Disclaimer: This article provides general information and does not constitute legal advice.
Detailed Answer
Under Nebraska’s Workers’ Compensation Act, employers must cover all reasonable and necessary medical services related to a workplace injury. See Neb. Rev. Stat. § 48-120. Typically, the insurance carrier or self-insured employer pays medical providers directly. You can confirm whether your medical bills were applied correctly by following these steps:
- Contact the Insurer or Employer: Reach out to your workers’ compensation adjuster and request an Explanation of Benefits (EOB) or payment summary. Nebraska law requires insurers to process and pay medical bills promptly. See § 48-120.
- Request an Itemized Billing Statement: Ask your medical providers for a detailed statement showing services, billed amounts, and payments received. Compare this with the insurer’s EOB to identify any unpaid charges.
- Review Payment Notices: Insurers must notify both you and the provider when medical payments are issued. See Neb. Rev. Stat. § 48-163. Check for “paid,” “denied,” or “pending” stamps on each bill.
- Request Claim Records: If you still see discrepancies, you can obtain claim records from the Nebraska Workers’ Compensation Court under Neb. Rev. Stat. § 48-174. This lets you review all medical billing and payment documents your employer submitted.
- Consider a Court Motion: If bills remain unpaid or misapplied, you may file a motion with the Nebraska Workers’ Compensation Court to compel correct payment. Follow procedures in Neb. Rev. Stat. § 48-178 and prepare for a hearing.
Helpful Hints
- Keep copies of all medical bills, EOBs, and correspondence with the insurer or employer.
- Document dates, times, and names when you speak with adjusters or providers.
- Use a simple spreadsheet to track billed and paid amounts across all visits.
- Limit any HIPAA authorizations to only the providers and time period needed.
- Consult a workers’ compensation attorney or an ombudsman if you face unexplained delays or denials.