Disclaimer: This article is for general educational purposes and does not constitute legal advice. Consult a qualified attorney for guidance on your situation.
Detailed Answer
Under Pennsylvania law, workers’ compensation insurers or self-insured employers must process and pay medical provider bills promptly. You can confirm payments were applied by following these steps:
1. Obtain an Explanation of Benefits (EOB)
Your workers’ compensation carrier should send you an EOB or payment summary each time they pay a medical bill. This document shows the billed amount, the amount paid by the carrier, and any outstanding balance. Review each EOB line by line to ensure it matches the services your provider rendered.
2. Request Itemized Provider Statements
Ask your medical provider for an itemized statement of services and payments received. Compare this statement with the carrier’s EOB. If payments align, your bills were applied correctly. If not, highlight discrepancies and discuss them with both your provider and the carrier.
3. Contact Your Workers’ Compensation Adjuster or Third-Party Administrator
Reach out in writing to your adjuster or TPA. Request a detailed payment ledger or claims history. Under 34 Pa. Code § 127.251, carriers must pay undisputed medical bills within 30 days of receipt:
34 Pa. Code § 127.251. A full ledger helps you track every payment the carrier issued.
4. Use the PA Workers’ Compensation Public Portal
If your employer is self-insured, you can often view claim documents online. Register at the PA Department of Labor & Industry’s Workers’ Compensation Public Portal. Once logged in, navigate to your claim and download EOBs, provider bills, and payment histories.
5. Review Statutory Rights and Dispute Options
Under the Pennsylvania Workers’ Compensation Act, you have the right to dispute unpaid or underpaid medical bills. Section 531 allows the carrier to seek reimbursement from a third-party tortfeasor but also confirms your right to proper payment:
77 P.S. § 531. If your carrier fails to pay eligible bills, you can file a medical fee dispute with the Bureau of Workers’ Compensation.
Helpful Hints
- Keep copies of all EOBs, provider statements, and correspondence.
- Track payment deadlines: carriers must pay undisputed bills within 30 days (34 Pa. Code § 127.251).
- Note service dates and billed amounts to spot discrepancies quickly.
- Follow up promptly on any missing or partial payments in writing.
- Use the Workers’ Compensation Public Portal to access claim documents anytime.
- If the carrier won’t pay, consider a medical fee dispute or seek legal guidance.