Disclaimer: This article provides general information only and does not constitute legal advice. For guidance specific to your situation, consult a qualified attorney.
Detailed Answer
Under Oklahoma’s workers’ compensation law (85 O.S. §35), your employer or its insurance carrier must promptly pay all reasonable and necessary medical expenses related to your job-related injury. To confirm whether these payments were applied to your medical provider’s bills, follow these steps:
- Obtain an Explanation of Benefits (EOB): Request an EOB from your medical provider or the insurer’s claims administrator. An EOB details what the provider billed, what the insurer paid, and any balance you owe.
- Contact the Insurance Adjuster: Call the adjuster handling your claim. Provide your claim number, date of injury, and billing codes. Ask for a payment summary or remittance advice.
- Review Medical Billing Statements: Compare statements issued by your healthcare provider before and after payment. Look for notes such as “Paid by workers’ compensation” or “WC carrier paid.”
- Check Commission Records: If your claim is filed with the Oklahoma Workers’ Compensation Commission, request copies of journal entries or medical fee submissions via the Commission’s website (wcc.ok.gov).
- Request a Formal Audit: Under 85 O.S. §41, you may audit the insurer’s payment records. Send a written request to both the insurer and your provider, including copies of outstanding bills and past correspondence.
If you identify unpaid amounts that should have been covered, send a detailed follow-up letter to the insurer and healthcare provider. Include copies of your bills, EOBs, and any prior communications.
Helpful Hints
- Organize all medical bills, payment records, and written communications in one file.
- Note the claim number and adjuster’s name on every document.
- Request written confirmation when you call the claims adjuster or your provider.
- If you cannot resolve payment disputes within 21 days, consider filing a motion with the Workers’ Compensation Commission.
- For complex disputes or appeals, consider consulting a workers’ compensation attorney.