Detailed Answer
When you receive workers’ compensation benefits in Texas, your medical providers should bill the insurance carrier directly. To confirm that payments were applied to your medical bills, follow these steps:
- Request an Explanation of Payment (EOP) or Explanation of Benefits (EOB): Contact the workers’ compensation insurance carrier or your claims adjuster and ask for an itemized EOP/EOB. This document lists each medical service, the amount billed, the amount paid, and any amount you may owe.
- Use the DWC Online Portal: The Texas Department of Insurance, Division of Workers’ Compensation (TDI-DWC) offers the Customer Benefits Management (CBM) system. You can register at https://www.tdi.texas.gov/wc/online/cbm.html to view payment details, dispute status, and medical bill information.
- Contact Your Medical Provider: Ask your doctor’s office or hospital billing department for copies of all submitted bills and any payments received from the workers’ compensation carrier. They can provide proof of payment or identify outstanding balances.
- Review Texas Payment Deadlines: Under Texas Labor Code §408.025, carriers must pay or dispute medical bills within 30 days of receiving a correct bill (Tex. Lab. Code §408.025). Section 408.028 outlines your right to receive medical benefits for a covered work injury (Tex. Lab. Code §408.028).
- Dispute Unpaid Bills: If you find unpaid bills after the 30-day period, you can file a medical dispute through TDI-DWC’s online system or request a benefit review conference. Visit TDI-DWC Medical Dispute Resolution for instructions.
Helpful Hints
- Keep a dedicated folder (electronic or paper) for all medical bills, EOBs/EOPs, and carrier correspondence.
- Note the date you receive each bill and the date you requested payment information.
- Use clear subject lines like “Request for EOB/EOP” when emailing your claims adjuster.
- Call TDI-DWC’s helpline at 800-252-7031 if you need assistance navigating the online portal or understanding your rights.
- Act promptly on any unpaid or underpaid bills to avoid collection actions or medical liens.
Disclaimer: This article is for informational purposes only and does not constitute legal advice. Consult a qualified attorney for advice on your specific situation.