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Medical Bill Payment Ambushes


Legally, workers’ compensation insurers must directly pay all job injury-related medical bills. Unfortunately for victims, insurance companies don’t always follow these requirements. They’re determined to cut benefits and pad their profits, even though these companies already earn more than $1 trillion a year.

Furthermore, under the law, injured workers aren’t financially responsible for any unpaid charges, such as the gap between the out-of-pocket cost and the insurance reimbursement cost for a medical service. Hospitals, like insurance companies, don’t always follow the rules.

A Tampa workers’ compensation lawyer performs a number of jobs. One of them is ensuring that insurance companies and hospitals follow the rules. This oversight helps ensure that job injury victims get the financial benefits they need and deserve.

Reasonably Necessary

The reimbursement requirement only applies to reasonably necessary medical bills. Frequently, insurance companies don’t examine individual cases to determine what’s reasonably necessary. Instead, they use boilerplate tables.

So, “reasonably necessary” becomes “average amount.” For example, when most people break their arms, they need some ER treatment, a few follow-up visits, and a few physical therapy sessions. However, if the broken arm is severe, the medical treatment will be much more intense, and much more costly.

Furthermore, “reasonably necessary” doesn’t mean “cheapest available.” Almost any doctor could set a broken arm bone. But only a few doctors are qualified to treat job injury-related broken bones. These doctors might charge more than others. A Tampa workers’ compensation lawyer helps ensure that victims get the treatment they need, not the treatment an adjuster is willing to pay for.

Fair Debt Collection

The aforementioned private pay-insurance reimbursement gap is usually very large. The “sticker price” for an MRI might be two or three thousand dollars, and the insurance reimbursement rate might be two or three hundred dollars.

When hospitals send bills to injured workers for the difference between these two rates, the stress makes injury recovery more difficult, which means more treatment, more bills, and the downward spiral continues.

In their defense, or at least partially in their defense, many providers use separate billing departments for job injury-related matters. These billing departments might be unfamiliar with the rules.

However, as the old saying goes, ignorance of the law is no excuse. If hospitals send bills to victims, they violate state and federal law, and punishment is forthcoming. This punishment could include treble damages in some cases.

Independent Medical Examination

Florida workers’ compensation law isn’t entirely victim friendly. In most cases, job injury victims must see company doctors. These doctors have a legal and ethical responsibility to prioritize the patient’s health and safety above everything else. However, they’re also keenly aware of who signs their paychecks.

Fortunately, Florida law allows job injury victims to get second opinions. We usually ask independent doctors to review treatment plans, and if they see anything amiss, we take steps to ensure that victims receive proper treatment.

This treatment often includes an independent medical examination from a doctor who’s experienced in job injury-related matters.

 Contact a Dedicated 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. We routinely handle matters throughout the Tampa Bay area.



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