Disclaimer: This article is for informational purposes only and does not constitute legal advice. Consult a qualified attorney or claims professional for guidance on your specific situation.
Detailed Answer
Under Rhode Island workers’ compensation law, employers (or their insurance carriers) must pay all reasonable and necessary medical expenses arising from a work-related injury or illness. See R.I. Gen. Laws § 28-35-20 and § 28-35-21. To confirm whether these payments have been applied to your medical bills, follow these steps:
1. Review Explanation of Benefits (EOB)
Your medical provider should send you an EOB or billing statement after submitting charges to the workers’ compensation insurer. The EOB details:
- Services rendered (dates and procedures)
- Amount billed by the provider
- Amount paid by the workers’ compensation carrier
- Remaining balance, if any
If you haven’t received an EOB within 30 days of treatment, request one from your medical provider or the insurer.
2. Contact the Claims Adjuster or Insurer
Locate your claims adjuster’s contact information on your injury report or the insurer’s correspondence. Ask for:
- Payment history for medical services
- Copies of EOBs or remittance advices
- Confirmation of payment dates and amounts
Insurers must process and pay undisputed medical bills promptly. If you face delays, ask whether your provider is authorized per § 28-35-21.
3. Request an Itemized Billing Statement
Your healthcare provider can issue an itemized bill showing:
- Dates of service
- Procedure codes
- Total charges
- Payments applied (with dates and payer names)
Compare these details with the insurer’s EOB to ensure all charges are covered.
4. Check Your Account with the Medical Provider
Contact the billing department of your doctor’s office or hospital. Ask whether any balance remains after workers’ compensation payments. If you see out-of-pocket balances, verify they aren’t related to non-compensable services (e.g., treatments not authorized by your employer).
5. Escalate Unpaid or Disputed Bills
If bills remain unpaid:
- Send a written request to the insurer and your employer’s risk manager.
- File a Request for Hearing with the Rhode Island Workers’ Compensation Court for disputed medical expenses.
- Use the Medical Fee Schedule in R.I. Gen. Laws § 28-35-26 to check compliance with fee limits.
Keeping clear records and following up promptly helps ensure timely medical payment under Rhode Island law.
Helpful Hints
- Keep copies of all medical bills, EOBs, and correspondence with your insurer or provider.
- Note all phone calls: date, time, person’s name, and summary of the discussion.
- Use certified mail for important dispute letters to create a paper trail.
- Ask your provider about in-network rates if your employer’s carrier uses a managed care plan.
- Check Rhode Island Workers’ Compensation Court resources for forms and guidance.