Injured workers with accepted workers’ compensation claims should not be getting bills for medical treatment from hospitals, doctors, an anesthesiologist, or radiologist. You know whether you have an accepted claim or not by whether you have received a letter from your self-insured employer or from a third-party administrator that says your claim is accepted. (An acceptance or denial letter must be sent by the adjuster handling your claim within 30 days of the adjuster receiving a copy of the C-4 Claim for Compensation form you completed when you first went to the clinic or hospital for treatment of your injury or occupational illness.)
The most important benefit under the Nevada workers’ compensation laws is the right of the injured worker to obtain medical treatment without having to pay a co-payment or deductible. However, many of my clients who have accepted claims still get bills from medical providers.
One reason a medical provider may be billing the patient instead of the workers’ compensation adjuster is that the provider never got good billing information from you or your doctor when you were treated. A phone call to the provider who sent you the bill with the name, address, phone number, and fax number of your workers’ compensation adjuster, along with your claim number should take care of that problem. I always send a letter with this information in addition to the phone call to have a record that I have notified the medical provider that this is an accepted workers’ compensation claim and who to bill. I also copy the adjuster on this letter so that she knows that there is a medical provider who needs to be paid on the claim.
Do not ignore the bills and collection letters. Your credit can be adversely affected, and it will be a tremendous hassle to undo that damage later. Ambulance services rarely have the correct billing information if you are unable to respond to their questions when you are injured. Call and write to them with the correct billing information on your claim.
Sometimes the medical provider has the correct billing information for your workers’ comp adjuster and still bills the injured worker. This is a violation of the law. NRS 616C.135 states that a provider who accepts a patient for treatment of an industrial injury or illness may not charge the patient, but must charge the insurer. That law also states that if the health care provider violates this law, the Division of Industrial Relations shall impose an administrative fine of not more than $250 for each violation.
I just wrote a letter to the DIR on behalf of one of my clients who was billed by a radiology company where the bill stated on its face the correct name of the third-party administrator handling the compensation claim, with the notation "w/c", meaning workers’ compensation. There was no explanation on the bill why the radiologist was billing the patient as opposed to the known work comp administrator. It will be interesting to see whether DIR does something with my complaint and actually fines the radiologist.
I’m wondering how many injured workers who don’t have legal representation have paid bills they weren’t required to pay, particularly to radiology companies who are notorious for billing injured workers. Let me hear from you if you think you have paid bills that really weren’t your responsibility. Did the medical provider reimburse you?