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3 facts about medical claims paid by workers' compensation

When you are injured on the job and workers' compensation kicks in, there can be some confusion on how your medical bills must be paid in Houston. By working closely with your provider's administrative office, you can cut down on confusion and help reduce the chance that you are fighting with leftover medical bills long after your recover.

First, it is important to understand how medical claims should be billed to your workers' compensation carrier. Sometimes, your medical provider will mistakenly bill the normal insurance provider. In such cases, the insurance provider might then seek restitution from your workers' compensation plan. In the meantime, you might have been billed for coinsurance or deductibles unfairly -- those payments might also be covered under your workers' compensation plan.

Next, understand that your workers' compensation plan is going to evaluate medical claims closely. They will only cover procedures and treatment related to the work injury. This means your clinical providers have to be very careful when coding the claims. The diagnosis has to relate to the work injury. If you have another diagnosis and receive treatment for it, that will not be covered by the carrier. For example, if you have diabetes, your diabetes claims must go to your regular insurance carrier.

Finally, if follow up treatment, such as physical therapy, is going to be part of your recovery, make sure your clinicians document this thoroughly so those claims will also be covered. If you return later with complaints that were related to the original incident, make sure those treatments are recorded and billed as related to the original injury, too.

If you are dealing with workers' compensation claims and feel that you are being billed for medical care that is related to your work injury, then you might have a legal case for compensation. Consider speaking with a lawyer about the next steps in the process.

Source:, "How to Bill Worker’s Compensation for Medical Treatment," accessed March 18, 2016

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