Legal Question in Workers Comp in Pennsylvania

If an employer denies workerscomp can a medical office hold the patietn responsible for charges


Asked on 2/18/10, 10:31 am

2 Answers from Attorneys

James Monaghan Law Office of James V. Monaghan

The short answer is yes. However, the medical provider should bill your health insurance carrier first as they must pay all bills denied by workers compensation. Please call my office to discuss the filing of a claim petition to obtain benefits on your behalf.

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Answered on 2/23/10, 10:40 am
Terrence Valko ERISA Disability Lawyer

If the case has been denied in its entirety via NCD, then the Doctor may send a bill. If any part of the case had been accepted and the reasonableness or work-relatedness is at issue, then the matter should be sent out for utilization review (by Carrier or Claimant) and the answer is, "No." I base this latter point on the Stark II amendments which prohibit direct billing of injured workers. The mecial provider has no standing to bring the UR action herself.

Good Luck.

TV

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Answered on 2/23/10, 10:52 am


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