Detailed Answer
Under Missouri law, your employer’s workers’ compensation insurer must cover medical treatment for work-related injuries. Mo. Rev. Stat. §287.220 ensures providers cannot bill you if the carrier handles payment. To verify that payments were applied to your medical bills, follow these steps:
- Request an Explanation of Benefits (EOB): Contact the insurer or claims adjuster. Ask for an EOB or payment summary showing all services, billed amounts, and payments made.
- Obtain a Medical Billing Ledger: Ask your health care provider for an itemized ledger. Compare each service date and billed charge against the insurer’s EOB.
- Match Dates and Amounts: Ensure the dates of service on the EOB match those on your medical bills. Verify that the insurer paid the full amount or the contracted fee schedule under Mo. Rev. Stat. §287.220 (§287.220).
- Check for Liens or Third-Party Recoveries: If you recover funds from a third party, the insurer may claim reimbursement under Mo. Rev. Stat. §287.227 (§287.227). Confirm any withheld amounts align with allowable liens.
- Contact the Division of Workers’ Compensation: If discrepancies remain, file Form WC-16 with the Missouri Division of Workers’ Compensation to request a medical payment audit or hearing.
Keeping clear records helps you confirm the insurer met its obligations. Always document communications, dates, and names of adjusters.
Helpful Hints
- Store every EOB, invoice, and letter in a dedicated file.
- Send requests to your insurer and provider in writing for proof of receipt.
- Record claim numbers, adjuster names, and dates of communication.
- Review Mo. Rev. Stat. §287.060 for medical treatment rights (§287.060).
- Consider consulting a workers’ compensation attorney if complex issues arise.
Disclaimer: This article provides general information and does not constitute legal advice. Consult an attorney for guidance on your specific situation.