Disclaimer: This article is for informational purposes and does not constitute legal advice.
Under
Detailed Answer
1. Review Your Explanation of Benefits (EOB): Obtain the EOB from your insurance carrier. It shows which services the insurer paid, denied, or adjusted. If you haven’t received an EOB, request one from the claims adjuster.
2. Compare Provider Statements: Ask medical providers for itemized statements. Match each charge with the EOB entries. Mark any unpaid or partially paid items.
3. Contact Your Claims Adjuster: Call or email the adjuster and reference your claim number. Ask for a breakdown of payments made toward your medical bills. They must respond under Indiana Code § 22-3-3-2, which requires carriers to pay for authorized medical treatment and provide payment details.
4. Send a Written Request: If the adjuster does not respond within a reasonable time, send a certified letter requesting an itemized report of payments. Keep a copy of your request and proof of delivery.
5. Involve the Indiana Workers’ Compensation Board: If the insurer fails to confirm payments, you may file a medical dispute with the Board. The Board can order the carrier to produce records and resolve unpaid bills. Learn more at Indiana Workers’ Compensation Board.
Helpful Hints
- Keep copies of all EOBs, bills, and correspondence.
- Document dates, amounts, and contact names when you call or write.
- Use certified mail for formal requests to establish proof of delivery.
- Cross-check insurer payments against your bank or credit union statements.
- Ask your employer’s safety or HR department for assistance contacting the insurer.
- Consider consulting a workers’ compensation attorney if disputes persist.