Billing Injured Worker under PA Workers Comp

Billing the Injured worker under PA Workers Comp

Question: Can a doctor or pharmacy balance bill a patient under PA workers comp?

Answer: No. Under the Pennsylvania Workers Compensation Act, there are specific amounts of monies that a medical provider must accept as payment in full for medical treatment. If a medical provider believes it is not paid the proper amount, the medical provider has a right to file a fee review to the Pennsylvania Bureau of Workers Compensation. The medical provider cannot ask an injured worker to pay the balance of a bill if the medical provider is not satisfied with the payment received from the workers compensation insurance carrier. The Pennsylvania Workers’ Compensation regulations are very specific on this issue. The regulations specifically provide: “a provider may not hold an employee liable for costs related to care of services rendered in connection with a compensable injury under the Act. A provider may not bill for, or otherwise attempt to recover from the employee, the difference between the provider’s charge and the amount paid by an insurer.”

If you do receive a bill for a copay, there is also a possibility that the Pennsylvania Workers’ Compensation Carrier has denied payment of your medical bill and the medical provider submitted the bill to health insurance for payment. If this is the case, this should be corrected immediately and the Pennsylvania Workers’ Compensation Carrier must be requested to pay the medical bill.

If the Pennsylvania workers compensation carrier denies payment of the medical bill, then a penalty petition can be filed to compel the Pennsylvania Workers Compensation Carrier to make payment of the medical bill and potentially award additional monies to the injured worker as well as the payment of the injured workers’ attorney fees.

Call our office at 717-238-1657 for a free consultation to discuss your Pennsylvania Workers Compensation case.