Disclaimer: This article is for educational purposes only and does not constitute legal advice.
Detailed Answer
Under South Carolina law, employers and their workers’ compensation insurers must cover all reasonable and necessary medical expenses related to a compensable workplace injury. The insurer typically pays medical providers directly. You can confirm whether payments were applied to your medical bills by following these steps:
- Request an Explanation of Benefits (EOB)
Contact your workers’ compensation adjuster or insurer and ask for an EOB for each medical service. An EOB details the service date, the amount billed, and the payment amount issued by the insurer. - Obtain Itemized Billing Statements
Reach out to your healthcare provider’s billing department. Request an itemized statement showing all charges, payments received, and any remaining balance. Compare the provider’s statement against the EOB to verify accuracy. - Review South Carolina Statutes
South Carolina Code Annotated § 42-15-75 requires insurers to pay medical service charges promptly. You can review this requirement here: S.C. Code Ann. § 42-15-75. - Maintain a Payment Log
Create a simple spreadsheet or ledger. Record the service date, billed amount, insurer payment, and any outstanding balance. Update it each time you receive an EOB or provider statement. - Dispute Unpaid Charges
If you identify unpaid or underpaid bills, notify the insurer in writing and keep copies of all correspondence. If the insurer fails to address the issue, you may file a hearing request with the South Carolina Workers’ Compensation Commission under S.C. Code Ann. § 42-17-10: S.C. Code Ann. § 42-17-10.
Helpful Hints
- Organize documents by service date and provider name to simplify comparisons.
- Save adjuster contact information from each EOB for quick reference.
- Send all communications via certified mail or email with read receipts to create a paper trail.
- Ask your provider to explain any unfamiliar billing codes before you compare statements.
- Visit the South Carolina Workers’ Compensation Commission website for claim forms and procedural guides.