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Medical Billing Disputes

Billing disputes are frustrating. They are especially frustrating when the injured worker or patient with a traumatic brain injury (TBI), catastrophic injury, spinal cord, or other serious injury gets no satisfaction with the insurance company which denies or delays in paying a bill for which it is responsible.

Various areas of the law have different rules. In Florida workers’ compensation cases, the rule on paying medical bills is 45 days from receipt. The bill must be on the proper form and pursuant to the Florida Workers’ Compensation Health Care Provider Reimbursement Manual or fee schedule.

 

We at DeCiccio & Johnson understand the stress produced from the injury and the unnecessary financial stress from receiving inappropriate bills."

Sometimes the carrier does not inform the health care facility or the injured worker there is a problem with the billing format and the bill sits, does not get paid and results in a late notice or collection notice. Sometimes the doctor or provider bills the patient when workers’ compensation should pay and sometimes the bill is turned over to aggressive collection agencies. If you do not obtain self-help results to your liking, seeking the advice and services of experienced counsel like DeCiccio & Johnson can really help. In Florida, a bill that should be paid by workers’ compensation can be brought before a Judge of Compensation Claims for resolution. There are state and federal laws against collection agencies calling you repeatedly or at strange hours, and there are available legal remedies and damages.

Not all doctors know that if only a certain amount is paid for medical services under the fee schedule, the workers’ compensation law prohibits the doctor from billing the patient for the difference. For example, if the medical service costs $100 and the fee schedule allows only $30, the doctor or hospital cannot bill the patient for the $70 difference—that’s the law in Florida. If that happens and your credit is damaged, then you have legal rights available to you to address the situation. We at DeCiccio & Johnson understand the stress produced from the injury and the unnecessary financial stress from receiving inappropriate bills.

A billing dispute between the workers’ compensation carrier and medical facility can affect the patient with a TBI living in a brain injury rehabilitation facility. Challenges by the workers’ compensation carrier against the TBI facility for allegedly excessive billing practices or for providing services without proper documentation or for providing services that are not supported by medical necessity, can result in fines against and repayment by the TBI facility. These disputes can put the patient in limbo and can result in the TBI facility discontinuing services to the patient. We at DeCiccio & Johnson can work with the patient, the patient’s family or legal guardian and the facility toward the goal of providing reasonable and medically necessary care under the law at a suitable facility appropriate to the client’s needs and at an appropriate per diem rate. Sometimes billing disputes are driven by the desire to reduce the per diem rate and save money. While is it understandable that the insurance company pay a fair price for medical services, it is equally important that the patient have an advocate to protect his or her dignity as a human being and insure he or she obtains that level of care required under the law.

Contact us at DeCiccio & Johnson if your are having billing disputes or delays.