How can I avoid payment delays or denials?

Although it is the insurer’s responsibility to investigate and process your claim within 21 days of the date that you provide notice to your employer of your work injury, the 21-day deadline is frequently missed. If you want to ensure speedy claims handling, you should obtain copies of your medical records from your physician and send them directly to your adjuster. You should send these records to the adjuster even if you are being treated by an American Airways physician. Contact our office immediately concerning your rights and responsibilities if the 21-day deadline is missed.

To ensure that medical bills are paid, your doctor should submit bills in an organized and timely fashion. The bills must be made either on the HCFA 1500 form or the UB42 form (HCFA 1450), which your doctor or medical provider should already have. The bills should contain complete and adequate information, including correct names, dates and treatments, services provided, and cost of treatment. Finally, a “Medical Report Form,” should accompany the bills. Call us at (215) 259-5879 to oget copies of the required forms.

If your claim has been accepted, the insurance company is obligated to pay bills within 30 days of receipt. If the bills are not paid within 30 days, your doctor or other medical provider should file a petition with the Bureau of Workers' Compensation for payment.

If the insurer denies your claim or refuses to pay some or all of your medical bills, you may be able to use your health insurance coverage. Your physician may obtain free assistance regarding payment for the treatment rendered to you by calling (215) 259-5879 and asking to speak with an attorney at our office.

Greg Boles
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Partner at The Boles Firm | Experience Matters