Confirming Application of Workers’ Compensation Payments to Medical Bills
Disclaimer: This article is for educational purposes only and does not constitute legal advice.
Detailed Answer
Under New Mexico law, employers and their insurers must cover all reasonable and necessary medical treatment for work-related injuries. Key provisions include NMSA 1978, Section 52-1-9 (medical and transportation benefits) and NMSA 1978, Section 52-1-37 (timely payment of undisputed bills). If you want to confirm whether payments have been applied to your medical bills, follow these steps:
- Obtain an Explanation of Benefits (EOB): Request an EOB from the workers’ compensation insurer or log into their online portal. The EOB shows the amounts billed by your medical provider, what the insurer paid, and any remaining balance.
- Contact Your Medical Provider: Ask the billing department for a detailed statement. This statement lists charges, payments received (including from workers’ comp), and any write-offs or patient balances.
- Review the Insurer’s Payment Ledger: Send a written request to your claims adjuster for a payment ledger or remittance advice. Under Section 52-1-37, undisputed medical bills must be paid within the statutory timeframe. The ledger confirms which invoices the insurer processed.
- Compare Dates and Amounts: Match the dates of service on the provider’s statement with entries on the EOB or payment ledger. Ensure the insurer’s payments align with billed services.
- Follow Up on Disputes: If you identify unpaid bills or discrepancies, notify the insurer in writing. They must respond and correct any errors promptly. If the issue remains unresolved after 21 days, you can request a hearing before the New Mexico Workers’ Compensation Administration (WCA).
Helpful Hints
- Keep all billing statements, EOBs, and correspondence in one file for easy reference.
- Note dates and names of adjusters or representatives when you call the insurer.
- Use certified mail or email with read receipts when sending written requests to the insurer.
- Check the WCA website for self-help guides and forms: workerscomp.nm.gov.
- If you still have questions, consider speaking with an attorney experienced in New Mexico workers’ compensation law.