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nemukkojenny | CAN MY DOCTOR BILL BOTH WORKERS COMP AND REGULAR INSURANCE? |
I had an on the job injury that has not been contested by worker's compensation. They have paid for numerous doctor visits, physical therapy visits, and a surgery. My doctor's office has accepted payment from WC, but has also billed my regular health insurance. The doctor's office explained that they had to bill my regular insurance because the WC insurance payment didn't cover all their usual and customary charges. Is the doctor's office allowed to do that? I thought that a WC case was paid exclusively through WC. |
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askmrknight
 |
Worker's Compensation covers a variety of issues in regard to an industrial accident. Not just healthcare coverage, but also lost wages, and disability when necessary.
When an industrial accident occurs, and a physician agrees to take the case, they can not bill outside of the WC carrier's jurisdiction. Both state and federal law prohibit physician's from billing WC and your private insurance company for the same treatment.
However, many physician's mistakenly believe that this is okay. It is not. They can only bill your private insurance for a chief compaint that is not related to the industrial accident.
You should inform your insurance carrier that this has occured, and allow them to follow up. They are better equipped to handle this kind of issue. Otherwise, you hire an attorney and do it yourself.
Doctors must write off any amount left unpaid by WC. They are not allowed to balance bill either the patient, or their private insurance.
Just for future reference: if this ever happens again, don't tell the doctor's staff that you have private insurance, or insurance through your employer.
It's really none of their business in an industrial accident case, anyways. It's between them and the WC carrier to work out. If the doc doesn't get paid what they think is reasonable, too bad. They can include the amount with their schedule C on their taxes.
Any physician who engages in this activity is really just asking to be audited.
Hope that helps. |
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src50
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I would notify your health insurance conmpany. |
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debijs
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~~Contact your private insurance carrier. They will take care of this promptly. What your doctor's office is doing is very illegal.~~ |
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Lilly
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Your doctor is just trying to cover his bill. On your health claim form there is usually a question which asks if the accident occurred at work or in a car accident. Your health insurance will usually decline, and look to the workers comp as primary. If the workers comp is not paying I would file a complaint with your states insurance department. |
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wolfie
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that doesn't sound right, i would call my insurance co. & workers comp. |
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robert r
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this is what lawyers are for, you`ll have to ask someone from your local bar assn as to what your state laws will allow, they vary widely from one to another,if the md is billing your insurance company, chances are that you are in a long drawn out battle between the two, make sure you save all of the documents and the envelopes the came in. you`ll need them for the post marks and proof |
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Books
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Yes, this is normal practice. They'll bill WC and bill your insurance company for any amount that WC doesn't cover. I've had the same thing happen when 2 insurance companies cover the same costs. They share the bill.
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