How Medical Bill Payment Works in Job Injury Cases

Insurance companies, including workers’ compensation insurance companies, pay medical bills according to a pre-negotiated fee schedule. If workers’ compensation covered a reasonably necessary expense, the provider must accept payment per the fee schedule from the workers’ compensation insurance company. Frequently, to collect more money, the provider claims the expense wasn’t covered or wasn’t reasonably necessary and bills the job injury victim.

Under the terms of the provider-insurance company agreement, the job injury victim should never get a bill. If you receive one, immediately speak with a Tampa workers’ compensation lawyer. A lawyer protects your rights in and out of court. Stress over medical bill payment delays injury recovery. A victim has the right to a peaceful and speedy medical recovery, so s/he can get back to work as quickly as possible. Unfortunately, most providers are more interested in their own profits than their patients’ recoveries.

Not a Covered Medical Expense

Workers’ compensation coverage is comprehensive. It doesn’t start or end with the hospital bill. Categories of covered expenses include:

• Transportation: Job injury victims have basically three options to reach a hospital: self-driving or rideshare, ambulance, and medevac helicopter. Frequently, hospitals claim that an ambulance or medevac ride isn’t a covered expense, even if that’s the transportation another hospital employee authorized.
• Emergency Care: Workplace accidents often cause catastrophic (life-threatening) injuries. Therefore, most job injury victims need multiple surgical procedures. Separate procedures cost more than a single combined procedure. Therefore, the provider often claims the breakup wasn’t covered and charges the patient for the extra money.
• Follow-Up Treatment: Job injury treatment doesn’t end at the emergency care phase. In fact, in most cases, it’s just beginning. Fee schedules often cover a set number of follow-up visits. But the doctor, not the insurance company, decides how many follow-up visits a victim needs.
• Physical/Occupational Therapy: After medical treatment ends, physical therapists help victims regain lost muscle and other functions. Occupational therapists help victims learn a new trade if they cannot go back to their old jobs. All victims progress at different rates, regardless of what a fee schedule says.

Workers’ compensation also covers all ancillary medical costs, such as prescription drugs and medical devices, regardless of their costs.

A Tampa workers’ compensation lawyer can also obtain money for lost wages. Most victims receive two-thirds of their average weekly wage for the duration of their temporary or permanent disabilities.

Not a Reasonably Necessary Expense

Doctors frequently use experimental or out-of-the-box methods to treat job-related injuries. Medical providers are quick to label these treatments as “not reasonably necessary” and bill patients for them.

Therapy outcome doesn’t make it reasonably necessary. A doctor, including an independent doctor, must make that assessment. Therefore, attorneys often partner with independent doctors in these situations, who testify about the reasonableness of a treatment.

If the matter goes to an Administrative Law Judge hearing, and it probably will, a doctor’s opinion about what’s reasonably necessary is much more compelling than a hospital administrator’s opinion.

 Reach Out to a Tough-Minded Hillsborough County Attorney

Injury victims are entitled to important financial benefits. For a free consultation with an experienced workers’ compensation lawyer in Tampa, contact Kobal Law. Virtual, home, and hospital visits are available.