have been making payments to my doctor’s office, too, for co-pay and other charges. Can I be reimbursed? What about my prescription costs?

Answer: Yes, you can be reimbursed for your expenses!

You can be reimbursed for medical expenses, prescription costs, travel expenses (when appropriate) and other costs once your workers’ compensation claim has been approved. In Washington State, though, the Department of Labor and Industries will only make payment to medical providers directly for services rendered, so you cannot receive direct reimbursement for payments to your doctor, physical therapist, chiropractor, etc… These providers will need to submit bills for services under the allowed claim, receive payment for those services, and then issue refunds to you and your private insurance carrier for payments previously made. This can be a difficult process, though, as the medical providers have already been paid, often at a higher rate than what is allowed under a workers’ compensation claim, so they often would prefer to not go to the hassle of rebilling for services they have already been paid for and then make refunds to you and/or your insurance carrier in excess of the workers’ compensation payments.

Prescription costs are easier to have reimbursed. If you have receipts, you can submit a Statement for Pharmacy Services form to request reimbursement. If you do not have your receipts, you can submit this form with a printout from your pharmacy of all filled prescriptions related to the claim. The printout and the form must be signed by the pharmacist to certify that you have paid for the claimed prescriptions. Reimbursement for pharmacy expenses will be paid to you directly.

Similarly, travel expenses can be claimed under certain circumstances. If the travel was at the request of the Department of Labor and Industries, or if travel greater than 30 miles round-trip was needed to see the closest appropriate medical provider, then you can request reimbursement of mileage at the State’s rate and some extra expenses, such as ferry fares, parking charges or meal expenses. The Travel Reimbursement Request form must be submitted using the appropriate code for the type of expense incurred and receipts must be provided to support the reimbursement request. As with pharmacy reimbursements, travel reimbursements are paid to you directly.

Medical Bills After an On-The-Job Injury – Do I Have to Pay Them?

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Today we have a guest post from Kit Case, our friend at the Causey Law Firm of Seattle, WA, which was founded by my good friend and fierce worker advocate Jay Causey. Workers compensation claims can affect how billing is handled when it comes to medical concerns. This article discusses Washington state law. Nebraska and Iowa law have essentially the same rules, but be sure to consult with a workers’ compensation attorney who is familiar with the laws in your state if you have questions or concerns.

Question: I’m Getting Medical Bills, but I have a Workers’ Compensation Claim – Do I have to Pay Them?

Answer: No! Well, maybe…

If the bill you have received is for a balance due, left over after payment from the Washington State Department of Labor and Industries claim for services rendered by a medical provider, then you do not have to pay the bill. Under RCW Title 51 and WAC Chapter 296-20 and all of its provisions, the medical provider is required to accept payment from the workers’ compensation claim for services rendered as payment in full, and is not allowed to seek from the claimant payment of any additional balance. To be more specific, if a charge is billed to the workers’ compensation claim for a particular service and payment is made by the claim for that service in such a way that a balance remains for that same service, the medical provider is not entitled to payment from the claimant for that difference.

In contrast, if authorization for a medical service is denied under the claim completely, you may, under those circumstances, be required to make payment for any denied services. If you also have private medical insurance, your medical provider may be able to receive payment for treatment services denied under the workers’ compensation claim by submitting a bill for his or her services to the private insurance carrier.

To find out what you should do if you have already paid a medical bill for an on-the-job injury, check back in soon for the next installment of this series.

Emergency Medical Treatment Does Not Need To Be Authorized

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If you don’t obtain prior approval for emergency treatment, you can still file a workers’ comp claim.

Today’s post is by my colleague Matthew Funk of New York.

When an injured worker needs emergency medical care, prior authorization isn’t always possible and obtaining it does not bar a workers’ compensation claim. When a worker is hurt at work and is rushed to the emergency room for treatment, there often isn’t enough time to seek authorization from an insurance company and to obtain a claim number.

At the time of the treatment, if possible, the injured worker should let the hospital and medical provider know that the injury occurred at work and the exact details of all his or her injuries. This is sometimes an effort since emergency staff are rushed and understaffed. After the emergency care is provided the worker should immediately seek the guidance of an attorney to assist in filing a claim and obtaining reimbursement for the medical care.

At the time of the treatment, if possible, the injured worker should let the hospital and medical provider know that the injury occurred at work and the exact details of all his or her injuries.

The law provides that the cost of Continue reading